to-the-point
To The Point
Episode 5

Ocular Aesthetics: A Much-Needed Service for Patients With Dry Eye

Want to take your dry eye practice to the next level? Consider adding ocular aesthetics. Listen as Leslie and Jackie talk with guest Selina McGee, OD, FAAO, about how she got into the aesthetics side of dry eye.

Leslie O'Dell (00:06):

Ocular Surface Disease: It's complex, chronic, and progressive, but ripe for opportunity for the enterprising optometrist.

Jackie Garlich (00:14):

The mission of this podcast is to make this condition more understandable and accessible to those interested in specializing in it. So, let's get to the point.

Jackie Garlich (00:26):

Welcome to another episode of To the Point Podcast. I'm Jackie Garlich and I'm joined by my cohost, Leslie O'Dell. And, today, we have something very exciting. We have a guest with us. We are gonna be chatting with Dr. Selina McGee.

Jackie Garlich (00:41):

So, Dr. McGee is the visionary founder of Precision Vision of Edmond, a boutique-style eye care practice that specializes in dry eye disease, specialty contacts, and aesthetics. She was also the co-founder of Precision Vision of Midwest City, an OD-MD practice specializing in premium eye well and cataract surgery.

Jackie Garlich (01:03):

She's a member of the Oklahoma Association of Optometric Physicians and the AOA, and she currently serves as the president of the OAOP. She was also named Young Optometrist of the Year in 2012 by the OAOP. Today, we are gonna be talking with Dr. McGee all about ocular aesthetics. So, let's get started.

Leslie O'Dell (01:24):

Dr. McGee, thank you so much for being part of To the Point today.

Dr. Selina McGee (01:27):

Thank you, guys, for having me. I'm super excited to talk about all things that we're gonna talk about.

Leslie O'Dell (01:33):

Yeah. So, you have a big interest in not only dry eye, but also in the aesthetics side of dry eye, which is a growing niche, um, and a much needed one for the patients that we serve with dry eye. And, that's really what we were hoping to lean on in your expertise for. So, maybe first, just give us a little background about your, um, journey with dry eye and then we can get into the, um, addition of aesthetics to your practice.

Dr. Selina McGee (01:59):

Sure. So, um, historically, I was in an MD-OD practice that I co-founded 17 years ago, and then about six years ago, I purchased a more boutique-style OD practice that con- it's more concierge, but I got heavy into dry eye probably around 2006. And so, it's interesting how this journey has happened because when you start down one road and you start to pull that thread with dry eye, it feeds into really everything that we do.

Dr. Selina McGee (02:27):

And so, that's been what's so much fun about dry eye, and why I really like talking about it, and just exploring it with patients because so many people suffer from it. And so, those same patients are doing things sometimes to their health that they don't even realize that they're sabotaging. And so, when you start talking about aesthetics, they're definitely interested.

Dr. Selina McGee (02:48):

And then when you start performing the procedures yourself, it's, they're really excited that they have a resource that, that we all have. And it, honestly, optometrists know more than they think they do around aesthetics. And so, I don't want people to feel like they're intimidated by this or these kinds of conversations because patients need this information.

Leslie O'Dell (03:08):

Yeah, and if you don't have it with them, obvio- you know, ho- sometimes they're gonna go places where they might not be treated with the ocular surface in mind. You know, whether it's a, um, dermatology office or, you know, even, uh, just an aesthetician office. Some of, some things are being done even in hairdresser, um, in hair boutiques. So, it can be kind of a (laughs) scary world when you aren't having that conversation.

Dr. Selina McGee (03:31):

Definitely.

Jackie Garlich (03:31):

Did you, did you, um, purchase that practice, like, thinking that you were gonna, you know, transform that into- like, 'cause it wasn't a dry eye practice, right, when you bought it?

Dr. Selina McGee (03:40):

No. No, it was rea- it really was, I bought it from a physician that was retiring and I transitioned him towards retirement and, you know, like all of our practices, if we're not really intentional about them in how we age with the practice, our patients tend to age with us. And if you're not really growing a practice every day, then things can happen.

Dr. Selina McGee (04:00):

And so, it was kind of on the decline, honestly. He's a fantastic physician, but he was tired and ready to retire. (laughs) And so, I didn't- with the intention of, you know, "Oh, I'm gonna have this big dry eye center of excellence, and then now we're gonna do aesthetics." But, it did, it's just morphed into through this journey, which has been really interesting.

Dr. Selina McGee (04:22):

And, uh, kind of the way that I got into aesthetics was a little bit of a, an accident. But I had a technician that worked with me, who was, um, also a nurse, and she worked in plastics for about 10 years. And, we just kept having these conversations and she's like, "Why don't you do injections?" She's like, "You are doing everything around the eyes. It doesn't make any sense to me. You have all of the anatomy and physiology; you know how to do this." And, I was like, "You know, that's a good question. I don't know."

Dr. Selina McGee (04:52):

And so, I started doing more research into it and talked to our, our board, and they were like, "I, I don't know if you can do that." I'm in, I'm in Oklahoma, right? We, we can, we have a- amazing scope of practice but I wasn't sure that even fit into it and, honestly, they weren't either. (laughs)

Dr. Selina McGee (05:09):

And so, that conversation went on for about four months, and we had discussions back and forth, and the board of examiners did in fact say that it is within our scope of practice. And so, at that point, I was like, "Okay, awesome. Here we go." So now, I have to, you know, train myself on how to do this, as far as cosmetic injections, because I learned how to do therapeutic injections, right? And so, a little bit different and you're injecting in different places with different reasons.

Dr. Selina McGee (05:37):

And so, I actually just went to an injection class that was intended for MDs, DOs, dentists, and I think there was RNs there as well. And it's, this is the interesting part, so whenever I went to this course, they weren't really sure they were even gonna let me in, and they were like, "Well, she'll just pay her money. Great, fine, I guess you can come."

Dr. Selina McGee (06:02):

So, (laughs) and I will never forget this, and people that have heard me lecture about this and hear this story, this is how this really unfolded and was one of those, like, pivotal moments in your life where you're, you look back and go, "Okay, that was the moment that this happened."

Dr. Selina McGee (06:15):

So, I was in this class and there was an MD that had passed her boards literally the night before we took this course. And- I mean, if she was like me, I was the smartest I was ever gonna be after boards, right? You have all this information before it, like, starts filtering out. And so, the proctor asked her as we're studying these injections, he said, "What's the muscle around the eye and what's it's action?" And she's like, "I have no idea."

Dr. Selina McGee (06:39):

And so, like, the hair on the back of my neck, like, you know, stood on end, and I was like, "Okay, not only do I belong in this room, but I'm the only person in here that knows the anatomy, (laughs) and how to do this." And so from that moment on, it was just full speed ahead.

Dr. Selina McGee (06:54):

And, that took, you know, once I got that, and then it was really funny, I got the little course, like, certificate when I got home. It said, um, "Selina McGee passed her Botox course, practice manager." Like, it didn't even have my degree or anything else around it. (laughs)

Jackie Garlich (07:10):

(laughs)

Dr. Selina McGee (07:11):

So, that was really interesting and fun. But, it's really hard to get trained. MDs don't wanna train us. I've been kicked out of more trainings, you know, trying to do other injections and learning. So, there's that piece. And so now, I just, I help doctors and help train them, too, as this has morphed over the last three years. But, that's how I got into it.

Dr. Selina McGee (07:32):

And then, it, it went into, "Okay, now, how do I offer this to patients in a way that makes sense," right? And so, you know, you don't wanna walk into a room and say, "Oh, well, let me fix those frown lines between your eyes. Don't those bother you?" That's not the best way to approach aesthetics.

Dr. Selina McGee (07:48):

So, that was an interesting journey as well. And so, that's morphed from just simple material in the room to a questionnaire that has photos on it, "Now, do these areas bother you?" And that's when it really took off, and it's part of my dry eye questionnaire too.

Dr. Selina McGee (08:06):

And so, I have questions on there that uncover dry eye, that uncover rosacea, that uncover sleep apnea, maculate health questions, and then I have the aesthetics piece at the bottom, which, by the way, don't put, "Are you interested in ocular aesthetics?" That's an epic fail.

Leslie O'Dell (08:20):

(laughs)

Jackie Garlich (08:20):

(laughs)

Dr. Selina McGee (08:23):

(laughs) So, um, and also on your rosacea questions, make sure that you put, "Does your skin flush after eating certain foods?" Don't leave out the skin part because that's essential. I made that mistake and that questionnaire lasted a day before I had to change it.

Jackie Garlich (08:36):

(laughs)

Dr. Selina McGee (08:38):

And so, (laughs) um, that, that has really taken off. And so, it's funny, I have patients now that come in that, I had a lady, you know, before all of this COVID crisis has happened, that came in for a subcon [inaudible 00:08:52], and she's like, "Okay. Well, I'm glad that that's all good and well, but I need you to fix these elevens. Can you do that while I'm here?"

Jackie Garlich (08:57):

(laughs)

Dr. Selina McGee (08:59):

(laughs) And so, it's been really fun because, you know, patients want to feel good and they wanna look good and they wanna do it in a way that is safe. And it, when you have nurses and physicians and other people, and your patients too, that say, "You know what? I would trust you more than anyone else to do this because you, you know the anatomy so well."

Dr. Selina McGee (09:19):

And so, that's kind of historically been how I got into injections. And then, it's morphed into other things because I do have a big dry eye practice, and so I have IPL, and that was a perfect fit because now I've got a treatment for MGD and dry eye, and also, by the way, we're doing aesthetics. And so, it's just, it's, it's done really well and it, very symbiotic relationship.

Jackie Garlich (09:45):

Can I get your opinion on, um, IPL? So, I have a friend of mine that has an, uh, IPL machine and he, you know, was he- se- he's like, "I, I see these patients with, like, terrible MGD and I internally think, like, 'Oh, these people would do great with IPL,'" and he's like, "and none of them are motivated until you, they're, they more want the photo facial."

Dr. Selina McGee (10:05):

Right.

Jackie Garlich (10:05):

Like, that's what they want. They don't really care that their glands look terrible. (laughs) They're like, "I'll take the photo facial." I don't know if you've had that same experience.

Dr. Selina McGee (10:12):

That has been the exact same experience, because you can talk about, "Oh, it's gonna make your dry eyes feel better. And, oh by the way, we're gonna make your skin and your texture look better too," and they're like, "Oh yeah, sign me up."

Leslie O'Dell (10:21):

Yep. (laughs)

Dr. Selina McGee (10:23):

I don't care how, I don't care how much it is, whatever. (laughs) Sounds good. And so, it has been really interesting to see. Um, I don't have the same, um, capture rate with my thermal pulsations as I do my, as I do my IPL. So, I've had to get creative with my packaging. (laughs)

Leslie O'Dell (10:42):

Well, I, I think that gets to the, um, the point that I hear sometimes people outside of eye say that, um, when people are going to the doctor, they don't want to feel old, and that's sometimes even what keeps them from coming us, to us in the first place.

Leslie O'Dell (10:55):

And so, really being able to offer things, like you're doing, kind of makes that fear go away, right? You're not making them feel old, you're helping to make them feel youthful. Um, and I think that's why IPL's caught on so well. You know, what I would say, "I have this treatment, um, you know, for M," there's a treatment rather, 'cause I'm not yet using IPL, only because of some state laws that are sorting themselves out.

Leslie O'Dell (11:17):

But I'd say, "There's this treatment for MGD and the upside is it makes your skin look better," (laughs) and people are always like, "Well, yeah, I want to do that," (laughs) over some of the other choices. So, I definitely think if you can look good and feel good, it's, uh, obvious win-win, for sure.

Dr. Selina McGee (11:34):

Definitely. And, well, and our patients, I had one patient that, you know, 'cause a lot of our, our dry eye sufferers, I mean, they're, they struggle with this every day, right? And so, it becomes part of their new normal. And so, I want them to feel as normal as possible, and so this is another step in that direction.

Dr. Selina McGee (11:50):

And, I had one patient, she's like, "You know, I feel bad because I'm vain," and I was like, "This has nothing to do with vanity. This has to do with your health and the way that you feel about yourself." This, it's, and so, those conversations become interesting and it, it, just, it's a different relationship with your patients, honestly, because you're spending even more time with them in these focused ways.

Dr. Selina McGee (12:14):

And so, that's been a really nice bonus, is the relationships that I've built with my patients, too.

Leslie O'Dell (12:20):

What? That's interesting, um, about being vain, because one, one of my patients, um, is post-cataract surgery and she's in her 70s and now she can see clearer and she was completely blown away about her wrinkles. And, I had the conversation, "Well, we could find, you know, you a place that can do something, as far as a fill or maybe do some kind of relaxing treatment (laughs) around your eyes," and she was all in, you know, in her mid-70s.

Leslie O'Dell (12:47):

And, um, I, I thought, actually earlier in my career, I had a woman in her 90s that said the same thing. She was mortified when she looked in the mirror, that she had wrinkles, but I thought, like, "You're 90. Like, (laughs) how did you think you got to 90 without wrinkles?"

Leslie O'Dell (13:02):

But, you know, her, she just couldn't see with that precision vision, um, to notice that she had wrinkles. And, that would be shocking. Imagine you couldn't see yourself clearly for 10 years, and then... I mean, it's like when you're in the hotel and you use that bright light magnifying mirror that you should never look at. (laughs)

Dr. Selina McGee (13:20):

Never. Never use those, never use those.

Leslie O'Dell (13:21):

So, I think there's just even talking to your patients after cataract surgery, um, to say, "Is anything bothering you?" is, is something that I'm gonna start doing more. Do you do any kind of, um, fills, or you're just doing the Botox?

Dr. Selina McGee (13:34):

I just do neurotoxin. I have done fills, but the interesting thing about filler and the way that it works in your face, you really need to do midface, um, if you're gonna target areas that we're familiar with, like teardrop, which is the most common one that people want done. But teardrop is always off-label and it's really hard to put it in the right place, and there's lots of anatomy there that is very delicate. And, you can blind somebody if you don't know what you're doing.

Leslie O'Dell (14:04):

Oh. Right, that's scary. (laughs)

Dr. Selina McGee (14:06):

So, yes, it is scary. And, it might look really good for a few months, but down the road, it can migrate. And so, until I get much better injecting and I have more practice, I am not comfortable doing that. But, what's interesting is, because patients ask about it, now we have a very really conversation about how they should educate themselves because other injectors may not be as forthright about that kind of information, and I've surrounded myself with injectors around me because a lot of patients want, you know, lower face too. They want lips, they want, you know, these little marionette lines, they want other things done.

Dr. Selina McGee (14:43):

And so, we can have a conversation about that, and then I can refer them to like-minded professionals, who also by the way send me referrals back. And so, it's created this whole other referral back and forth, which is really nice to have too.

Leslie O'Dell (15:00):

Is that mostly with dermatology in your area or plastics or?

Dr. Selina McGee (15:05):

It's actually, the, the one that I've worked with the most is a nurse injector, and she's done injections for 20 plus years, so. And, she's a trainer too. So, if you can find people in your area like that, that train, they're awesome. So, my ocular plastic surgeon that I work with, he doesn't like cosmetics. He hates cosmetic oculoplastics. He wants functional oculoplastics.

Dr. Selina McGee (15:28):

So, he and I have a perfect symbiotic relationship because he sends me his cosmetic stuff and then I send him my functional, and so that relationship works really. And so, you can build some really cool relationships around you, that I want people to think about oculoplastics like they do their cataract surgeons. You know, when I lecture about this, I always ask, you know, how many people in the audience co-manage their cataract patients? And every hand typically goes up in the audience.

Dr. Selina McGee (15:54):

But when you ask, how many co-manage with their oculoplastics? It might be one or none. And so, that's what I wanna change, the mindset of that, and especially moving forward, because back to dry eye and MGD and especially dermatology, I mean, our patients that are on Accutane and more and more of youth are on Accutane, which we know destroys meibomian glands. So, those relationships are becoming more and more important as we learn more. And so, building those and being intentional about building that kind of a community is really essential.

Leslie O'Dell (16:28):

Hm.

Jackie Garlich (16:30):

How do you do your IPL? Like, do you sell it in a package? Like, what's your...

Dr. Selina McGee (16:35):

Yes, yep. So, I sell it in a package, and the reason I do that is because I want them to get the full treatment. I want, I don't want them to do one or two and then they feel a little bit better and look a little bit better and then don't get the full effect. And so, I do them in packages.

Dr. Selina McGee (16:50):

Um, and I have, I also have, um, so I have thermal pulsation for dry eye and then I also have radiofrequency, which is skin tightening. And so, I've got basically a, a non-invasive Bleph package that's skin tightening, skin texture, plus neurotoxin. So, you can build some creative things like that.

Dr. Selina McGee (17:11):

And, I mean, when you, if you've ever visited, you know, an injection clinic or, you know, a medical spa or, you know, somebody that's doing heavy plastics like this, that's the kind of menus that they're gonna have, so to speak, is packages of different things customized to the patients. But yes, they're all packages.

Leslie O'Dell (17:30):

Sounds like I should be making a trip to Oklahoma soon. (laughs)

Dr. Selina McGee (17:32):

(laughs)

Leslie O'Dell (17:34):

For all these delightful things. But, radiofrequency, um, is very interesting as well. Are you doing that mostly, like, around the crow’s feet or you do it at-

Dr. Selina McGee (17:44):

Mm-hmm (affirmative).

Leslie O'Dell (17:44):

Yeah, mm-hmm (affirmative).

Dr. Selina McGee (17:45):

So, and you, and you do it on forehead too. So, you do forehead and then you do periorbital because it will, you can get two to three millimeters of, um, elevation on patients that aren't ready for a full Bleph. And so, you know, done, you can put off surgery for a while, and patients are usually much more interested in that than they are in having s- a surgical procedure. Sometimes they need the surgical procedure, but sometimes they wanna buy time.

Leslie O'Dell (18:11):

Yeah. I mean, but that's hard to recover from. If you can put it off for a while, that's, that would be good. How long, so how does that work? Is that a multiple treatment-?

Dr. Selina McGee (18:21):

Mm-hmm (affirmative).

Leslie O'Dell (18:21):

Yeah, tell me about that.

Dr. Selina McGee (18:22):

S- yes. So, it's multiple treatments too, and the idea is you're heating the, the skin, the, the dermal layer of the skin to 42 degrees Celsius and for a- an extended amount of time so that you start to create basically inflammation and then you're body will start building collagen.

Dr. Selina McGee (18:38):

So, you wanna do those treatments typically four weeks apart, which is just like what we do for IPL. So, I can do these customized sessions together. I do, um, IPL first and then I do radiofrequency afterwards, because if you do radiofrequency, you've got too much target there. So, do your IPL first, then do your, um, you're-

Leslie O'Dell (18:59):

On the same day or you mean-

Dr. Selina McGee (18:59):

Uh-huh (affirmative).

Leslie O'Dell (18:59):

On the same day?

Dr. Selina McGee (19:00):

Yeah, you do them on the same day.

Leslie O'Dell (19:02):

Okay.

Dr. Selina McGee (19:03):

Yep, same day, and then radiofrequency. And then if you still wanna do neurotoxin, you do that, obviously, at the very end 'cause you don't wanna migrate that anywhere that it's not supposed to be.

Jackie Garlich (19:14):

So, how do you start this conversation with your patient? Like, I'm just thinking, like, this is a comprehensive exam, someone's just coming in, and then just as an aside, maybe they see it in your waiting room or something, um, you know, and they, they're asking you questions about that.

Jackie Garlich (19:28):

Like, how do you s- like, how do you talk about all of that w- in the exam? How do you approach that to somebody who's like, "Oh, I see you do this," or, you know, like, how do you, what's your beginning spiel that you tell patients?

Dr. Selina McGee (19:39):

Sure. So, I love that they ask the question, and so that's the super important piece to discussing it with them in a way that makes sense. And so, my first question is, "Tell me what bothers you," because what bothers me may not bother them and you don't wanna point out something that doesn't bother them, right?

Jackie Garlich (19:56):

(laughs)

Dr. Selina McGee (19:57):

So then, we talk about, "Okay. Well, there's, there's different ways to treat different things." And so, then we walk through, like, all of those steps, and then we can schedule, you know, after that. But I typically don't discuss, like, the end question usually comes up about money. So, I try to do my best to not discuss finances in the room. I like to leave that to my, my technician or my optician, but sometimes it does come to that.

Dr. Selina McGee (20:26):

My advice usually to doctors is don't talk about money in the room. But, um, so yeah, that's how it comes up. One of the conversations that is an easy one is I always, when I'm doing my slit lamp exam, I always look at lids and I tell the patient, "By the way, I'm looking at lids, we're looking at lumps and bumps, we're looking for any kind of skin cancer because that's a really common place for skin cancer to show up."

Dr. Selina McGee (20:51):

And, they're usually like, "What? What are you talking about?" And then they're, then that is a whole other conversation, right? And so now, we talk about sunscreen, then we talk about products, and then that morphs into, "These are the things you need to avoid because it's sabotaging the front of your health in the front of your eye," and then it just, it's like that thread we talked about. When you pull the thread, it just starts to, (laughs) it just starts to come.

Dr. Selina McGee (21:12):

Um, and so, sometimes those conversations can get lengthy. So, if I have a new consult, um, I will put that in a slot of its own, because you can spend an entire comprehensive exam slot discussing all of these options. So, there are specific consults in this, built into the schedule for that so we don't wreck the flow.

Jackie Garlich (21:33):

Yeah, that's what my thought was.

Dr. Selina McGee (21:35):

Yeah.

Jackie Garlich (21:35):

Like, "Uh, I could see, like, this conversation getting pretty lengthy."

Leslie O'Dell (21:37):

(laughs) Oh, I get it.

Dr. Selina McGee (21:38):

Yes. And when I started, because I was much slower and the conversations were more difficult, I wasn't as comfortable, I built those where I only did aesthetics on one day. But once you get comfortable with it and you get the flow, you can start tucking that stuff into what you're already doing, which is really nice. But I would not advise that to start off with. Starts, start slow. (laughs)

Leslie O'Dell (22:00):

Do you think that, um, so since I'm in a state that there aren't injectable laws but I definitely have the interest in adding this, you know, to my dry eye, um, center as well, do you think just having certain things like radiofrequency paired with IPL you could get a- enough of an effect or you would just have to share the next step with, you know, like a nurse injector like you were talking about?

Dr. Selina McGee (22:24):

It really depends on the patient, but you can definitely get a, a direct effect with just doing those. And, not everyone loves needles, right? And so, it's a non-invasive way to achieve the things that they wanna to achieve. But, you know, you can always follow the MD model too, right? If you have a, a lot of these places have an MD that's not actually doing the procedures. It's, it's an injector that they're overseeing.

Dr. Selina McGee (22:51):

So, there's another way to be able to do that, and I have colleagues that are the injector, but they still have an MD medical director. So, that's an option. Um, or you can, you know, if your law allows to have someone in your practice, just not you doing it, then there's another way to do that. So, there's more than one way to, to achieve it even if your law doesn't say that you can.

Jackie Garlich (23:15):

Mm-hmm (affirmative). Do you feel like you're, you get more, like, more of your patients are doing IPL versus like a, you know, LipiFlow, or TearCare, or something?

Dr. Selina McGee (23:25):

Yes, and I've tried to figure out how to couple those packages because with my IPL, they, and what's re- and it's really interesting because I have my pricing set for thermal pulsation at like half of what my IPL is, but I get way more uptake with IPL than I do thermal pulsation. And, there's a handful of patients that even at the end of their fourth treatment for IPL still need thermal pulsation, but it's not nearly as many as, um, as it used to be before I did IPL.

Dr. Selina McGee (23:58):

But, it's, that to me is really interesting on the patients that are, are getting those kinds of treatments.

Jackie Garlich (24:08):

That just goes to, that goes with what we said earlier. Like, people are like, "Oh, I can look a little bit bitter too? I'll pay the upgrade to do that." Like. (laughs)

Dr. Selina McGee (24:15):

Yes, yes. Yes, so. (laughs)

Jackie Garlich (24:20):

So, Selina, can you talk a little bit about, you know, cosmetics is another big issue, that patients will ask questions about what makeup is safe to us. How do you talk about that? What do you say to patients? Do you give a handout? How does that work for you?

Dr. Selina McGee (24:35):

Sure. So, this one's super important, and because patients are not getting the information that they need, you know, especially in the age that we live in with, you know, the beauty bloggers and the influences and all of this stuff that's on the market right now that, and we see behind the film, and we have a microscope, right, that we're looking at eyelash extension and, and glue issues, and just rampant things that patients do themselves without them even knowing it.

Dr. Selina McGee (25:05):

So, first is, we have to have a conversation around that. And so, I just ask, you know, "Hey," if they, you can tell, you know, our patients too when you look at eyelashes if they're using some kind of serum. I mean, I can tell if my glaucoma patients are compliant or not from across the room, right?

Dr. Selina McGee (25:21):

So, you know that, but you can, you can ask, "Hey, are those, are your, are your lashes naturally? Great, good for you." If they're not, "Let's talk about what you're using," and then that drives that conversation. If they have extensions, I ask how they clean them and how they take care of them, and then that starts another conversation.

Dr. Selina McGee (25:38):

And then, I talk about how they take their makeup off, and that all feeds around that same eyelid-sunscreen conversation. So, I talk about ingredients because historically, it's been really hard to find any kind of product that was specific, that was safe, right? Because in the U.S., we know, based on all the work that, that Leslie has done and others in the field, that have looked at, you know, the U.S. bans, what, 11 ingredients in different products. In Europe, it's like over 1,300.

Dr. Selina McGee (26:14):

So, when you start to ha- educating patients around that, they're A, horrified and B, like sometimes really upset because, you know, I've had a patient that, she's like, "But I buy really expensive makeup." Okay, but you're buying really expensive marketing, and she's mad, right? (laughs)

Dr. Selina McGee (26:31):

And so, how do we educate our patients around this? And so, I do have handouts that I give patients and we talk about the ingredients and, "This is what you should avoid." But, yay, finally, we have something, um, on the market that is coming soon, and Eyes Are the Story is what we are gonna be able to have in our offices now, and I already carry products. I carry sunscreen, you know, I have different drops for patients. So, this is, this is not new, but this is a final product line that I can tell patients, "This is what I would use," and it's mascara, and eyeliner, you know, eye, um, an eye serum, a facial cleanser.

Dr. Selina McGee (27:13):

Because, historically, what most of my patients take their makeup off with is the Neutrogena towelettes. Guess what is in that: VAK at a very high level, (laughs) which is just stripping everything right off the front. So-

Jackie Garlich (27:27):

I'm not gonna lie to you, I totally use those. (laughs)

Dr. Selina McGee (27:28):

(laughs)

Leslie O'Dell (27:28):

(laughs)

Dr. Selina McGee (27:28):

So.

Leslie O'Dell (27:28):

Well, you just have to turn the package over and read sometimes, Jackie, and you'll be completely appalled. I, I have been. Mostly if, if I'm traveling and they'll have, like, the convenient eye makeup remover and on the front, it will say, "No alcohol," or something. And then on the back, it's like literally five parabens all in a row and I'm thinking, "Okay. Well, there's no alcohol but there's still things that are gonna be irritating to my eye.

Leslie O'Dell (27:56):

So up until Eyes Are the Story really launched, nothing was made, things were starting to come, you know, through other companies, um, and doctors were even reselling some of those products in their practices, like Beautycounter and different lines like that. But, so cleaner beauty but nothing yet was developed with the eye in mind.

Leslie O'Dell (28:15):

So, that's what really is gonna set this product apart is its clean cosmetics rooted on science with the ocular surface in mind. And, and, um, governed kind of by that European standard. So, hopefully patients will receive them as well, um, as, uh, the doctors have so far.

Dr. Selina McGee (28:34):

Well, and I think it's a, it's amazing because that's what takes up a ton of chair time, right? Patients want something easy and they want you to tell them what to do. And so, historically when I, when I have to give them a handout that's got 15 things on it that says, "Avoid these," they're like, "Okay, great."

Dr. Selina McGee (28:51):

And now, I can say, "Okay, here's the five products I would use," and, okay that conversation, we can move on to something else. And so, I think that's gonna be huge for doctors across the country and our patients.

Jackie Garlich (29:02):

Yeah, and myself, apparently. (laughs)

Leslie O'Dell (29:05):

(laughs) Right.

Dr. Selina McGee (29:06):

Okay. Well, true. So, I, when I started doing IPL, I took everybody's makeup off with those Neutrogena towelettes until started reading the back and I was like, "I'm doing more damage to my own patients, crikey." So, (laughs) don't feel bad.

Jackie Garlich (29:21):

Okay, good. (laughs)

Leslie O'Dell (29:21):

(laughs)

Dr. Selina McGee (29:21):

This is an education process for all of us. (laughs)

Jackie Garlich (29:25):

When you said that, I was like, "Uh, I have to admit this publicly."

Leslie O'Dell (29:30):

If you think about the BAK, it's actually listed on those products, so it's as high as 1%. So, think about the glaucoma medicine that you know is wreaking havoc on the ocular surface 0.003%, you know, and lower sometimes. And so, these, these are thousands of times higher. So, that one's easy for us to see just as eye doctors and think like, "This doesn't belong here," but it is, you know, a different language to our patients and the consumer, and so whatever you could do to simplify it, um, is, is good, for sure.

Jackie Garlich (30:03):

So, do you think you'll do that, your, or, Selina, do you have that now, like, where you have a list of h- like, a handout you just had ingredients to avoid and not like product recommendations? But now, that might flip, right?

Dr. Selina McGee (30:14):

Correct, yeah. I have a list of ingredients to avoid, and then I have the two apps, the Think Dirty app and the EWG app, like, on that. And then, I have also, you know, products that we do recommend, and so that's where this will fit in nicely. Um, but I mean, I have handouts on sunscreen, how to put it on. You know, we always, the reason that skin cancer's so prominent around the eyelids is because no one puts sunscreen there and they don't wear sunglasses. And so, 'cause they don't wanna get sunscreen in their eyes or it burns. And, so-

Leslie O'Dell (30:44):

Or, maybe they don't wanna get funny suntans, you know, like, the, um, raccoon eyes. (laughs)

Dr. Selina McGee (30:50):

True. (laughs) That too. So, yes, I have, I am the, if, my, my goal is everyone is educated about something new when they leave our office, whatever that may be.

Leslie O'Dell (31:00):

So, how do you tell them to put on sunscreen? I need to know this.

Dr. Selina McGee (31:03):

So, um, the, so we talk about the ingredients first, no parabens, um, we talk about zinc oxide being, and not the oxy, um, ingredient. And then, they need to put it, you know, just on their fingers around and then on their face, and then the very last thing they do, once they, like, get it all rubbed in, is use their fingertips and do the top of their eyelids and one more time underneath their eyelids.

Dr. Selina McGee (31:27):

And so, that will, and then of course, they need to wear sunglasses, period. But-

Jackie Garlich (31:32):

What sunscreen do you tell people to use? What are you, what's on your list of recommended products?

Dr. Selina McGee (31:36):

So, I- I carry a product called Epionce in my office and it dove tails with my products that I recommend post IPL procedures, because they've got some, um, cleansers and some products medical barrier cream that just feel really good post procedure, and I really like their sunscreen and it's tinted. So, they can, at least, I have been able to, like, I don't even wear foundation anymore. I wear sunscreen and I roll on out of the house.

Dr. Selina McGee (32:07):

And so, it's one less step of product they're having to put on their face too, but that's just the one that, that I happen to carry.

Leslie O'Dell (32:15):

Well, I think this has been super informative. Like I said, I'm definitely planning a trip to Oklahoma soon so that I can look and feel as good as you do.

Dr. Selina McGee (32:21):

(laughs)

Leslie O'Dell (32:21):

And, I've, I've learned a ton. Um, so I really, really appreciate you taking the time out of your schedule to kind of share some of your knowledge in this niche of aesthetics and dry eye.

Dr. Selina McGee (32:34):

Definitely, thank you, guys, for having me.

Leslie O'Dell (32:43):

And now for the To the Point wrap up: when building out your dry eye niche, considering things like ocular aesthetics can really help set you apart from others. When adding this to your practice, instead of you pointing out the flaws of your patients, direct the question to them. What bothers them? And, maybe you can help offer a solution.

Leslie O'Dell (33:01):

Starting the conversation around cosmetics and sun protection is a great way to start. When you're offering services a la carte, like IPL or radiofrequency, offering packages are really great and allow the patients to complete treatments instead of giving up halfway through because they feel better.

Leslie O'Dell (33:20):

Offering aesthetics is a great way to build relationships with outside referral sources. So, who's to say we can't have fun, stay youthful, and look good while we're trying to help the patients we serve?

6/9/2020 | 33:49