In July, Osmotica Pharmaceuticals disclosed the FDA's approval of Upneeq, a novel nonsurgical treatment for acquired blepharoptosis, also known as ptosis or sagging upper eyelid. "Ptosis is related to the actual placement of the eyelid," states Dr. Rob Schwarcz, a board-certified oculoplastic surgeon in New York City. He elaborates that the consequence of this medical condition is that the eyelash line sits lower on the pupil, resulting in a droopy lid that makes the eyes appear small and drowsy.
How Upneeq for Drooping Eyelids Functions
Traditionally, the remedy for drooping eyelids is ptosis surgery, which differs from a blepharoplasty, or eyelid lift, in that it doesn't eliminate excess skin or fat from the eye region. Instead, "it advances or stitches the muscle that opens the eye to make it shorter vertically and widen the eye," remarks Dr. Schwarcz, who was on Osmotica's advisory board for Upneeq. But now, those afflicted with this condition have an alternative in the form of daily eye drops that promptly contract the muscle to lift the eyelid.
Dr. Schwarcz has witnessed some patients obtain outcomes comparable to those from ptosis surgery, yet the effects of the drops persist for up to merely six hours. Once the medication completely wears off, he says, the eye drops can be used again in a day for the maximum impact. Nevertheless, he notes, "It's comparable [to surgery] for someone with only a minor amount of eyelid sag, because [the drop causes] a small lift of the eyelid. If someone has a very significant sag, obviously the surgical outcome would be much greater."
Dr. Mehryar (Ray) Taban, a board-certified oculoplastic surgeon in Beverly Hills, California, concurs: "[Upneeq] is a decent temporary solution for mild, perhaps moderate, ptosis, but it won't suffice for severe ptosis." Beyond the lifting effects, Dr. Taban adds that the duration of the results is not remotely comparable. Ptosis surgery yields results that are "essentially permanent or on average last about 2024 years," he states.
But Dr. Schwarcz views Upneeq as a potential solution for a distinct usage that doesn't require surgery: Botox-induced ptosis. "One of the complications of obtaining Botox is a temporary droop in the lid if the Botox reaches the upper eyelid muscle," explains Dr. Schwarcz. This could occur due to a leakage or an incorrect injection technique. "That individual would most likely benefit from using the drops for the two months it takes for the eyelid to recover."
The prescription isn't suitable for everyone though. If you have excessive skin or fat around the eye and are contemplating an eyelid lift, Dr. Schwarcz cautions that ptosis correction could make the area look worse. He likens the effect to that of a Roman shade. When opening the shades to let in more light from a window, the fabric bunches up at the top. Utilizing Upneeq to open the eye when there is excess skin could have a similar "bunching" effect.
Potential Side Effects of Upneeq
"Another side effect of the drops is what we term rebound redness," says Dr. Taban. Rebound redness – when the blood vessels cease reverting to their original size once the drug wears off – is a risk associated with over-reliance on any type of eye drops. "That's a major reason I don't consider Upneeq a favorable long-term option. I wouldn't prescribe it for more than a few weeks," he says. Additional side effects of the treatment for drooping eyelids include those typical of eye drops, such as dryness, blurred vision, and irritation.
Only time will reveal, but in the future, Dr. Schwarcz perceives Upneeq as having "significant implications in the beauty realm" for those merely seeking the immediate, short-term effect of larger eyes that "stand out." For the present, it's worthwhile to discuss the drug with your eye doctor if you're dealing with ptosis and hoping for a nonsurgical eyelid lift solution.
