The authors take opposing viewpoints as they discuss different aspects related to this corner of the beauty and cosmetics realm.
As eye care professionals at the forefront of eye health and aesthetics, we’re witnessing an unprecedented surge in the popularity of eyelash enhancements. This sector, spanning from dramatic extensions to growth serums, has not only become integral to global beauty routines, but also presents unique challenges and opportunities for patient care.
In 2020, the lash extension market was valued at $1.36 billion, with projections indicating a growth of $569.8 million by 2027, reflecting a compound annual growth rate of 4.81%.1 Such statistics underscore the significant consumer interest and the evolving landscape of eyelash enhancements.
In response to this trend, we aim to explore the multifaceted aspects of eyelash enhancements. Our goal is to equip fellow professionals with the knowledge to navigate these trends, ensuring patient education focuses on both the aesthetic benefits and the paramount importance of ocular health.
THE CASE FOR AND AGAINST EYELASH EXTENSIONS
Eyelash extensions involve the attachment of lashes made of synthetic, silk, or mink to natural lashes using glue. They come in a variety of sizes and shapes. Lash extensions are usually applied by a technician in a beauty salon, using tweezers and a specially formulated, semi-permanent glue. The procedure can take as long as 3 hours, and eyes should remain closed for the duration of the application. The faux lashes must be removed with glue solvents and reapplied every 3 to 4 weeks as the natural lashes grow out. This is called a lash fill, which takes another 1 to 3 hours, and is fraught with potential complications involving the ingredients in the lash glue solvents.
The Perceived Benefits of Eyelash Extensions to Our Patients (Dr. Compton)
Eyelash extensions, when applied correctly, can offer an unparalleled aesthetic enhancement. They create volume, length, and a sense of drama that mascara or natural lashes alone cannot achieve. For many of my patients, extensions have been a game-changer, boosting confidence and saving precious time in their morning routines.
Technological advances are also transforming the application process for eyelash extensions, including being applied by a robot.
Amador et al provided a fascinating look into the natural function of eyelashes, suggesting that future enhancements could also focus on protecting the eye from airborne particles and evaporation, in addition to aesthetic improvements.2
When patients choose to wear eyelash extensions, they should understand the associated risks. From a health care perspective, the safe enjoyment of eyelash extensions hinges on adhering to specific practices. It’s crucial to use a reputable technician who uses high-quality, hypoallergenic materials and lightweight lashes to accommodate sensitive eyes. Safety can be further ensured if the technician conducts a patch test to preclude allergic reactions to the adhesive, applies the extensions at least 1 mm away from the skin to prevent direct contact, maintains proper ventilation during the procedure, and diligently monitors the adhesive’s shelf life—using it within 6 months if unopened and 1 to 2 months once opened. Additionally, ensure that patients have a way to clean their extensions (eg, with micellar water and hypochlorous spray). When these guidelines are followed, eyelash extensions can be a safe enhancement, reducing the risk to natural lash health.
The Concerns With Eyelash Extensions (Dr. Madan)
Eyelash extensions have been reported to cause discomfort, itching, eye redness, pain, and eyelid heaviness.3 A study by Han et al found that eyelash extensions can also cause ocular surface changes, including corneal epithelial defects and decreased tear film stability.4 The most commonly reported ocular disorder associated with this cosmetic procedure is blepharitis.5 Numerous studies have investigated the underlying cause of these ocular responses and found that lash glue adhesive and mechanical limitations of the lash extensions themselves are the main contributors.
The adhesives typically used to apply lash extensions contain cyanoacrylate, latex, or ammonia. Formaldehyde is a byproduct of these chemicals, which studies suggest can trigger mild to severe contact dermatitis, keratoconjunctivitis, and blepharitis.5 Although many eyelash extension salons claim to use “safe” glue, it’s worth noting that the FDA does not regulate eyelash glue.
Furthermore, there are several mechanical implications of eyelash extensions, such as lagophthalmos, which results in corneal exposure during sleep. Bacteria buildup beneath the lash bed and difficulties maintaining proper eyelid hygiene can lead to microbial infections.5 An increase in eyelash length is also shown to increase tear evaporation.4 Thinning and discoloration of natural lashes following the removal of false ones has also been observed.
Although rare, extensions can also lead to fibers getting stuck in the conjunctiva, which may necessitate surgical removal.6
Collective Verdict
Although eyelash extensions offer aesthetic benefits, they require careful consideration of potential risks to eye health and lash integrity. We advise prioritizing safety by choosing certified technicians and inquiring about the materials used. Requesting the ingredient list of the adhesive and conducting a spot test on your arm for allergens before application near the eyes is advisable. Using extensions in moderation and maintaining proper eyelid hygiene is crucial. Using natural lash lengths is also preferable. Maintaining open communication with eye care professionals can help enjoy the beauty of extensions while minimizing risks.
GROWTH SERUMS: MIRACLE SOLUTION OR MARKETING HYPE?
In the quest for fuller, longer lashes, many turn to eyelash growth serums as a less invasive alternative to extensions. But do they live up to the hype?
The Science Behind Growth Serums (Dr. Compton)
In the realm of eyelash growth serums, bimatoprost ophthalmic solution 0.03% (Latisse, AbbVie) has set a benchmark for efficacy and safety, gaining widespread acclaim among both patients and health care professionals since its FDA approval in 2008. Its active ingredient, bimatoprost, has been clinically validated to stimulate eyelash follicles, enhancing lash length, thickness, and darkness, as evidenced by a 6-month follow-up study on eyelash hypertrichosis induced by topical latanoprost.7
Appropriate application of eyelash growth serum involves applying one drop nightly along the upper eyelid margin at the base of the eyelashes with a sterile, single-use (per eye) applicator. It should not be used on the lower eyelash line.8 The treatment effects will diminish by 4 to 6 months following treatment cessation.
Following in the footsteps of topical bimatoprost 0.03%, numerous companies have ventured into the eyelash growth serum market, introducing a variety of formulations aimed at replicating or surpassing its current outcomes. These newer products often incorporate a blend of peptides, biotin, and other growth-promoting ingredients, catering to consumers seeking alternative options for active compound or price point.9,10
Skepticism Surrounding the Serums (Dr. Madan)
Common side effects of the only FDA-approved prostaglandin analog, topical bimatoprost 0.03%, are hyperpigmentation of skin and iris, conjunctival hyperemia, itching, and lash loss. Patients can also experience periorbitopathy due to orbital fat loss, resulting in a hollow or sunken eyes appearance.11 These side effects are dose-dependent and may be reversible with treatment discontinuation.11
Several other prostaglandin analogs in OTC serums, such as latanoprost ophthalmic solution 0.005% (Xalatan, Viatris), fluprostenol (eg, travoprost ophthalmic solution 0.004% [Travatan Z, Novartis]), dechloro ethylcloprostenolamide, and isopropyl cloprostenate, have risen in popularity due to their lower price points, offering some competition to topical bimatoprost 0.03%. However, I caution patients against using these other prostaglandin analogs because they have not been adequately assessed for safety. Unlike pharma companies, cosmetic companies are not required to list potential side effects in their packaging.
Isopropyl cloprostenate in particular is a popular synthetic prostaglandin analog to watch for in OTC eyelash serums. No formal research studies have been conducted to examine the effectiveness of this compound in enhancing eyelash appearance, and several lawsuits have been filed for lack of consumer awareness of its potential side effects.12
Numerous OTC nonprostaglandin analogs are used in eyelash serums that claim to have beneficial cosmetic effects on eyelashes; however, these claims are largely anecdotal. Unfortunately, there is insufficient research evaluating many of these serums and their safety and efficacy. Some common nonprostaglandin analog products include peptides, growth factors, ginseng, panthenol, proline, pumpkin seed oil, Jarilla–Coffea extract, and castor oil. Most of these have been given a Grade D recommendation by The Oxford Centre for Evidence-Based Medicine, emphasizing the need for more comprehensive research.
Collective Verdict
Growth serums present a promising solution for enhancing lash appearance, but skepticism remains due to the variability of results and potential side effects. It’s essential to select products with proven ingredients and consult with an eye care professional. Informed decisions and manufacturer transparency are crucial for safe and effective use.
THE FUTURE OF EYELASH ENHANCEMENTS
As public opinion increasingly prioritizes environmental issues, there’s a growing consciousness about the effect of beauty products on both personal health and the environment. Because they cannot be recycled, conventional faux lashes and their packaging often contribute to plastic pollution. However, consumers are increasingly seeking eyelash enhancement products that are free from harsh chemicals, leading to the creation of serums and adhesives that are kinder to both the eyes and the environment. There has also been a visible shift within the industry towards embracing cruelty-free and environmentally friendly beauty products. Polybutylene succinate, a thermoplastic polymer resin of the polyester family, and polylactic acid, a biodegradable, biocompatible and thermoplastic polyester mainly derived from corn starch, emerge as promising alternatives to false eyelashes derived from renewable sources. This trend indicates a positive direction in the industry, aligning with consumer values of sustainability and ethical consumption.
As we look to the future, the landscape of eyelash enhancements is evolving towards greater safety, sustainability, and ethical responsibility. As practitioners dedicated to the intersection of beauty and eye health, we anticipate these advances with optimism, recognizing their potential to enrich patient care and education. It is imperative for fellow professionals to stay abreast of these developments, equipping themselves to guide patients through informed decisions that prioritize ocular health alongside aesthetic desires.
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- 2. Amador G, Mao W, DeMercurio P, Montero C, Clewis J, Alexeev A, Hu D. Eyelashes divert airflow to protect the eye. J R Soc Interface. 2015;12(105):20141294.
- 3. Han J, Xie Z, Zhu X, et al. The effects of eyelash extensions on the ocular surface. Cont Lens Anterior Eye. 2024;47(2):102109.
- 4. Han J, Xie Z, Zhu X, et al. The effects of eyelash extensions on the ocular surface. Cont Lens Anterior Eye. 2024;47(2):102109.
- 5. Masud M, Moshirfar M, Shah TJ, Gomez AT, Avila MR, Ronquillo YC. Eyelid cosmetic enhancements and their associated ocular adverse effects. Med Hypothesis Discov Innov Ophthalmol. 2019;8(2):96-103.
- 6. Dowlut MS, Ahmed Y, Knox A. Ocular inflammation associated with fibers from eyelash extensions. JAMA Ophthalmol. 2018;136(1):e175723.
- 7. Stecchi G, Saccucci S, Molinari S, De Gregorio F. Eyelash hypertrichosis induced by topical latanoprost: 6-month follow-up study. Acta Ophthalmol Scand Suppl. 2002:236:56-57.
- 8. Johnstone MA, Albert DM. Prostaglandin-induced hair growth. Surv Ophthalmol. 2002;47 Suppl 1:S185-S202.
- 9. Melville NA. Eyes wide open: Patients, physicians embrace eyelash growth products. Dermatology Times. October 1, 2009. Accessed April 19, 2024. www.dermatologytimes.com/view/eyes-wide-open-patients-physicians-embrace-eyelash-growth-product
- 10. Latisse summit introduces physicians to eyelash-growing products. Dermatology Times. May 5, 2009. Accessed April 19, 2024. www.dermatologytimes.com/view/latisse-summit-introduces-physicians-eyelash-growing-product
- 11. Baiyasi M, St Claire K, Hengy M, Tur K, Fahs F, Potts G. Eyelash serums: a comprehensive review [published online ahead of print March 12, 2024]. J Cosmet Dermatol.
- 12. Welcome to the Settlement Website for the class action lawsuits, known as Scherr v. Rodan & Fields, LLC, Gorzo et al. Scherr v. Rodan & Fields, LLC, No. CGC-18-565628, coordinated in the Superior Court of California, County of San Francisco, Lash Boost Cases, JCCP No. 4981. Sherr v. Rodan & Fields. January 23, 2024. Accessed April 9, 2024. bit.ly/3UdMhYR
