Clinical

Dr Joshua Van der Aa gives an insight into the process of creating a signature injectable treatment, and tells us the story behind his own

Top: before, Bottom: immediately after InclinEyes treatment

Dr Joshua Van der Aa

Dr Joshua Van der Aa is an injection-focused cosmetic practitioner specialising in rejuvenation of the peri-orbital area. He is a graduate of Leuven University’s Medical School in Belgium. Before opening Dr Joshua Harley Street Aesthetics in 2020, he worked in some of the best-known, award-winning clinics in London and Europe. Follow him on Instagram: @drjoshualondon

Generation Z model and it-girl Bella Hadid has never visited my clinic, but her name is ever-present inside these four walls. For the past two years at least, the way her eyes look has triggered more patient enquiries (both in person and via my inbox) than perhaps any other external influence. She’s not the reason I set out to create a new treatment technique, but on some subconscious level, her sway at the outset is undeniable.

I launched my first signature treatment, InclinEyes, in May. It uses dermal filler to achieve lifted brows, enhanced symmetry and subtly elongated eyes. It was born out of a mix of concern from first-hand observations in my clinic, and a fixation and determination to solve a “puzzle”. It was becoming perplexing and troubling to be routinely met with as many young female patients asking for “eyes like Bella” as the number I had to counsel who had undergone unsuccessful or unsightly “Bella” treatments elsewhere. “Can I undo it without surgery?”, they would ask. I felt strongly there was a big need for a safe, predictable and reproducible treatment to improve eye shape and brow position. So, my task became to do this convincingly and minus the surgical sutures.

Top: before, Bottom: immediately after InclinEyes+ treatment (addition of tear trough filler)

The fox eye trap

One of the biggest beauty misconceptions in circulation right now is the belief that Bella Hadid has had a “fox-eye” thread lift. She’s publicly denied it and I share in the opinion that her covetable eye shape most likely results from a specific surgical brow lift and perhaps a canthopexy, further emphasised at times by the application of accentuating make-up. Nonetheless, the increasing popularity of fox-eye thread lifts to achieve, non-surgically, the look that has social media buzzing, means there is a large demand in the market for treatments that can elevate the eyebrow position and elongate eyes.

Unfortunately, in my opinion, fox-eye threads not only over-promise and under-deliver on results, but they can also come with substantial risks. Personally, I don’t condone the fox-eyes thread lift treatment; it can cause significant swelling and downtime and carries risks such as scarring, visible threads, dimples, puckering of the skin and long-lasting pain. From what I’ve seen, this type of threads rarely last longer than two weeks to two months. Where brow thread lifting is concerned, the risks far outweigh the rewards. Add to that, often, the treatment is overdone, sometimes giving the patient an alien-like appearance, albeit very temporarily.

Another way

My starting point was literally to ponder whether there could be a way to achieve that more open and winged-eye effect without any need for forcibly hoisting the brow tail into unnatural angles. I began by deconstructing the eye region to its natural anatomy and assessing which parts needed to be augmented in which patients to achieve optimal results. I studied the minimally invasive work of great plastic surgeons and set about comparing this to the relevant local anatomy. It made me believe that a certain improvement in the shape of the brow and eye is achievable.

I’ve had a long-held fascination with treating the temples and upper eyelids from a rejuvenation point of view, and over more than 12 months, I found a duplicable way that gently raises the brow tail by adding volume, while also improving the appearance of the canthal tilt, or inclination, of the eye, resulting in a more feminine, almondeye shape and a youthful, lifted brow. For this treatment, I found, it’s a combination of addressing both bony volume deficit as well as strategically optimising fullness in certain fat pads in the brow and eyelid area.

It was at this point that InclinEyes was born and also when I realised that I had to take my medical hat off and put on the business one. I’d done the hard work, even given it a name, and now I had to promote it and protect it if I was going to get it out there, which meant registering the trademark. That’s not something that came naturally to me but, for the benefit of fellow clinicians yet to attempt it, I can say I found it relatively straightforward, albeit occasionally nail-biting. I began with a search to confirm nobody else in our industry grouping was using it. Then it was just a case of working my way, step-by-step, through the application process, a final review, and with nervous excitement, clicking “submit”. Be prepared for a wait of about three months for the trademark to be filed, during which time it can also be challenged. That was the nerve-racking part.

Top: before, Bottom: immediately after InclinEyes+ treatment (addition of tear trough filler)

Eyes wide open

As with most treatments, the InclinEyes process begins with careful and considered selection of the patients; arriving at mutually agreeable outcomes is always key, with the proviso from me that the end result can only ever look natural, of course. The ideal candidates are patients with generally sad, droopy or tired-looking eyes, with a heavy or hollow appearance and minimal excess eyelid skin. Essentially though, anyone who goes into this with the right expectations will benefit from the treatment. I find that in older patients, with skin draped over the eyelashes, a surgical intervention, such as upper eyelid correction, is advisable first.

Using a cannula, I gently administer a soft, light hyaluronic-acid product that integrates well in the delicate tissue around the eye area. Teosyal by Teoxane is a good choice but I’m also trialling a couple more. There are no toxins, threads or other devices used. – the treatment consists entirely of filler. In a nutshell, what InclinEyes involves is strategic volume optimisation of the periorbital bone and fatty tissue to improve the appearance of the inclination of the brow and the canthal tilt (the apparent tilt of the eye itself). To what extent this happens is dependent on factors that vary from patient to patient, unique to each face. The outcome is always a more youthful and lifted, open and sensual look, which is arguably more credible and natural looking because it’s less extreme than fox-eye threads. I couldn’t be more delighted with the results so far and with patients’ reactions to them.

Unlike a brow lift with botulinum toxin that lasts three to four months, InclinEyes lasts for 12. And unlike existing upper eyelid fillers, this – quite distinctly – repositions the brow tail and creates that more desirable outer-eye slope. Crucially, it’s also safer because it’s fully reversible, and this was a key motivator for me given that I see so many patients stuck with tension and rippling from threads. Downtime is minimal; often there’s none but in some cases it’s no more than a mild swelling for about 10 days at most, which is so slight it wouldn’t be noticeable to others. What’s more, because the treatment uses fillers exclusively, and no toxin or threads, a safe, predictable and long-lasting effect is achieved. In some cases, patients can also have a second or third treatment, and after these additional treatments it’s not unusual to have results that last for up to two years.

Alongside InclinEyes, I’ve introduced InclinEyes+, which includes bespoke options adaptable to each face. In essence, this adds affordable treatments for people who are suffering from volume loss in the surrounding areas that act as scaffold to the eye area. If this is the case, it’s important to address these at the same time to ensure optimal results of the InclinEyes treatment itself. Usually, this is either in the temple or tear trough regions.

Looking ahead

So, is InclinEyes the new “fox eyes”? In short, no. And neither would I want it to be. I’d rather it was considered the elegant, safer and more natural-looking alternative. After all, this procedure’s effect will work somewhat differently with each individual face, and that’s the key. Like many of my colleagues, I believe our role is not to promote a single beauty ideal, encourage trends, or change or distort a face to look a certain, prescribed way. It’s not about giving my patients eyes like Bella Hadid’s, it’s about introducing them to a new opportunity to appear refreshed, brighter and wider-eyed, if that’s what they want. I think less in terms of lifting brows because I believe the most important thing I can lift with my work as an aesthetic doctor is someone’s spirit.