Lisa Kurts works out five days a week, eats right and stays out of the sun. Her beauty regimen gets more complicated from there, with injections, creams and prescription medication — much of it aimed at enhancing the beauty of her eyes.
"Your eyes stand out," said Kurts, 44, of Millers Island, a regular at BE Lifestyle Luxury Medspa in Towson, Maryland, who uses high-end eye creams and a prescription eyelash-growing medication and has had Botox and Juvederm injections around the eyes. "I try to make them look as young as possible."
If eyes are the window to the soul, they're also a view into a culture and medical-cosmetic industry increasingly focused on them. Much of the emphasis is on products and cosmetic surgery procedures aimed at erasing the signs of aging: dark circles, crow's feet, saggy lids. But some, including eyebrow threading and the eyelash-growing serum Latisse, are aimed at younger women, too.
One of the latest eye-enhancing fads, an oversized contact lens popularized by Lady Gaga, has gained wearers among young women and teens eager to make their eyes look larger — despite warnings from doctors that the illicit lenses can damage eyes and even cause blindness.
Whether they reach for drugstore eye creams or go under the knife — cosmetic eyelid surgery was the third most popular cosmetic procedure in 2009, behind breast augmentation and liposuction — more women seem to be focused on their peepers. Eyes, it seems, are the new teeth.
"You want your eyes to pop," said Ora Powers, 32, a nail technician at Usha Salon in Locust Point, who gets her eyebrows groomed there using a traditional Asian technique known as threading. "When people look at you, the first thing they see is your eyes."
"Men might not look at them at first," she added with a laugh. "But eventually, they have to."
There is a reason people focus on the eyes, said Dr. Larry H. Lickstein of the Cosmetic Surgery Center of Maryland, which is affiliated with BE Lifestyle spa.
"The eyes and appearance around the eyes give so much emotion," Lickstein said. "That's what makes people look sad or angry or tired. Just by doing some minor procedures, we can really refine or rejuvenate the way somebody appears. … In this economy, people are sometimes hesitant to do a full facelift, but they still want to do something to feel better about their appearance."
So they opt for an eye job.
"We see aging around the eyes," Lickstein said. "It's one of the first signs of aging and it's one of the subtlest to correct, which is why it's so popular."
The eyelash-growing serum Latisse costs about $100 for a three-month supply. An injection of Restylane, an acid that can be used to plump up saggy lids, costs about $500 to $600 and lasts for six months to two years. Average surgeon's fees for cosmetic eyelid surgery are $2,700, according to American Society for Aesthetic Plastic Surgery figures.
Surgeon's fees for a full facelift average nearly $7,000.
Connie Kihm never used to focus on eye beauty. She had far more important matters of eye health before her.
Kihm, 63, has not been able to see from one eye since birth. She is not technically blind in that eye, but that eye registers no image to her brain. Several years ago, she noticed that the lid on her good eye had started drooping. She saw a doctor and learned the lid was blocking 70 percent of the vision in that eye.
She had surgery on that lid, which was covered by insurance because it was medically necessary. The surgery not only improved her vision but quite literally opened her eyes to the world of aesthetic eye improvements.
While she was being treated for the drooping lid, her doctor at Katzen Eye Group noted that Kihm's lashes were very sparse. Dr. Emily MacQuaid suggested that Kihm try Latisse, a prescription product that makes lashes grow.
The medication is based on one initially developed to treat glaucoma, MacQuaid said. After it was discovered that the drug had the welcome side-effect of promoting lash growth, a less-potent version was developed for cosmetic purposes. While there are warnings that Latisse can change blue eyes to brown, the main side effect seems to be a little darkening along the lash line, MacQuaid said.
"Most women actually love that side effect," MacQuaid said. "It looks like eyeliner."
Kihm, a natural blonde who has always had very sparse lashes, saw results almost immediately.
"It's unbelievable," Kihm said. "I would never buy mascara. There was nothing to put mascara on."
Kihm also elected to have blepharoplasty, cosmetic eyelid surgery that's akin to a tummy tuck for the lid, removing excess skin and fat.
"It really has made a difference in the way I look," said Kihm, 63, a retired fashion-industry buyer and planner. "I'm still fairly slender and I still want to maintain a somewhat youthful appearance."
Kihm swears that's it. She's not trying anything "age-inappropriate," as she put it.
"I've been married to the same man for 45 years, for heaven's sake," she said. "I'm not out trolling for men."
Younger women who may be out on the prowl, and certainly not worried about droopy eyelids and under-eye bags, seek other ways to enhance their eyes: oversized contact lenses like those Lady Gaga sometimes sports. If they do so, doctors warn, they'll be lucky to see their own crow's feet when they reach middle age.
Through illicit online Asian sellers, they are buying so-called circle lenses. The contacts are similar to conventional tinted contacts worn — sometimes for prescription purposes, sometimes for purely cosmetic ones — to change the eye color. But these lenses are larger than normal, so they cover some of the white of the eye in addition to the iris, with the effect of making eyes look larger.
This source of strangely doe-eyed sex appeal is also cause for concern among eye doctors, who say the lenses can damage eyes to the point of blindness. The U.S. Food and Drug Administration classifies contact lenses as medical devices that can only be sold by prescription, but that has not stopped their illegal online trade.
"It's become this fashion fad in the U.S. in the past six to 12 months," said Dr. Richard Edlow, chief executive officer of Katzen Eye Group. "They first came out in Japan a couple years ago. You're able to order them online, and they're not that expensive. For a young kid who just wants to play around and look different, they're readily accessible."
Part of the concern is that the lenses will damage the eye because they will not fit properly. Saran-wrap-thin soft contact lenses might seem pliable enough to take the shape of any eye, but they are not one-size-fits-all.
"The cornea has a certain curvature to it," Edlow said. "That curvature is measured for each individual patient fit for contact lenses." If the curvature of the contact lens is too steep, the lens doesn't move on there and that causes a lot of problems. If it's too flat, the lens is going to move around a lot, creating discomfort and variable vision.
And a larger lens also makes it easier to get a foreign body trapped between lens and eye, he said.
"It can be something a tenth of a millimeter, a teeny speck of dirt, constantly rubbing against the outer layer of the cornea," Edlow said. "Eventually it breaks down, and you end up with corneal abrasion. It can be pretty damaging. Corneal ulcers can lead to a lot of vision-threatening problems."
Even minor irritations can cause breaks in the surface of the eye, making it more vulnerable to serious infection, said Dr. Elliott H. Myrowitz, assistant professor and chief of Optometric Services at the Johns Hopkins Wilmer Eye Institute.
"It's scary," Myrowitz said. "The cornea is pretty durable, but once infection occurs, you can be blinded and the correction of that is very challenging. A corneal transplant is a last-resort option. If you need that, you're looking at a very long — like year — recovery period. And over a lifetime, it has to be replaced. If a person buying these contacts knows there's a risk, I think they would think twice."