Q&A: James Chelnis discusses AAO 2025 presentation on aesthetic facial surgery

James Chelnis, MD, FACS, is an ophthalmic plastic and reconstructive surgeon at Manhattan Face & Eye. At the 2025 American Academy of Ophthalmology meeting held in Orlando, Florida, he gave a presentation titled, "Introduction to Aesthetic Facial Surgery by Fractional Lasers, Intense Pulsed Light, Radiofrequency and Ultrasound Devices.”

Note: The following conversation has been lightly edited for clarity.

Ophthalmology Times: You’re giving an introduction to aesthetic facial surgery using several energy-based technologies. What motivated you to create this talk, and what do you hope ophthalmic surgeons will take away from learning about lasers, IPL, RF, and ultrasound-based devices?

James Chelnis, MD, FACS: There’s an ever-expanding number of machines, wavelengths, and techniques, which can make it challenging to manage all that information. I think that’s why we get so many people to attend this course each year. I hope attendees continue to grow from the information we offer them and understand that learning is constant, so be prepared to be creative and adapt as time goes on.

In my presentation, I focused on the cutting edge of this field and what’s next on the horizon. Our CO2 and erbium platforms, such as the new UltraClear, are raising the bar in terms of skin improvement for our patients. For periocular treatments, OptiLIGHT and other dedicated IPL platforms, as well as the new OptiLIFT dynamic muscle stimulation device, are enabling us to address ocular surface concerns in new, exciting ways. Hopefully, my talk will help everyone keep up as these technologies continue to advance.

OT: Each of these modalities—fractional lasers, IPL, radiofrequency, and ultrasound—has distinct mechanisms and clinical advantages. How do you determine which technology is best suited for a particular patient or aesthetic concern?

Chelnis: Well, I believe confidence in choosing the right therapy comes from both knowledge and experience. It doesn’t happen in a day, and it doesn’t all have to come from firsthand exposure—but continued investment in learning about treatment modalities is what has helped me grow my personal understanding.

I also believe that the ability to offer great treatments starts with being able to deconstruct the problems we face and employing basic principles. For example, if we have a patient with meibomian gland dysfunction along with lower eyelid laxity, I have to incorporate a modality that will mechanically improve the patient’s blink, like dynamic muscle stimulation, along with modalities that improve the quality of the meibum—otherwise the patient will never know that their glands have improved.

Similarly, when it comes to skin quality, I consider whether we’re treating pigment, texture, or laxity. What is the patient’s skin type and ethnic makeup? What is their allowance for downtime and recovery? I ask my patients these questions over and over to ensure that we are utilizing the correct device and protocol for their specific case. We have a dozen or so options for energy-based care in my office for this reason, because no two patients are exactly the same.

OT: Many ophthalmologists are exploring facial aesthetics as an extension of oculoplastic practice. What are some of the most important safety and training considerations for those looking to incorporate these devices into their practice?

Chelnis: One thing that cannot be overlooked when it comes to safety is having staff who are knowledgeable and well prepared. Everyone in our office completes laser safety courses, and several team members hold life support certifications. We maintain strong internal resources, and we routinely review laser and other energy-based treatments throughout the year. It’s important to set the stage that each treatment needs to be addressed in the most serious manner possible, especially when dealing with aesthetic concerns, where there is very little room for error.

That said, ophthalmic training does prepare us to excel in providing aesthetic treatments to our patients. Essentially all ophthalmic subspecialties develop skills working within narrow anatomic windows, requiring a high level of dexterity to achieve results for our patients. The typical ophthalmic exam involves biomicroscopy, using a scale smaller than those used in nearly all other medical disciplines.

When considering expanding a practice with new therapies, it’s important to ask colleagues about their experiences and apply those insights to one’s own patient population. It’s also essential to consider co-morbidities, skin types, age, and much more. For those new to these types of treatments, I recommend looking at non-ablative technologies first, and considering device companies for their reputation, their dedication to research and development, and history of producing mature devices that may have gone through multiple iterations. No one rule applies to every scenario, but these are some of the key factors everyone should take into account.

OT: Looking ahead, how do you see the role of energy-based technologies evolving in aesthetic facial surgery, and what innovations are you most excited about in the coming years?

Chelnis: Patients are more sophisticated and aware of available treatments than ever before. Many are seeking treatments earlier in life to prevent unwanted changes and to avoid surgery with more advanced, noninvasive options. Patients also increasingly expect minimized downtime and treatments that don’t interfere with their daily lives. This means we have to keep pushing the boundaries of what’s possible to meet patient demand.

I believe that compound treatments—such as minimally invasive surgery coupled with lasers that can reach deeper than ever before and biostimulants that can regenerate tissue—will win out over older mono-modal techniques. For example, when treating the ocular surface, we use IPL coupled with topical RF and/or dynamic muscle stimulation. We know this yields better results with less maintenance required once the patient has finished their treatment course.

This progress still amazes me, as we used to believe there was no way to regenerate meibomian glands at all, which we now know to be patently false. With aesthetic skin treatments, we are pushing the boundaries, especially for patients of color. We can now safely ablate darkly pigmented skin in ways I never would have dreamed to dare when I first completed my fellowship. I often think back to my time as a medical student, when one of my professors told us that half of what he was teaching us was incorrect—he just didn’t know which half. Medicine is advancing increasingly quickly, and it’s an exciting time to be a doctor in that sense. I’m really excited for the tools we will have at our disposal next.