Latisse is an FDA-approved treatment to grow eyelashes for people with inadequate or not enough lashes. Latisse is clinically-proven to make eyelashes longer, thicker, and darker. The active ingredient in Latisse is bimatoprost ophthalmic solution 0.03%.

Latisse should be used at night. If you wear contacts, please remove them before applying Latisse and leave them out for 15 minutes after applying Latisse. After washing your face and removing make-up, apply one drop of Latisse to an applicator. Brush the applicator along the skin of the upper eyelid, where the skin meets the eyelashes. Blot away any excess liquid to avoid liquid running onto your cheek. Use one applicator for each eye and throw away after use. Only apply at the base of the upper lashes. DO NOT APPLY directly into the eye or to the lower eyelid. If you miss a dose, do not try to “catch up.” Just apply Latisse the next night. Using Latisse more than once a day does not increase eyelash length or decrease time to seeing results.

If Latisse solution gets into the eye, it is not expected to cause medical harm. Do not rinse the eye if Latisse gets into the eye.

Avoid contamination of the Latisse bottle by using one applicator per eye and avoiding contact of the tip of the bottle with fingers or other surfaces or surroundings.

Please log in to your secure Ro account and message your provider. Your provider should be your first point of contact regarding questions about medication efficacy, side effects, and whether or not you would benefit from a change in dose or even a change in medication.

Do not use Latisse if you are allergic to Latisse or one of its ingredients. Do not use Latisse if you use or have used prescription medication for eye pressure problems. Do not use Latisse if you are under 18 years old or if you are pregnant, trying to become pregnant, or breastfeeding.

Common side effects include itchy and red eyes. Hair may grow outside the treatment area, especially if the medication is applied directly to the eye or to the lower eyelid. Latisse may cause brown darkening of the colored part of your eye (the iris) which is likely permanent and occurred in less than 4% of patients in the Latisse clinical trial. Latisse may also cause eyelid skin darkening which may be reversible. If Latisse is discontinued, lashes gradually return to their previous appearance.

If you: – Experience a new eye condition (trauma or infection or injury) – Experience a sudden change/decrease in vision – Have eye surgery – Develop any eye reactions, especially eye redness and eyelid reactions – Develop any new symptom while on Latisse – Start a medication to lower the pressure in your eye. Patients on eye pressure-lowering medications should not use Latisse without prior consultation with their eye physician.

Welcome. The story of Latisse is an interesting one. In 2001, Allergan developed a medicated eye drop, called bimatoprost, to treat glaucoma. Many of the patients noticed their eyelashes grew longer, fuller, and darker while on the medication. This unintended side effect prompted Allergan to study bimatoprost for use in eyelash hypotrichosis. Hypotrichosis is the medical term for an inadequate amount of hair. The studies established the safety and effectiveness of Latisse—resulting in the only FDA-approved solution for eyelash hypotrichosis.

The reasons people use Latisse vary. Some women experience changes in their hair due to perimenopause and menopause. Some men and women want to enhance the length, thickness, and darkness of their lashes even if they have not experienced any changes. Whichever reason brought you to Ro, we are pleased you have chosen us to provide some of the educational material you need to make an informed decision and to provide the treatment your provider has prescribed.

Medication works for most patients and often without side effects. However, no medication is a magic bullet. And, just as no drug works on everyone, no drug is without potentially serious side effects. It is important that you learn all that you can about your treatment by reading this treatment plan. The more you read, the better the plan can work and the quicker you can recognize any side effects.

Telemedicine has the advantage of convenience, but it relies on your honesty and involvement in the process. That includes reading everything below carefully, reading the package insert when it arrives in print with your medication, and communicating with your provider. If your health should change, should you have a side effect, should the medicine not work or stop working over time, should you be prescribed ANY new medication or change your medication regimen, or should you visit another healthcare provider for any reason, please contact us. Keep EVERY healthcare provider informed.

First, read this treatment plan, which is followed by information about eyelash hypotrichosis. Lastly, read the detailed information about the medication prescribed by your provider. We recommend you read it all, and read the package insert and the official Prescribers’ Digital Reference (PDR).

Your provider has reviewed your medical information and has prescribed Latisse (bimatoprost ophthalmic solution 0.03%) to treat eyelash hypotrichosis. This medication helps patients grow thicker, fuller, and darker eyelashes. The medication your provider has prescribed should only be used as directed.

With regular applications along the lash line of the upper eyelid, Latisse gradually encourages the growth of longer, thicker, and darker eyelashes. Latisse should never be applied to the lower eyelid or directly to the eyeball. For full results, you should use the medication daily for at least two months. Eyelash improvements remain as long as you continue to use the medication. When you stop using Latisse, your eyelashes will gradually return to their original appearance.

We want you to be aware that Latisse can cause side effects and you should familiarize yourself with the list included in the section that discusses side effects. Most people use Latisse without difficulty, but familiarity with the possible side effects will help you identify if you are one of the people who experience them.

Let’s begin. Read everything below and keep all of the literature handy in case your medical status changes and you need to refer back to it.

Latisse should be applied at night. Before applying Latisse each night, make sure you have removed all makeup, that your face is clean, and that you have removed contact lenses if you wear them. Any facial care products such as moisturizers and serums should be applied before applying Latisse.

Your Latisse comes in a 3 ml bottle and with 70 applicators that are used to apply the medicated drops to your upper eyelid lashes. Remove one applicator from its tray. While holding the applicator horizontally, squeeze one drop of Latisse on the applicator near the tip. Immediately, but no more rapidly than can be done carefully, rub the applicator along the skin of the upper eyelid where the skin meets the lashes (i.e. the lid margin). Start at the inner part of your lash line and move towards the outer part of the lash line. NEVER APPLY Latisse directly into your eye or rub the applicator along the lower eyelid.

If you apply Latisse directly into your eye, you may experience decreased eye pressure, as well as a color change of your iris where your eyes may become brown from increased melanin production in the iris. This means that blue, green, hazel, grey and light brown eyes may turn brown. If you apply Latisse directly into your eye or along the lower eyelid, you may experience excess, unwanted hair growth along the inner corner of the eye or even on the part of your cheek closest to your eyes.

After you apply the Latisse to your upper eyelid, the base of the eyelashes will feel moist. Blot any excess solution that is not on the upper eyelid-eyelash border with a clean tissue. Throw away the applicator after one use. Repeat for the opposite eyelid, using a new sterile applicator. It is recommended that you use one applicator per eyelid.

Remember:

Do not apply Latisse to the lower eyelid or allow any Latisse to enter the eye. Blot excess solution with a tissue. Applying Latisse to the lower eyelid or in the eye increases the risk of: – Turning your eye color brown – Decreasing eye pressure – Unwanted hair growth at the inner corner of the eye and along the cheek

Only use the sterile applicators supplied with Latisse to apply the solution to your UPPER eyelid lash line.

Do not allow the tip of the bottle or applicator tip to touch your fingers or any other surfaces. This will decrease the risk of contamination with bacteria that could cause eye infections.

Remove your contact lenses before applying Latisse. Contact lenses can be replaced 15 minutes after applying Latisse.

If you stop using Latisse, your lashes will gradually return to their pre-treatment length and thickness.

The bottle of Latisse should be stored at 36˚F to 77˚F (2˚C to 25˚C). You can easily store the medication bottle in your medicine cabinet and the applicators, in their box, in a clean bathroom drawer. The medication must be stored away from children. The applicators, while in their plastic wrap, are sterile.

Eyelashes will not grow overnight. It will take 16 weeks or four months to see the full effect of Latisse. Most patients report an increase in eyelash length at four weeks. Increased darkness and fullness are typically seen at week eight. Continuing with the treatment past week eight usually results in larger, fuller, thicker, and darker eyelashes.

The active ingredient in Latisse is bimatoprost. Bimatoprost is a structural prostaglandin analog. Prostaglandins are naturally occurring chemicals that function as local messengers. They are not hormones like estrogen or progesterone but work locally to pass messages between cells and organs. It is not widely understood why bimatoprost results in longer, fuller, and darker eyelashes. One hypothesis is that the prostaglandin effect increases the growth phase of the hair cycle.

Like all hair on the body, our eyelashes follow a specific growth cycle before they are shed. The first phase is called anagen. In anagen, the hair is rooted in the follicle and receives nutrients to promote growth. The next phase is called catagen. In the catagen phase, the hair stops growing and the follicle begins to collapse, which leads to the telogen phase. The telogen phase is a resting stage and lasts 30–90 days. At the conclusion of the telogen phase, the hair is detached from the follicle and sheds. If every hair went through all the stages at the same time, we would have periods with full eyelashes and periods with none. Hairs go through the stages at different times so this does not happen. The average person loses 3–5 eyelashes per day by staggering the stages of the cycles.

It is thought that bimatoprost, the active ingredient in Latisse, increases the time that the eyelashes spend in the anagen or growth phase.

Allergan studied Latisse looking at its effect on overall eyelash enhancement in a clinical trial of 278 patients for four months of treatment. Several doctors from several hospitals enrolled patients and neither the doctor nor the patient knew who was using Latisse or a placebo solution. The patients were monitored for four months.

The doctors looked for an overall improvement in the eyelashes as measured by the Global Eyelash Assessment tool. They compared eyelash prominence at baseline to prominence at the end of four months.

What they found is that eyelash prominence was more effective in the patients prescribed Latisse at the 8-week, 12-week, and 16-week time points. At 16 weeks or four months, 78% of patients treated with Latisse had improvement in their eyelashes compared to 18% in the inactive solution group.

The doctors also analyzed the photos of the patient to assess improvement in eyelash length, fullness/thickness, and darkness. The improvement was statistically significant across all parameters at all time points (week 8, week 12, and week 16).

At week 16 (four months), patients who used Latisse had an average of 1.4 mm growth of their eyelashes, which was a 25% increase in length, compared to a 0.1 mm increase or 2% increase in length for patients who were treated with the placebo solution.

For fullness and thickness, the Latisse patients had a 106% increase compared to a 12% increase for the patients treated with the placebo solution. The intensity of eyelash darkness increased by 18% in the Latisse-treated patients versus 3% in the placebo solution patients.

During Allergan’s clinical trial, there were cases of light-colored eyes (blue, green, hazel) having increased pigmentation and causing the eyes to have new brown pigmentation or completely turning brown. The hyperpigmentation, or darkening of the iris, is likely not reversible even after the medication is stopped. In order to reduce the likelihood of hyperpigmentation, please use Latisse as directed. It should not be applied directly to the eye, nor should it be applied to the lower eyelid. The incidence of increased brown pigmentation was less than 4% in the clinical trials. Postmarketing reports (i.e. reports from patients who have used the medication after FDA approval) from Allergan do not list iris hyperpigmentation as a side effect that has been identified or voluntarily reported. The color change is due to increased melanin in the normal melanocytes of the iris and is not due to an increased number of melanocytes. Melanocytes are the cells that make melanin and melanin is the pigment that gives skin its color and allows people to tan.

The long term effects of the increased darkening of the iris are unknown. Iris color changes associated with bimatoprost (the active ingredient in Latisse) may not be noticeable for several months to years.

Usually, the brown pigmentation around the pupil spreads from the pupil outwards towards the edges of the iris and the entire iris or parts of the iris become more brownish. Freckles of the iris do not appear to be affected by Latisse. Latisse can be continued in patients who develop iris darkening or increased pigmentation but if you continue to use the medication the darkening or browning of the iris may continue and may become worse.

In patients who use bimatoprost (the active ingredient in Latisse) for glaucoma, the incidence of brown pigmentation of the iris occurs in 1–2% of glaucoma patients. Glaucoma patients instill the medication by squeezing the bottle and applying the medication DIRECTLY into their eyes. When Latisse is properly applied to the lash line with the applicator, only approximately 5% of the medication makes its way into your eye and onto your cornea and iris, making the risk of darkening of your iris (colored part of your eye) very low—especially when used as directed (i.e. with the applicator and NOT directly into the eye).

Bimatoprost (the active ingredient in Latisse) has been reported to cause darkening of the skin and eyelashes. The darkening increases as long as the bimatoprost is used but has been reported to be reversible (not permanent) once the medication is stopped. If you notice darkening of the skin of your eyelids and wish to reverse it, please stop Latisse. The only way to reverse the darkening of the skin is to stop the medication.

There is a potential for hair growth if Latisse contacts the skin repeatedly. The most common areas affected are the cheeks. Excess solution that runs off the eyelid can cause the typical fine hairs on the cheek to grow.

It is important to apply Latisse only to the upper eyelid lash line, at the base of the eyelashes, and to use the sterile applicators that come with the solution. Be careful to blot any excess Latisse from the eyelid margin to avoid it running onto the cheek or other areas.

Macular edema (including cystoid macular edema) has been reported during the treatment of patients with glaucoma with Lumigan (which has the same active ingredient as Latisse). Latisse should be used with caution in patients who have had eye surgery on their lens or in patients with a torn posterior lens capsule. Providers on the Ro platform do not prescribe Latisse, via telemedicine, to a patient who has had trauma to their lens or surgery on the lens.

Headache, nausea, tearing, eye itchiness, eye irritation, dry eye, eye pain, eyelid inflammation, red eye, blurry vision, eye bleeding, macular edema, difficulty seeing, and eye inflammation.

See the PDR for a comprehensive list.

If you: – Experience a new eye condition (trauma or infection or injury) – Experience a sudden change/decrease in vision – Have eye surgery – Develop any eye reactions, especially eye redness and eyelid reactions – Develop any new symptoms while on Latisse – Patients on eye pressure-lowering medications should not use Latisse without prior consultation with their eye physician.

Who can use Latisse and for what conditions?

The active ingredient in Latisse is called bimatoprost. The same active ingredient can be found in the FDA-approved glaucoma medication Lumigan. This treatment plan discusses Latisse only.

Latisse is FDA-approved for the treatment of hypotrichosis (inadequate amount) of the eyelashes in adults. It is also approved for use in children ages 5–17 who are post-chemotherapy or have alopecia areata (a type of baldness)—as well as in teens ages 15–17 with decreased eyelashes not caused by a medical condition. Providers on the Ro platform do not treat patients under 18 via telemedicine.

Who cannot use Latisse?

Latisse should not be used in patients with a hypersensitivity or allergy to bimatoprost or any of the inactive ingredients in Latisse.

The safety and efficacy of Latisse have not been established in children under age five or in infants or neonates. People who are allergic or have a hypersensitivity to bimatoprost should not take or use Latisse. Patients with closed-angle, inflammatory, or neovascular glaucoma should not use Latisse or its active ingredient, bimatoprost.

There are no adequate or well-controlled studies examining the effects of bimatoprost ophthalmic solution in pregnant women. However, there is no increase in the risk of major birth defects or miscarriages based on information collected after Latisse was FDA-approved. According to the manufacturer, Latisse should only be used during pregnancy or in those trying to become pregnant when the benefit outweighs the potential risk to the fetus. It is our policy at Ro not to prescribe Latisse to a woman who is pregnant, possibly pregnant, or trying to become pregnant.

It is not known whether bimatoprost is excreted in breast milk. According to the manufacturer, care and caution should be exercised if a breastfeeding woman would like to use bimatoprost. Prescribing provider should consider the benefits of breastfeeding, the potential risk to the infant of drug exposure, and the risk of an untreated or inadequately treated condition. It is our policy at Ro, that Latisse should not be prescribed to a woman who is pregnant, possibly pregnant, trying to become pregnant, or breastfeeding because there is no data to show that it is safe to the fetus or the breastfeeding infant.

Latisse should be used with caution in patients with active, intraocular inflammation (e.g. iritis and uveitis). Medications similar to bimatoprost (the active ingredient in Latisse) have caused increased inflammation in the eye. Using the medication in patients with active inflammation may worsen the condition. Latisse should be used within caution in patients with damage to the eye’s surface, such as a corneal abrasion. Patients with a history of surgery or trauma to the lens of the eye, which are known risks for macular edema, should use Latisse with caution. Providers on the Ro platform do not prescribe Latisse to patients with the above conditions.

Following the FDA’s approval of Latisse, additional reactions have been reported to the FDA: dry, upper eyelid skin, dry skin around the eyelids, eye swelling, eyelid swelling, local allergic reactions, increased tear production, photophobia, temporary loss of a few lashes to loss of sections of eyelashes and temporary eyelash breakage, periorbital and lid changes associated with deepening of the eyelid sulcus, rash, skin discoloration around the eye, and blurry vision.

Please be careful not to contaminate the Latisse bottle. There have been reports of bacterial infections of the eye associated with the use of multiple-dose bottles, such as the one that Latisse comes in.

Please be sure to use the applicators as directed to decrease this risk. Also, contamination of the Latisse bottle may increase the risk of infection in patients who have just had eye surgery, in patients who have an infection, or in patients who have experienced recent eye trauma.

Latisse should be used with caution in patients with lens injury or surgery as well as patients with macular, including cystoid, edema.

As mentioned above, contact lenses should be removed before applying the solution with an applicator. The contact lens can be reapplied 15 minutes after the drops have been placed.

Patients who have had corrective vision surgery, such as LASIK, should wait at least six months after surgery before starting Latisse.

The PDR does not list any drug interactions associated with bimatoprost.

The following is a warning about drug class duplication. Patients who are already on a prostaglandin analog to treat glaucoma should not use Latisse. Examples of other prostaglandin drops are Xalatan, Lumigan, Travatan Z, Zioptan, and Vyzulta.

Caution should also be taken in patients who are on an eye drop medication that is not a prostaglandin but is used to treat glaucoma. Examples are Alphagan, Iopidine, timolol, betoptic, Betagan, OptiPranolol, Istalol, Timoptic, Betimol, Azopt, Neptazane, Trusopt, Diamox Sequels, Isopto Carpine, Isopto Carbachol, pilopine, pilocarpine, Rhopressa, Combigan, Cosopt, and Simbrinza.

There can be mild lowering of eye pressure while on Latisse if taken while on any of the above medications. If you start any medication used to lower eye pressure, please let your provider know as Latisse may not be suitable for you.

Drug interactions with bimatoprost are exceedingly uncommon. Still, interactions that have yet to be identified are possible. Therefore, if you encounter a medical emergency please call 9-1-1 and for less urgent issues please contact your Ro provider or your primary care physician.

Hypotrichosis is defined as an inadequate or decreased number of eyelashes. The majority of the patients who use Latisse do not lack eyelashes or have a decrease in eyelashes. They use the medication for eyelash enhancement. There are medical reasons eyelash length or number can change. Some of these conditions will be addressed below.

Non-prescription options for eyelash enhancement include but are not limited to the following: mascara, eyelash extension, and eyelash tinting. Eyelash serums marketed to enhance eyelash length or appearance have varying degrees of success. At this time, Latisse is the only FDA-approved prescription medication that has demonstrated an increase in the growth of eyelashes, including length, thickness, and darkness.

Eyelashes serve a protective function and are generated and maintained through the continuous cycling of hair follicles. Hair has a life cycle that consists of phases. Thankfully, not all of our hairs are in the same phase at any given time, or else we would have periods of full eyelashes or full heads of hair and then periods without eyelashes or hair on our heads. The number of eyelash follicles does not increase after birth; we are born with all of the follicles we will ever have.

Below is a chart of medical causes of loss of eyelashes categorized by cause. Some of the more common causes are alopecia areata, or a widespread loss of hair, infection (e.g. leprosy, syphilis, HIV), endocrine diseases such as hypothyroidism, certain medications (e.g. chemotherapeutic drugs), radiation or trauma, loss of eyelid including the eyelash or self-inflicted picking of eyelashes, or autoimmune disorders (e.g. lupus and scleroderma).

Kumar and Karthikeyan. Madarosis: A Marker of Many Maladies. Int J Trichology. 2012 Jan-Mar; 4(1): 3-18

The 3 phases of hair growth

– Anagen: This is when hair grows. The root divides rapidly, as rapidly as any cells in the body, and a hair will stay in this phase of growth for 1–2 months. One person’s growth phase might last two months and grow long eyelashes; another person’s growth phase might last for less than a month; they will have a shorter maximum length. Most hairs (approximately 85%) are in this phase at any one time. – Catagen: This phase is very short (15 days) and it is here that hair stops growing. The outer sheath of hair attaches to the root of the hair and begins to weaken at its base. About 5% of hairs are in this intermediate phase. – Telogen: This phase lasts for 4–9 months and the hair cells are completely at rest. Approximately 10% of hairs are in this phase. Hairs called “club hairs” are now ready to be shed at a rate of about 3–5 per day. This is normal.

Again, the vast majority of Latisse users have normal eyelash hair growth and cycle. Latisse enhances the length, thickness, and darkness of their normal eyelashes. For patients with alopecia areata, an autoimmune disorder, Latisse has not been proved to be as effective in eyelash enhancement but there can be some improvement. Patients with chemotherapy and radiation-induced eyelash loss do not respond with eyelash enhancement when using Latisse.

During your online visit, a series of questions about eye health and hair health were asked. If you have any changes to your eye health such as LASIK surgery or cataract surgery, your Ro provider and your primary healthcare provider should know.

If you are noticing a loss of eyelash hair and eyebrow or scalp or body hair, your provider should know because you could have a medical cause for the loss of eyelashes.

The most common side effects associated with Latisse are itchy eyelashes and eyelids after application, eyelid dry skin, temporary eyelid redness, and darkening of the upper eyelid along the lash line. Cases of iris darkening (brown pigment to blue or hazel or green eyes) are uncommon. However, if this occurs, it is likely a permanent change in eye color. If you are experiencing any side effects, please inform all your healthcare providers.

Overall, Latisse is a well-tolerated medication that is proven effective to enhance the length, darkness, and thickness of eyelashes. The treatment effect is only sustained through the consistent use of Latisse. Be sure to take photos of your eyelashes before you start treatment, and again monthly throughout your treatment to track your progress.

If you experience any unusual side effects, contact your Ro provider or your primary care provider. If you are having a medical emergency, call 9-1-1 or go immediately to your local emergency room. Any new symptom should be discussed with your provider. Any severe symptom should be treated as an emergency. Contact your provider after it is addressed. Again, take the time to read the list of potential side effects.

If you have any questions about this information or any other concerns, we’re here for you. Please contact your provider to discuss any questions or concerns.