Dark Circles Research Articles

Cell-Free Fat Extract with Anti-melanogenic Property Improves the Appearance of Infraorbital Dark Circles: A Preliminary Clinical Study.

The formation of infraorbital dark circles involves various factors including hyperpigmentation, skin aging and laxity. This study is to investigate whether cell-free fat extract (CEFFE) inhibits melanin synthesis and improves the appearance of infraorbital dark circles. Imaging systems analysed the melanin content in three groups of zebrafish embryos treated with 0 (CTRL), 100, and 200μg/mL of CEFFE. Eleven patients with infraorbital dark circles were enrolled and received intradermal injections of autologous CEFFE. Clinical trial assessments included subjective assessments (Global Aesthetic Improvement Scale and Likert satisfaction scale) and objective assessments (standard two-dimensional photographs, VISIA® photographs, and infraorbital skin colour measurement). In the experiment of zebrafish embryos, the melanin content of CEFFE treatment was significantly reduced. In clinical trial, 72.73% of patients considered CEFFE treatment for infraorbital dark circles to be effective, and more than half of the patients were satisfied with the treatment. In the evaluation of skin colour at the inner, middle, and outer edges of the infraorbital dark circles, there was a gradual improvement in infraorbital skin colour after each treatment and at the 3-month follow-up, with a statistically significant improvement in skin colour on the outer edge of the infraorbital dark circles (p < 0.05). Simultaneously, we observed a reduction in periocular wrinkles, with a significant difference at the 3-month follow-up (p < 0.05). The events observed included bruising, erythema, and oedema, which resolved spontaneously. Our study demonstrated that CEFFE inhibits melanogenesis and is a safe and effective treatment for infraorbital dark circles. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

TRATAMENTO DE GORDURA INFRAORBITAL COM ULTRASSOM MICROFOCADO

Aging is a physiological process determined by various intrinsic and extrinsic factors, being a normal and inevitable process. The periorbital region is one of the first to show signs. This aging in the periorbital region is manifested by several anatomical changes that result in dark circles, wrinkles and sagging skin. These changes are influenced by factors such as the loss of adipose tissue volume and reduced collagen production, in addition to the projection of orbital fat and reduced skin elasticity. Given the significant aesthetic impact of these changes, effective treatment of dark circles has become a priority in aesthetic procedures. This study aimed to present and describe a treatment technique and its results in infraorbital pockets, using the non-invasive method of microfocused ultrasound. Through a case report involving a 50-year-old male patient with complaints of persistent dark circles, a treatment protocol was carried out with microfocused ultrasound using 60 shots per infraorbital region in two sessions, with an interval of 3 months. The evaluation of the results included photographic documentation and facial scanning, which showed a significant improvement in skin firmness and a reduction in infraorbital bags. The work concludes that microfocused ultrasound proved to be effective in treating localized fat and repositioning tissues in the dark circles region, promoting facial rejuvenation and representing a less invasive alternative to blepharoplasty. Results may vary depending on age, skin condition and technique used, in which case additional sessions may be necessary.

Correction of Infraorbital Dark Circles Using Autologous Adipose-Derived Collagen Filler: A Novel Regenerative Option.

Numerous intrinsic and extrinsic factors, notably the aging process, contribute to the development of infraorbital dark circles. These features, commonly associated with old age and fatigue, are caused by a disruption of dermal melanin and impairment of skin barrier function. Common aesthetic concerns affecting patients with infraorbital dark circles are primarily owing to lean and translucent lower eyelid skin overlying the orbicularis oculi muscle. This study aimed to present a novel technique for correcting infraorbital dark circles utilizing an adipose-derived extracellular matrix concentrate-adipose collagen fragment (ACF)-to correct infraorbital dark circles. Female patients (n = 94) aged 20-38 who presented infraorbital dark circles were enrolled to assess the efficacy of this technique for an eight-month follow-up. Following intradermal injections with ACF filler, the clinical outcome was determined by responses to GAIS and patient satisfaction surveys. Statistical analysis was performed with the one-way ANOVA test, and a p value of < 0.05 was considered statistically significant. Patients (n = 92) completed a single treatment session and underwent an eight-month follow-up. Eighty patients (86%) reported being "highly satisfied" or "satisfied" with the outcome and responded that the technique resulted in brighter, tighter, and smoother infraorbital skin. Over 97% of patients were rated as "improved," "much improved" and "Very much improved" throughout the follow-up on GAIS by three independent surgeons (p < 0.05). The statistical analyses demonstrated the percentage differences among groups are highly significant (p < 0.0001). No irregularity or lump was observed during the follow-up. Two patients were excluded from the study due to having undergone cosmetic eyelid surgery. Intradermal ACF filler represents a novel approach to addressing infraorbital dark circles and yields significantly high patient satisfaction. ACF fillers provide a degree of bio-stimulation, and adipose-derived concentrate is a natural filler with regenerative effects used in periorbital rejuvenation. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Prospective study of using 1064-nm Q-switched Nd: YAG combined with radiofrequency-imported vitamin C on pigmented infraorbital dark circles

Infraorbital dark circles are a common manifestation of periorbital melanosis, which is aesthetically defective and bring a negative impact on life quality. However, there is no acknowledged treatment for infraorbital dark circles. The 1064-nm Q-switched Nd: YAG laser (QSNYL) is commonly utilized to treat hyperpigmentation disorders. Radiofrequency (RF) therapy can improve the transdermal absorption rate of drugs. A prospective clinical trial was conducted to investigate the clinical efficacy and safety of 1064-nm QSNYL combined with RF-imported vitamin C for the treatment of infraorbital dark circles. A questionnaire was used to explore the relevant factors affecting the severity of infraorbital dark circles. A total of 30 patients with pigmented infraorbital dark circles were enrolled in this clinical trial. Each participant received 4 treatments and was followed up for at least 12 months after the last treatment.We focused on the overall change in the appearance of the included participants before and after treatment, by using satisfaction evaluation.In order to reduce evaluation bias, the vivo reflectance confocal microscopy images were taken on days 1 and 120 to detect pigmentation. The questionnaire survey before treatment showed that high-frequency makeup was positively and statistically significant with the severity of infraorbital dark circles (p < 0.01). Both participants and independent evaluators found that the hyperpigmentation in the infraorbital region was significantly reduced after combined treatment with high treatment satisfaction. The density of melanin particles in the infraorbital dark circles region showed a decreased trend. No significant side effects were observed. The 1064-nm QSNYL combined with RF-imported vitamin C is a safe and effective treatment for pigmented infraorbital dark circles by reducing melanin particles.

Assessment of Pain and Satisfaction After Orofacial Harmonization Procedures.

This long-term study assessed satisfaction and pain levels following facial aesthetic procedures. The study also aimed to correlate expectations, and psychological and social well-being immediately and after one month, describe perceived age, and assess differences in satisfaction between injectable fillers and other Orofacial Harmonization procedures such as hyaluronic acid treatments (for dark circles, nasolabial fold lips, malar, jaw), botulinum toxin injections, enzymatic lipolysis of the double chin, micro-needling, and PDO threads. Data were collected immediately after the procedures and then again 30days later. Among the participants, 159 (92.4%) were females and 13 (7.6%) were males, who completed FACE-Q questionnaires addressing perceived age, expectations, psychological and social well-being, satisfaction, and facial appearance, as well as the visual pain scale. The average age of the patients treated in the Dental Clinics in Brazil was 40.4years (SD± 12.7), with 48.8% of participants perceiving themselves as older immediately after the procedures, decreasing to 47.7% after 30days, and pain intensity was reported as low. The total number of Orofacial Harmonization procedures performed was 256. Satisfaction after 30days was high, especially among those who received fillers. The psychological and social function scales were positively correlated with satisfaction with the decision, result, and appearance scales. Fillers showed a significant improvement in perceived age appearance, with half of the patients feeling younger after 30days. The patients exhibited high satisfaction levels in one-month post-aesthetic orofacial harmonization procedures. Despite initially high expectations, patients reported enhanced psychological and social well-being, along with minimal pain during interventions CONCLUSION: Positive correlations were observed between satisfaction, decision-making, result perception, and appearance. Injectable fillers notably improved perceived aging, with a significant portion of patients initially perceiving themselves as older than their actual age, but later feeling younger post-procedure. Fillers also yielded superior satisfaction and pain relief compared to alternative interventions. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Investigation of water variation and surface crust of Polygonati Rhizoma extract during vacuum drying

In order to better understand the drying process, the water variation and surface crust of Polygonati Rhizoma extract during drying were investigated. Water variation investigation showed that the total water content decreased gradually over drying time, mainly attributed to the removal of most of the immobile and all of the free water; As drying progressed, the mobility of immobile water and free water increased, while the bound water increased; water in different status underwent mutual transformation. Surface crust investigation showed that the extract surface gradually shrunk and became roughness during drying; crust with a dark color circle appeared on the extract surface, and some cracks connected between pores were found; as drying progressed, the porosity, total pore number and pore volume increased, the number of pores for all volume distributions below 1 mm3, 1–2 mm3 and over 2 mm3 initially increased and then decreased.

Outstanding user reported satisfaction for light emitting diodes under-eye rejuvenation.

The under-eye region is an area of significant cosmetic concern. Photobiomodulation (PBM) has emerged as an effective, safe, inexpensive, and convenient treatment for skin rejuvenation. Herein, we aim to evaluate the safety and efficacy of a LED under-eye device for under-eye rejuvenation, as measured by objective and patient reported outcomes. Eleven participants self-administered treatment using a commercially available LED device emitting red (633nm) and near infrared (830nm) light for six weeks. Standardized photographs and questionnaires were administered at baseline and six weeks. Photographic digital analysis indicated an improvement in under-eye wrinkles at six weeks compared to baseline, with a reduction in wrinkle score from 20.05 to 19.72. However, this finding was not statistically significant. Participants self-reported consistent improvements in under-eye wrinkles, texture, dark circles, bags, pigmentation, and erythema. All participants reported a high degree of comfortability, ease of use, and satisfaction with the eye device. The participants noted no moderate or severe adverse events and few reports of transient expected outcomes such as mild erythema. The participants' self-reported improvementsand high user satisfaction, and the device'sfavorable safety profile, highlights the benefits of at-home LED devices for under-eye rejuvenation. Future randomized controlled trials with larger sample sizes could further establish the safety and efficacy of at-home LED under-eye treatments.

In vitro, exvivo, instrumental and clinical evaluation of atopical cream on the signs of periorbital ageing.

Periorbital skin ageing signs are multidimensional, highly visible and a concern for many. We evaluated the potential efficacy of an eye cream to diminish these signs. Biological markers associated with ageing, barrier function and homeostasis were analysed invitro to determine the effects of topically applied eye cream, compared to those of a placebo using human skin tissue models and/or explants. Collagen IV, elastin and bone morphogenic protein 4 (BMP4) expression was investigated by immunohistochemical labelling, while filaggrin, kallikrein 7 (KLK7) and HB-EGF were evaluated by RT-qPCR. IL-1α and melanin levels in darkly pigmented skin models were also quantified. The protective effect of the cream on glycation was assessed by a non-enzymatic assay. Finally, the benefits of twice-daily applications of the eye cream for 56 days were instrumentally and clinically evaluated on 33 women. Only the eye cream, not the placebo, stimulated collagen IV and BMP4 protein expression, as well as increased elastin fibre length. It also led to higher HB-EGF, filaggrin and KLK7 mRNA levels. The placebo and the eye cream did not induce changes in IL-1α and melanin levels, but both reduced non-enzymatic glycation. When assessing the invivo effects of the cream, short-term results indicated skin hydration, transepidermal water loss (TEWL) and skin profilometry improvement within 15 min. Instrumental evaluations of wrinkles showed a reduction after 7 days, which was clinically perceivable after 28 or 56 days. The eye-opening angle and eyelid sagging also improved after seven and 28 days, respectively. Finally, dark circles became lighter within 7 days (instrumental measurement) or 28 days (clinical assessment). The instrumental and clinical evaluations revealed that the eye cream reduced all periorbital ageing signs evaluated. Its effects are supported by the invitro and exvivo analyses of molecular markers.

Design and Evaluation of Natural Face Pack

The majority of cosmetic products on market are synthetic in nature and have a variety of negative side effects when used is an extended length of time. Use of herbal cosmetics is one remedy for this issue. Herbal cosmetics are thought to be generally safe with little adverse effects. Some of main skin problems are acne, redness, wrinkles, dark circles, pimples, dry skin, dead skin. By utilising herbal cosmetics such as face packs, scrubs, creams, etc., all these issues can be reduced. The objective of this work is to Formulation and Evaluation of herbal face pack by using natural ingredients for by using natural substances, radiant skin. Four differ-rent formulations with varying conc. of ingredients like multani-mitti, turmeric, aloe vera, sandal wood, orange peel, neem , nutmeg and rose petals powder are evaluated for their organoleptic properties, stability, physico-chemical parameters, irritancy test and microbial load.

Evaluation of the effectiveness of picosecond KTP and fractional thulium lasers on pigmented-type periorbital dark circles.

To determine the effectiveness of picosecond KTP in reducing peri-ocular dark circles caused mainly by excessive pigmentation and to compare Picosecond KTP with Thulium laser ability in reducing the intensity and extent of peri-ocular dark circles. This split-face prospective study included twelve women with periorbital dark circles (pigmented or mixed-pigmented type). The left lower eyelid was treated using the PicoHi machine (HIRONIC Ltd), a full beam Q-switched Nd-YAG provided by KTP crystal (523nm) at settings of 0.3J/cm2, 5mm, 5Hz, and 300 Ps. Whereas the right lower eyelid was treated using the Lavieen machine (WON TECH Co., Ltd), a fractional Thulium laser (1927nm) at setting 1320mJ/cm2, 30 × 15mm, 1500 microseconds. Patients received a series of 3 treatment sessions, given at 4-week intervals. The 532-nm full beam Q-switched KTP and fractional Thulium lasers were more likely to induce post-inflammatory hyperpigmentation rather than decrease the pigmentation. The risk is higher with a Q-switched KTP laser, which may be attributed to the skin tone of the participants. Nonetheless, some improvement in the pigmented type of PDCs, although not detected clinically, was documented by the VISIA software. No solid conclusion can be drawn from the results of the study. Picosecond KTP and Thulium lasers may have a role in reducing PDCs yet more studies should be performed in order to determine the exact impact these lasers have.

Evaluation of the effects of carboxytherapy in the treatment of periorbital dark circles.

Dark eye circle (DEC) is one of the most common cosmetic problems. It has a great impact on the patients' quality of life. Carboxytherapy is a cosmetic technique using pure carbon dioxide for different uses in different areas of the body. The goal of this study is to evaluate the efficacy and tolerability of carboxytherapy in the cosmetic correction of DECs. This study was conducted on 27 patients requesting the correction of DEC. The treatment was performed using a carboxy device in medical grade. The gas injection was performed intradermal after local anesthesia, with a pressure of one tenth bar and a speed of 20 cc/min, 1 cc in each upper and lower eyelid. The treatment sessions were done every 2 weeks for four sessions. The mean physicians' score of DECs before and after treatment was 8.7 ± 0.81 and 4.6 ± 1.1, respectively. The mean patients' score before and after treatment was 9.2 ± 0.5 versus 5.41 ± 1.37. The mean scores showed a significant reduction of skin discoloration without major side effects (p < 0.00001). Carboxytherapy seems to be an effective treatment option for dark circles around the eyes with a good safety profile and patient satisfaction.

The investigation and comparison of the efficacy and safety of stromal vascular fraction (SVF), platelet rich plasma (PRP), and 1064-nm Q-switched Nd:YAG laser in reducing nanofat treated infraorbital dark circles and wrinkles: A controlled blinded randomized clinical trial.

To evaluate the efficacy and safety of stromal vascular fraction (SVF), platelet rich plasma (PRP), and 1064-nm Q-switched Nd:YAG laser in reducing nanofat treated dark circles and wrinkles under the eyes. This study was a single-blinded randomized clinical trial conducted on patients with suborbital darkening under the eyes that randomly divided into control and case groups. In the control group, 15 patients were treated with one session of nanofat injection only, and five patients of each intervention groups received one session of nanofat+SVF injection, nanofat+PRP injection, and nanofat injection+Nd:YAG laser, respectively. Assessments methods were (1) evaluation of the degree of darkness and repair under the eyes by a blinded dermatologist based on clinical photographs, (2) investigating patient satisfaction, (3) using biometric variables for color, thickness, and density of the skin (only 3 months after the treatment), and (4) recording the possible adverse effects. In terms of the extent of reduction in the intensity of darkness under the eyes, the combined treatment of nanofat injection together with SVF, PRP, and Nd:YAG laser had a much greater therapeutic effect than nanofat injection alone. In all three groups of combined treatments, patients were 100% satisfied. In terms of biometric variables, amount of changes in colorimeter, complete and dermal thickness, complete and dermal density, between the different groups was statistically significant. The use of combined treatments including nanofat with SVF injection, PRP, and 1064 Q-switched Nd:YAG laser may be more effective than nanofat alone, in reducing infraorbital dark circles and wrinkles.

Establishment and application of perceived age prediction model for the periocular aging research of Chinese Han women.

The assessment of skin aging through skin measurements faces limitations, making perceived age evaluation a more valuable and direct tool for assessing skin aging. Given that the aging process markedly affects the appearance of the eye contour, characterizing the eye region could be beneficial for perceived age assessment. This study aimed to analyze age-correlated changes in the eye contour within the Chinese Han female population and to develop, validate, and apply a multiple linear regression model for predicting perceived age. A naïve panel of 107 Chinese women assessed the perceived ages of 212 Chinese Han women. Instrumental analysis evaluated periorbital parameters, including palpebral fissure width (PFW), palpebral fissure height (PFH), acclivity of palpebral fissure (AX), angle of inner canthal (AEN), and angle of outer canthal (AEX). These parameters were used to construct a multiple linear regression model for predicting the perceived ages of Chinese Han women. A combined treatment using Fotona 4D and an anti-aging eye cream, formulated with plant extracts, peptides, and antioxidants, was conducted to verify the cream's anti-aging efficacy and safety. This eye cream was then tested in a large-scale clinical trial involving 101 participants. The prediction model was employed in this trial to assess the perceived ages of the women after an 8-week application of the eye cream. All parameters were observed to decrease with age. An intergroup comparison indicated that eyelid aging in Chinese Han women accelerates beyond the age of 50. Consequently, a linear regression model was constructed and validated, with the perceived age being calculated as 183.159 - 1.078 * AEN - 4.487 * PFW + 6.061 * PFH - 1.003 * AX - 0.328 * AEX. The anti-aging efficacy and safety of the eye cream were confirmed through combined treatment with Fotona 4D, showing improvements in wrinkles, elasticity, and dark circles under the eyes. In a large-scale clinical evaluation using this eye cream, a perceived age prediction model was applied, suggesting that 8weeks of use made participants appear 2.25 years younger. Our study developed and validated a multiple linear regression model to predict the perceived age of Chinese Han women. This model was successfully utilized in a large-scale clinical evaluation of anti-aging eye cream, revealing that 8weeks of usage made participants appear 2.25 years younger. This method effectively bridges the gap between clinical research and consumer perceptions, explores the complex factors influencing perceived age, and aims to improve anti-aging formulations.

Illuminating the shadows: an insight into periorbital hyperpigmentation

Periorbital hyperpigmentation (POH), also referred to as periorbital melanosis or dark eye circles, is a common dermatological concern characterized by darkening of the skin around the eyes. This review article aims to comprehensively analyze the current understanding of POH, encompassing its epidemiology, etiopathogenesis, clinical manifestations, diagnosis and available treatment modalities, and focusing on patients’ skin color. The review also consolidates a grading system for POH and emphasizes the importance of accurate diagnosis using clinical examination, assessment scores, Wood’s lamp, ultrasonography, and dermoscopy. Treatment modalities range from non-pharmacological measures to topical agents, including kojic acid, alpha-arbutin, vitamin C, vitamin E, niacinamide, retinoids, and hydrating agents. The manuscript explores the efficacy of various skin-lightening agents, such as hydroquinone, and introduces emerging treatments like caffeine, carotenoids, lactic acid, curcumin, and vitamin K. Additionally, it delves into procedural treatments like chemical peels, lasers, blepharopigmentation, mesotherapy, platelet-rich plasma therapy, fillers, autologous fat transplantation, and surgical interventions. The comprehensive approach to understanding and managing POH presented in this review aims to provide clinicians with valuable insights into the diverse therapeutic options available for this challenging cosmetic concern.

Formulation Development of Haritaki Cream by Using 2 (square ) Factorial Design

Creams, in general, are versatile skincare formulations that provide a balance of water and oil to deliver hydration and nutrients to the skin. Eye creams are a category of skincare products specifically designed for the sensitive and delicate skin around the eyes. The skin in this area is thinner and more prone to issues such as fine lines, wrinkles, puffiness, and dark circles. Eye creams are formulated to be lightweight and easily absorbed, and they typically contain ingredients tailored to address these specific concerns. Common ingredients in eye creams include hydrating agents, anti-aging compounds, brightening ingredients, and sometimes caffeine or other ingredients to reduce puffiness. From the developed formulation of haritaki cream we concluded that it can be used for dark circle. It contains various other excipients like potato starch, alovera, methyl and propyl paraben etc. it does not only reduce dark circles but also glows skin and reduces skin damage. As it causes no irritation it is better than allopathic cream. As it had passed all the evaluation parameters like pH, washability, phase separation, irritations, edema, spread ability etc.

Electrical stimulation of the lower eyelid orbicularis oculi muscle improves periocular dark circles.

We developed and tested the safety and efficacy of a cosmetic device to improve dark circles using electrical muscle stimulation of the orbicularis oculi muscle. Overall, 18 participants (36 eyes) were studied. The following five items were evaluated before and after the intervention:(1) the Clinical Dark Circle Score using clinical findings and photographs, (2) transcutaneous oxygen partial pressure (TcPO2) on the lower eyelid, (3) thermography, (4) two-dimensional laser blood flowmetry, and (5) spectrophotometry. The mean score at baseline was 2.0±0.90 (mean±standard deviation), and that at the end of the study was 1.2±1.0 (Wilcoxon signed-rank sum test, p<0.0001), indicating a significant reduction. The spectrophotometer showed a significant decrease in a* and L* values before and after use (Wilcoxon signed-rank sum test, p<0.0001). There was also a weak negative correlation between the change in score and the change in blood flow and TcPO2 measured using a laser perfusion device (Spearman's rank correlation coefficient, r=-0.32 and -0.39, respectively). Stratified analysis of the baseline score showed a strong negative correlation between the change in score and the change in spectrophotometric a* in the subjects/group with mild periocular dark circles (Spearman's rank correlation coefficient, r=-0.46). Contrastingly, no correlation was observed for any of the measurements in the subjects/group with severe periocular dark circles. After 1 month, no device-related ophthalmic adverse events were observed in any of the participants. Electrical muscle stimulation could improve periocular dark circles, especially in the subjects/group with mild periocular dark circles, and was safe.

Facial adult female acne in China: An analysis based on artificial intelligence over one million.

To further clarify the acne profile of Chinese adult women, we included 1,156,703 adult women. An artificial intelligence algorithm was used to analyze images taken by high-resolution mobile phones to further explore acne levels in Chinese adult women. In this study, we assessed the severity of acne by evaluating patients' selfies through a smartphone application. Furthermore, we gathered basic user information through a questionnaire, including details such as age, gender, skin sensitivity, and dietary habits. This study showed a gradual decrease in acne severity from the age of 25 years. A trough was reached between the ages of 40 and 44, followed by a gradual increase in acne severity. In terms of skin problems and acne severity, we have found that oily skin, hypersensitive skin, frequent makeup application and unhealthy dietary habits can affect the severity of acne. For environment and acne severity, we observed that developed city levels, cold seasons and high altitude and strong radiation affect acne severity in adult women. For the results of the AI analyses, the severity of blackheads, pores, dark circles and skin roughness were positively associated with acne severity in adult women. AI analysis of high-res phone images in Chinese adult women reveals acne severity trends. Severity decreases after 25, hits a low at 40-44, then gradually rises. Skin type, sensitivity, makeup, diet, urbanization, seasons, altitude, and radiation impact acne. Blackheads, pores, dark circles, and skin roughness are linked to acne severity. These findings inform personalized skincare and public health strategies for adult women.

Lower Eyelid Dark Circles (Tear Trough and Lid-Cheek Junction): A Stepwise Assessment Framework.

Despite increasing popularity, the use of hyaluronic acid (HA) fillers for the correction of dark under-eye shadows remains challenging. Specific guidance on patient assessment is limited. The aim of this study was to develop a stepwise assessment framework for lower eyelid dark shadows to help practitioners classify patients based on their underlying problems and facilitate a more strategic approach to treatment. Literature review and peer collaboration informed the current availability of educational material for use by experienced injectors when assessing patients presenting with dark circles. A practitioner survey provided insight into current practices. A focus group convened to review the survey results and discuss best practice approaches to patient assessment. Surveyed practitioners (n = 39) reported patient concern about under-eye hollows (91%), dark eye circles (80%), and looking tired (60%). All (100%) agreed that midcheek volume was critical when treating tear-trough depression, and only 26% reported use of a tear-trough classification system. The focus group developed a framework for assessing tear-trough depression and the lid-cheek junction in patients presenting with dark circles. Key factors within this framework included the importance of appropriate lighting when conducting a visual inspection, regional inspection of the cheek and tear trough, palpation of the orbital rim and soft tissues, determination of the orbital vector, and assessment of lower eyelid pigmentation and skin quality. Careful step-by-step assessment can reduce the challenges of treating dark circles by identifying patients in whom dark eye circles may be improved without the need to directly inject filler into the tear trough.

Differences in the annotation between facial images and videos for training an artificial intelligence for skin type determination.

The Grand-AID research project, consisting of GRANDEL-The Beautyness Company, the dermatology department of Augsburg University Hospital and the Chair of IT Infrastructure for Translational Medical Research at Augsburg University, is currently researching the development of a digital skin consultation tool that uses artificial intelligence (AI) to analyze the user's skin and ultimately perform a personalized skin analysis and a customized skin care routine. Training the AI requires annotation of various skin features on facial images. The central question is whether videos are better suited than static images for assessing dynamic parameters such as wrinkles and elasticity. For this purpose, a pilot study was carried out in which the annotations on images and videos were compared. Standardized image sequences as well as a video with facial expressions were taken from 25 healthy volunteers. Four raters with dermatological expertise annotated eight features (wrinkles, redness, shine, pores, pigmentation spots, dark circles, skin sagging, and blemished skin) with a semi-quantitative and a linear scale in a cross-over design to evaluate differences between the image modalities and between the raters. In the videos, most parameters tended to be assessed with higher scores than in the images, and in some cases significantly. Furthermore, there were significant differences between the raters. The present study shows significant differences between the two evaluation methods using image or video analysis. In addition, the evaluation of the skin analysis depends on subjective criteria. Therefore, when training the AI, we recommend regular training of the annotating individuals and cross-validation of the annotation.

Interventional and device treatment of the periocular area

Growth in the research, innovation, and development of laser and energy-based technologies over the past few decades has led to dramatic increases in treatment options for dermatologic and cosmetic concerns of the periorbital area. We highlight recent treatment options using laser and energy-based devices for the clearance of periocular pigmented lesions, including solar lentigines and nevus of Ota; vascular lesions, including port-wine birthmarks, infantile hemangiomas, superficial telangiectasias, and reticular veins; laser ablation of benign tumors, such as xanthelasma; cosmetic rejuvenation; treatment of infraorbital dark circles and festoons; laser removal of eyebrow and eyeliner tattoos; and device-based treatment of chronic dry eyes.