A validated photonumeric scale for infraorbital dark circles and its application in evaluating the efficacy of a cosmetic treatment product in a split-face randomized clinical trial

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

BACKGROUND

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.

METHODS

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).

RESULTS

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.

CONCLUSION

Our study demonstrated that CEFFE inhibits melanogenesis and is a safe and effective treatment for infraorbital dark circles.

LEVEL OF EVIDENCE IV

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 .

Evaluating the Efficacy of Combined Platelet-Rich Plasma and Microneedling for Aesthetic Rejuvenation of the Periorbital Area: A Randomized, Blinded Cohort Study

INTRODUCTION

Microneedling, a technique involving controlled dermal microwounding, and platelet-rich plasma (PRP) injections are both employed for skin rejuvenation. While both treatments individually show promise, limited research has explored their combined efficacy. This study aimed to evaluate the effectiveness of combining PRP injections with microneedling for aesthetic concerns around the eyes under standardized conditions.

METHODS

This single-center, longitudinal cohort study was conducted from October 2017 to October 2020. Thirteen adult participants (mean age 35, 92.3% female) with aesthetic concerns in the periorbital area underwent combined PRP and microneedling treatment. Standardized photographs were taken preprocedure, at 1 week, and 3 months. Photographs were evaluated by three blinded dermatologists using validated photonumeric scales. Participants completed a self-assessment questionnaire at the 1-week follow-up regarding skin homogeneity, texture, pigmentation, and wrinkles.

RESULTS

Self-reported outcomes indicated perceived improvements in skin homogeneity (72.7% reporting mild or significant improvement) and texture (81.8% reporting mild, moderate, or significant improvement). Improvements in pigmentation and wrinkles were less pronounced. Dermatologists' assessments revealed no significant differences in skin attributes before and after treatment.

CONCLUSION

Despite subjective reports of improvement, objective evaluations by independent dermatologists did not demonstrate significant changes. Variability in outcomes might be attributed to differences in study design, treatment protocols, and assessment methods. Further research with larger sample sizes and multiple treatment sessions is needed to better understand the benefits of combining PRP with microneedling for periorbital rejuvenation.

Combined Application of Hyaluronidase and Collagenase for Late-Onset Edema in Periocular Area After Hyaluronic Acid Volume Repositioning: A Six-Case Retrospective Review

BACKGROUND AND OBJECTIVE

Although generally low-risk, hyaluronic acid (HA) dermal fillers can lead to late-onset edema, particularly in the periocular region. This condition typically manifests three to four months post-injection and requires specialized management, usually with hyaluronidase. However, increased use of hyaluronidase has resulted in instances of post-hyaluronidase syndrome, leading to unaesthetic outcomes. This study presents a retrospective case series that utilizes a novel technique combining two enzymes to improve late-onset edema and prevent post-hyaluronidase syndrome development.

METHODS

From 2019 to 2024, six patients in our aesthetic clinic received a novel therapeutic approach involving co-administration of 1,500 IU of hyaluronidase and collagenase with a cannula to address late-onset edema in the periocular area.

RESULTS

The combination of high-dose hyaluronidase and low-dose collagenase improved late-onset edema in all patients after a single treatment. Statistical analysis showed a significant improvement in aesthetic scores (P < 0.05), with effect sizes of 0.89 for Hirmand, 1.3 for the Teoxane Infraorbital Hollows Scale (TIOHS), and 1.2 for O'Mahoney's photo-numeric scale. No post-hyaluronidase syndrome or complications were observed.

CONCLUSIONS

This combined technique utilizing 1,500 IU of hyaluronidase and collagenase GH PB220 from Pbserum (Madrid, Spain) effectively achieves significant aesthetic improvements with a high safety profile, offering a promising alternative for managing late-onset edema after HA dermal filler treatments.

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

BACKGROUND

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.

METHODS

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.

RESULTS

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).

CONCLUSION

Carboxytherapy seems to be an effective treatment option for dark circles around the eyes with a good safety profile and patient satisfaction.

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

BACKGROUND

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.

OBJECTIVES

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.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.

LEVEL OF EVIDENCE: 5

Effectiveness and tolerance of multicorrective topical treatment for infraorbital dark circles and puffiness

BACKGROUND

Treatment of infraorbital dark circles and under-eye puffiness is challenging due to its multifactorial nature and lack of broadly applicable, effective treatments. A daily skincare treatment option that is multimodal, effective, and tolerable across a broad patient population is an unmet need.

AIM

A multicorrective topical eye cream (MTEC) formulated with Tetrahexyldecyl (THD) ascorbate (vitamin C), prebiotic Inula Helenium, bioavailable peptides, botanical extracts, chrysin, and caffeine is hypothesized to improve the appearance of infraorbital dark circles and under-eye puffiness by targeting microvasculature congestion and permeability, melanin accumulation and hemoglobin degradation-related pigmentation, and skin health.

METHODS

An IRB approved, open-label, 12-week clinical study set out to evaluate the efficacy and tolerability of the MTEC across a broad patient population including varying ethnicities and Fitzpatrick Skin Types (FST). Female subjects (n = 40) ages 35-60 years old, with moderate-to-severe under-eye dark circles, moderate under-eye puffiness, and mild-to-moderate fine lines were enrolled into the study. Objective (Chromameter, VISIA® imaging, and Laser Doppler) and subjective assessments (clinical grading and self-assessment questionnaire) were conducted at baseline and post-baseline timepoints.

RESULTS

Thirty-seven subjects completed the study, and the MTEC efficaciously demonstrated short-term and long-term improvements in objective and subjective assessments across a broad patient population. Specifically, the MTEC demonstrated significant improvement of infraorbital dark circles, mainly by the reduction in microvasculature congestion and permeability, melanin, and hemoglobin degradation-related pigmentation.

CONCLUSION

Topical application of the MTEC may offer an effective and tolerable treatment option for infraorbital dark circles and puffiness.

A Cluster Validity Index-Based Objective Criteria for Aesthetic Evaluation of Periorbital Treatment

Purpose

Dark circles and pigmentation around the eyes are common reasons people see dermatologists. An effective assessment of the severity of infraorbital color and texture differences is critical for determining appropriate treatment. Evaluation of the visual severity of cases is mostly based on visual inspection. Treatment efficiency is often measured using patient questionnaires in many cases. The subjectivity of assessments may lead to a prolonged healing process, misdiagnosis, and excessive use of drugs or chemicals.

Patients and Methods

In this study, a computer-aided objective evaluation approach was proposed for grading periorbital facial rejuvenation. This approach is based on the analysis of numerical features extracted from different facial regions in digital images. Healing was objectively graded by evaluating data clusters formed using the extracted features. Accordingly, an increase in the visual similarity between paired facial regions is accepted as an indicator of healing, which directly affects the form of data clusters. An intracluster validity index was measured to evaluate the clusters as dense and well separated. A total of 144 facial regions were extracted and examined, and the automatically calculated grades were compared with expert evaluations.

Results

The cosmetic effects of the experimental drug were evaluated during the experiments, and expert grades were accepted as the ground truth. The results show that the proposed automated grading approach can evaluate rejuvenation with an accuracy of up to 0.91 accuracy in the upper orbital region.

Conclusion

This study concluded that the proposed data-clustering-based approach is promising and can be functional without any special instruments.

Image Perceptual Similarity Metrics for the Assessment of Basal Cell Carcinoma

Efficient management of basal cell carcinomas (BCC) requires reliable assessments of both tumors and post-treatment scars. We aimed to estimate image similarity metrics that account for BCC's perceptual color and texture deviation from perilesional skin. In total, 176 clinical photographs of BCC were assessed by six physicians using a visual deviation scale. Internal consistency and inter-rater agreement were estimated using Cronbach's α, weighted Gwet's AC2, and quadratic Cohen's kappa. The mean visual scores were used to validate a range of similarity metrics employing different color spaces, distances, and image embeddings from a pre-trained VGG16 neural network. The calculated similarities were transformed into discrete values using ordinal logistic regression models. The Bray-Curtis distance in the YIQ color model and rectified embeddings from the 'fc6' layer minimized the mean squared error and demonstrated strong performance in representing perceptual similarities. Box plot analysis and the Wilcoxon rank-sum test were used to visualize and compare the levels of agreement, conducted on a random validation round between the two groups: 'Human-System' and 'Human-Human.' The proposed metrics were comparable in terms of internal consistency and agreement with human raters. The findings suggest that the proposed metrics offer a robust and cost-effective approach to monitoring BCC treatment outcomes in clinical settings.

Evaluation of the Effect of Artemisia Absinthium L. Eye-Cream on Infra-Orbital Dark Circle: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial

BACKGROUND

The relative darkening of the lower eyelid skin, which is often linked with dark circles, may make you seem fatigued and older than your real age. Considering the recommendations in the sources of Persian medicine regarding Artemisia absinthium L., the purpose of this clinical trial is investigating the effectiveness of cream prepared from the aqueous extraction of A.absinthium to remove periorbital dark circles.

MATERIALS AND METHODS

The eye cream is made with 20% of aqueous extract of A.absinthium in the base of the cream. It was standardized based on Artemisinin via HPLC method. For the clinical trial, 60 patients equally enrolled in two drug and placebo groups. Erythema and Pigmentation were evaluated via a mexameter instrument.

RESULTS

The cream is standardized, including 1.29±0.02 µg/mg Artemisinin in the product. Finally, 21 and 24 patients reached the end of study in drug and placebo groups, respectively. In these groups, the difference in the mean (SD) DE, DL, Erythema and Melanin factors before and after the research were significant (p0.05). However, the rate of reduction of DE, Erythema, and Melanin and rise of DL is greater in the treatment group than in the placebo group. Furthermore, the mean value of DE and DL factors before the research were significantly different in two groups (p0.001), but after the research did not show a significant difference. The mean value of Erythema factor in the two groups before (p=0.25) and after (p=0.5) did not show a significant difference. The mean value of Melanin after the research between two groups showed a significant difference (p=0.01).

CONCLUSION

The results show that the cream prepared from the herbal composition of Persian medicine improves Infra Orbital Dark circle around the eyes.

Assessing the Rejuvenation Effectiveness of a Hyaluronic Acid and Amino Acid Mixture in the Periorbital Region

Purpose

We performed an assessment of the rejuvenation effect of an amino acid and hyaluronic acid mixture in the periorbital area.

Methods

A total of 23 of the 35 participants completed all application sessions and measurements. These 23 women were aged 30-55 years. A hyaluronic acid and amino acid mixture was injected into the participants' periorbital area. Three sessions of application with 15-day intervals were undertaken. Subjects' age, height, weight, smoking status, and sport participation were recorded. A photonumeric dark circle scale and Fitzpatrick's periorbital wrinkling classification were used for evaluation of dark circles and wrinkles in the periorbital area. Anatomical measurements (height of upper and lower eyelids) were done using ImageJ and a skin-analysis system (Observ 520).

Results

The 23 women had a mean age of 42.46±9.33 years, mean height 164.46±4.96 cm, and mean weight 63.94±8.26 kg. Before the sessions, the mean heights of the upper eyelids were 1.24±013 cm (right) and 1.21±013 cm (left), while those of the lower eyelids were 0.98±014 cm (right) and 0.97±0.17 cm (left). One month after the third session, mean upper-eyelid heights were 1.30±0.09 cm (right) and 1.28±0.11 cm (left) and lower-eyelid ones 1.02±0.11 cm (right) and 1.02±0.13 cm (left). Dark-circle and wrinkle-scale scores showed significantly positive results between before the sessions and 1 month after the third session.

Conclusion

A hyaluronic acid and amino acid mixture can be used to rejuvenation of the periorbital area in women aged 30-55 years.

Facial Aesthetic Priorities and Concerns: A Physician and Patient Perception Global Survey

Background

Minimally invasive and noninvasive facial aesthetic treatments are increasingly popular, and a greater understanding of patient perspectives on facial aesthetic priorities is needed.

Objectives

The authors surveyed facial aesthetic concerns, desires, and treatment goals of aesthetically conscious men and women, and physicians, in 18 countries.

Methods

This was a global, internet-based survey on desired appearance and experiences with, or interest in, facial aesthetic treatments. Eligible respondents were aesthetically conscious adults (21-75 years). Eligible aesthetic physicians were required to see ≥30 patients per month for aesthetic reasons, have 2 to 30 years of experience in clinical practice, and spend ≥70% of their time in direct patient care.

Results

A total of 14,584 aesthetically conscious adults (mean age, 41 years; 70% women) and 1315 aesthetic physicians (mean age, 45 years; 68% men) completed the survey. Most respondents (68%) reported that aesthetic procedures should be sought in their 30s to 40s; physicians recommended patients seek treatment earlier. Respondents expressed greatest concern over crow’s feet lines, forehead lines, facial skin issues, hair-related concerns, and under-eye bags or dark circles; in contrast, physicians tended to underestimate concerns about under-eye bags or dark circles, mid-face volume deficits, and skin quality. Although both physicians and respondents cited cost as a major barrier to seeking aesthetic treatments, respondents also emphasized safety, fear of injections or procedure-related pain, and concern about unnatural-looking outcomes.

Conclusions

This global survey provides valuable insight into facial aesthetic concerns and perspectives that may be implemented in patient education and consultations to improve patient satisfaction following aesthetic treatments.