Treatment OfInfraorbital Dark Circles Using Long-Pulsed 1,064-nm Neodymium-Doped Yttrium Aluminum Garnet Laser

Abstract

Dark circles around the eyes are considered as a major cosmetic problem for many people especially for women as it gives them a tired and sad appearance. Infraorbital darkening has multiple etiological factors such as: increased dermal melanin deposition which considered as the common primary cause which is seen in most of the cases including; post inflammatory hyperpigmentation secondary to atopic or allergic contact dermatitis , hereditary hyperpigmentation, nevus of ota and heavy metal deposition, other etiological factor is the superficial location of blood vessels which is the second common primary cause of infraorbital discoloration and in these cases the entire lower eyelid has a purplish appearance, it is seen with aging, venous congestion and it may be familial and the last etiological factor is due to shadowing which is seen with the tear trough deformity, periorbital edema and pseudoherniated orbital fat . Moreover, dark circles around the eyes worsened with certain conditions such as: stress, fatigue, lack of sleep, unbalanced diet, and alcohol abuse.

Although various treatment options are available for dark circles but there is no any evidence that one single treatment can eliminate it completely.

Topical sunscreens application considered as a good protective method as sunlight intensifies the pigmentation so the choice of appropriate sunscreen considered as the first step in the treatment of dark circles around the eyes. Among the available treatment options for periorbital darkening: topical bleaching agents including (Hydroquinone, topical retinoic acid, azelic acid, arbutin and kojic acid), chemical peels including (TCA, lactic acid and Glycolic acid), antioxidants including (vitamins c, k, and e), lasers, carbon dioxide therapy, blepharoplasty, autologous fat transplantation which is used in patients with thin skin and hypervascularity , and injectable fillers wherehyaluronic acid is used to fill the affected area and restore volume. The choice of appropriate treatment depends mainly on the cause of dark circles.

Several types of lasers are used nowadays in the field of cosmetology, and many studies have been done on different types of lasers and their role in the treatment of dark circles around the eyes.

One of the most used lasers nowadays is the long pulsed Nd:YAG laser 1064 nm which is used in the treatment of venous malformations, so in this study we tried to use the long pulsed Nd: YAG laser in the treatment of infraorbital dark circles due to the visible prominent veins.

This study was designed as a control study to compare the effect of long pulsed 1064 nm Nd:YAG laser on only one eye and the other eye left as the control. In this study,long-pulsed 1,064-nm Nd:YAG laser was used with the following parameters, spot size7 mm; fluence, 80 J/cm2 and pulse width 20 ms, in two passes . Eleven patients were enrolled in the study and they were all females. The number of sessions ranged between one to three sessions, with one month interval between the session and the other one.

Four patients completed three sessions, five completed two and other two patients did only one session.

The results of this study showed that, the improvement ranged between very mild to moderate improvement in the treated area compared with the untreated one, even after finishing three treatment sessions. The clearance score and the patient satisfaction score were higher in patients who completed two or three sessions than who did only one session.

The overall clearance score and patient satisfaction score were not high among most of the patients.