Periorbital Hyperpigmentation: Review of Etiology, Medical Evaluation, and Aesthetic Treatment

April 2014 | Volume 13 | Issue 4 | Original Article | 472 | Copyright © April 2014

Wendy E. Roberts MD

Generational and Cosmetic Dermatology, Rancho Mirage, CA

trough deformity was minimally present (Figures 1A and 1B). Because of her obvious increased suborbital melanization and failure to clear with topical bleaching as monotherapy, conservative fractional resurfacing was chosen as her first line treatment She underwent non ablative laser fractional photothermolysis with 1550-nm fractionated erbium-doped fiber laser (Fraxel Restore, Solta Medical, Haywood, CA). Settings used: 30 mJ/Treatment level (TL) 5/4 passes for a total of 3 sessions at 4 week intervals.
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A 58-year-old Asian female, Fitzpatrick skin type 4 (Roberts Skin Type F4/H2/G2/S2), reported progressive darkening of the skin around her eyes and cheeks. She had a significant past medical history for Melasma but reports eyelid darkening ten years prior. She was also on HRT. On presentation, she had significant bilateral confluent brown patches periorbital patches that were bilateral and symmetrical involving both upper and lower eyelid. She had mild skin laxity and a mild tear trough deformity (Figures 2A and 2B). In addition to discontinuing her HRT in consultation with her Primary care she was counseled about using SPF daily and she underwent 3 x 30% Salicylic acid peels at 3 week intervals.
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A 44-year-old Caucasian female, Fitzpatrick skin type 2 (Roberts Skin Type F2/H1/G2/S1), reported progressive darkening and sagging of her suborbital skin that was making her look drained and tired. She had no significant past medical history. She had used various undereye creams with no success. On presentation, she had significant mid facial descent, fat herniation skin laxity and suborbital hyperpigmentation. Tear trough deformity was present (Figure 3A). Because of the mid face aging polylactic acid 1 vial per session for 2 sessions at 4 week intervals. PLLA dilution with 6 cc of distilled water and 2ccs 1% Lidocaine for a total dilution of 8 cc was injected into the mid face.