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.
CASE 2
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.
CASE 3
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.
