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CONCISE COMMUNICATION
Year : 2019  |  Volume : 10  |  Issue : 4  |  Page : 471-472  

Treatment of dark circles with the new 15 mg/ml hyaluronic acid filler with lidocaine


Department of Dermatology, Yavana Aesthetics Clinic, Hallmark Complex, Mulund West, Mumbai, Maharashtra, India

Date of Web Publication28-Jun-2019

Correspondence Address:
Madhuri Agarwal
Yavana Aesthetics Clinic, 236-239, 2nd Floor, Hallmark, LBS Marg, Mulund West, Mumbai - 400 080, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/idoj.IDOJ_381_18

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How to cite this article:
Agarwal M. Treatment of dark circles with the new 15 mg/ml hyaluronic acid filler with lidocaine. Indian Dermatol Online J 2019;10:471-2

How to cite this URL:
Agarwal M. Treatment of dark circles with the new 15 mg/ml hyaluronic acid filler with lidocaine. Indian Dermatol Online J [serial online] 2019 [cited 2019 Jul 21];10:471-2. Available from: http://www.idoj.in/text.asp?2019/10/4/471/255542



Sir,

In patients looking for improvement in under eye dark circles, one of the predominant clinical findings is tear trough deformity (TTD). Soft tissue hyaluronic acid (HA) fillers are an ideal treatment to restore the volume loss in the tear trough area and relieve instantly the sunken tired appearance.

A 28-year-old female patient visited our clinic for treatment of dark circles. On clinical examination, she had a deep tear trough concavity involving the entire circumference of the infraorbital rim with more deficit on the left side of the face. She was diagnosed to have Class III TTD according to the Hirmand's classification.[1] On the day of treatment the patient's baseline front, left, and right profile view photographs before treatment were taken using the Canon SLR camera [Figure 1]a, [Figure 2]a and [Figure 3]a. A topical anesthetic cream was applied before the procedure. The product injected was Juvederm® Volbella XC (VYC-15L). About 2ml of VYC-15L was injected using the 30-G needle, in a linear retrograde manner in the supra-periosteal plane throughout the circumference of the TTD till optimal correction was visibly appreciable. There was an instant, dramatically visible improvement in the dark circles of our patient after treating the TTD with VYC-15L filler. There was no evidence of any immediate or long-term adverse effects except transient redness and negligible swelling. The patient was called for a follow up and the front, left, and right profile views photographs were repeated to check for the efficacy and longevity of the results. [Figure 1]b, [Figure 1]c, [Figure 2]b, [Figure 2]c and [Figure 3]b, [Figure 3]c Show the results after 1 and 6 months, respectively. The Hirmand's classification improved from Class III to Class 0 within a week of treatment and the results were maintained at 6 months of followup [Figure 1]c, [Figure 2]c and [Figure 3]c.
Figure 1: (Front view) Patient treated for dark circles with Volbella filler. (a) Baseline clinical picture taken before treatment, (b) after a month, and (c) after 6 months. Improvement in dark circles and tear trough deformity is seen along with sustained results upto 6 months

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Figure 2: (Left view) – Patient treated for dark circles with Volbella filler. (a) Baseline clinical picture taken before treatment, (b) after a month, and (c) after 6 months. Improvement in dark circles and tear trough deformity is seen along with sustained results upto 6 months

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Figure 3: (Right view) – Patient treated for dark circles with Volbella filler. (a) Baseline clinical picture taken before treatment, (b) after a month, and (c) after 6 months. Improvement in dark circles and tear trough deformity is seen along with sustained results upto 6 months

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TTD correction with HA filler has limitations as the existing portfolio of fillers can cause high incidence of swelling, uneven filling effects, and Tyndall effect. In India, the introduction of new filler VYC-15L (Allergan, Santa Barbara, CA) overcomes all these adverse unwanted effects. VYC-15L is a moldable filler that uses the Vycross (Allergan, Irvine, CA) technology platform, which combines low- and high-molecular-weight HA with a novel cross-linking process.[2],[3] This novel cross-linking affects the rheology of the product in tissues and the hydrophilic properties of the HA gel. The optimized homogenous matrix is smooth rather than granular; this forms a highly malleable gel that is expected to distribute evenly in the treated tissue. The inclusion of mainly low-molecular-weight HA in the gel, and a lower overall amount of HA, reduces the attraction of water from surrounding tissue, thus reducing the swelling of the gel.[4] In a study conducted by Niforos et al., it was shown that the results of infraorbital depressions treated with VYC-15L were superior, with 99% of eyes reaching the primary endpoint of >1 grade Allergan Infra-oRbital Scale (AIRS) improvement at month 1 and 88% of the eyes attaining a >2 grade improvement.[5] The >1 grade AIRS improvement was durable with 92% of subjects maintaining the response in both eyes at month 6 which is consistent with results seen in our patient too. Their study results were superior to those reported in a single-arm study of infraorbital treatment with cohesive polydensified matrix HA.[5]

Our case shows the safety, efficacy, and high patient satisfaction for dark circles due to underlying TTD with new proprietary mix of low- and high-molecular-weight filler VYC-15L. This is first of its kind case report from India of this new filler in TTD improvement.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Hirmand H. Anatomy and nonsurgical correction of the tear trough deformity. Plast Reconstr Surg 2010;125:699-708.  Back to cited text no. 1
    
2.
Raspaldo H, Chantrey J, Belhaouari L, Sahel R, Murphy DK. Juvederm Volbella withlidocaine for lip and perioral enhancement: A prospective, randomized, controlled trial. Plast Reconstr Surg Glob Open 2015;3:e321.  Back to cited text no. 2
    
3.
Eccleston D, Murphy DK. Juvederm® Volbella in the perioral area: A 12-month prospective, multicenter, open-label study. Clin Cosmet Investig Dermatol 2012;5:167-72.  Back to cited text no. 3
    
4.
Philipp-Dormston WG, Hilton S, Nathan M. A prospective, open-label, multicenter, observational, postmarket study of the use of a 15mg/mL hyaluronic acid dermal filler in the lips. J Cosmet Dermatol 2014;13:125-34.  Back to cited text no. 4
    
5.
Niforos F, Acquilla R, Ogilvie P, Safa M, Signorini M, Creutz L, et al. A prospective, open-label study of hyaluronic acid-based filler with lidocaine (VYC-15L) treatment for the correction of infraorbital skin depressions. Dermatol Surg 2017;43:1271-80.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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