377 J. Cosmet. Sci., 73, 377–390 November/December 2022) Address all correspondence to Ahmed F. Elhawatky, dramfat@yahoo.com Using the 3D Antera Camera for Accurate Evaluation of Melanin and Hemoglobin Infraorbital Level Changes While Using Polydioxanone Threads and Autologous Plasma Gel (Filler) in Treating Infraorbital Hyperpigmentation: A Split Face Comparison Study HEBA MAHMOUD EL-SAYED DIAB, WASSAN MOHAMMED JWAD ZAYED, AHMED ELHAWATKY AND SAMAH IBRAHIM HASSEN Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Ain-Shams University (H.M.E.D., S.I.H.) MSc. Basrah University Iraq (W.M.J.Z.) Department of Dermatology, Venereology and Andrology, National Research Center (A.F.E.) Accepted for publication February 14, 2023. Synopsis Infraorbital dark circle refers to the darkness of the infraorbital area below the lower eyelids. It creates significant cosmetic problems, impacts quality of life, and leads patients to seek medical advice. Now it is possible to extract data from images related to the 3D shape of the skin, which will allow one to quantify the efficacy of treatments and monitor changes over time by using the 3D Antera camera. The aim of this study is to make comparisons between the efficacy and safety of threads versus autologous plasma gel (filler) injection in treating infraorbital pigmentation and vascularity by the Antera camera and find whether its benefits exceeds its harms and side effects. In this study, 40 patients with infraorbital dark circles were included. Patients underwent plasma gel (filler) injections on the left eye, with polydioxanone thread treatment on the right eye. All patients were assessed using the 3D Antera camera before and after 1 month and 6 months of treatment. Both treatment modalities revealed marked cosmetic improvements. Both treatments also showed marked response, yet the results on the left eye were superior with regard to average melanin concentration. In conclusion, both polydioxanone thread insertion and plasma gel injection exert beneficial effects in improving periorbital hyperpigmentation and dark circles. However, plasma gel (filler) revealed more potent effects. INTRODUCTION Many etiological factors can cause infraorbital darkening, including dermal melanin deposition, periorbital edema, superficial location of vasculature, and shadowing occurring with skin laxity (1–3). Atopic patients and those complaining of allergic contact dermatitis continue to rub and scratch their skin, which leads to excessive postinflammatory

378 JOURNAL OF COSMETIC SCIENCE hyperpigmentation under the eyes (4). Many cosmetic procedures—including lasers, fillers, and autologous fat transplantation—have been used with varying degrees of success, and the outcomes of most of them have been unsatisfactory (5). An injectable autologous plasma gel (filler) has been described. It is a gel-like formula of the ordinary plasma with platelets, but with more stability in volume and shape, although it has the characteristic bioactive molecule secretions that enhance tissue regeneration (6). For correction of the aging face, surgeons are creating more procedures with fewer incisions and shorter postoperative recovery periods. Many of these procedures use absorbable and nonabsorbable sutures (7). Polydioxanone (PDO) threads are known to be used in tightening and lifting the face, and they can be used to improve skin texture, with a brightening effect for the skin. However, the mechanism underlying these positive skin changes remains unclear (8). The Antera 3D® (Miravex Limited, Dublin, Ireland) uses an innovative optical method and complex mathematical algorithms to acquire images in 3D. This makes it possible to extract data from images related to the 3D shape of the skin, which allows one to quantify the efficacy of treatments and monitor changes over time. The equipment uses light-emitting diodes to shine light on the skin. MELANIN MODE IN ANTERA CAMERA The melanin mode allows one to map the distribution of melanin and to measure its average concentration and uniformity. The Antera 3D® (Miravex Limited, Dublin, Ireland) (Figure 1) allows one to measure three different parameters related to melanin content: Average level. This is the average concentration of melanin per unit area relative to the area selected. In the example shown in Figure 2, this is 0.527. Variation. This parameter measures the variation of melanin in the selected area and provides information on the uniformity of the pigment. The variation is inversely proportional to the uniformity of the pigment, meaning that a lower variation corresponds to a higher degree of uniformity. The variation provides important metrics in evaluating the complexion of the skin. For example, a blotched complexion (mottled pigmentation) corresponds to a higher degree of variation than a good complexion. The closer the variation is to zero, the more uniform the melanin distribution is, and the better the skin complexion is. Variation Figure 1. Antera 3D® (Miravex Limited, Dublin, Ireland) camera (9).