381 Using the 3D Antera Camera for Accurate Evaluation syringes were extracted. Calcium gluconate was added to the mixture of PPP +PRP in a concentration of 0.01 mL/1 mL. The mixture was then placed into a plasma filler machine and heated to 90 °C (5 minutes), then cooled to 70 °C (5 minutes), and finally cooled to 40 °C (5 minutes). The viscous gel was then ready for use. Topical anesthetic cream was applied over the treated areas for 45 minutes. The gel was injected using a 1-mL, 4-mm 27 G needle. The left infraorbital area was injected with plasma gel (filler) in the deep dermis as multiple injections, with 0.1 mL in each one, 0.5 cm apart. This procedure was done for three sessions, 1 month apart. The PDO mono threads (Venus V Line®, TM 25 mm, Thread 30G, Korea) were inserted in the right infraorbital area for one session. The numbers of threads were between three and five, inserted in the deep dermis. Post-treatment. A sunscreen cream was applied after each treatment session to be used daily before sun exposure and to be reapplied every 2 hours. STATISTICAL ANALYSIS OF THE DATA The collected data was revised, coded, and tabulated using Statistical Package for the Social Sciences (IBM SPSS Statistics for Windows, Armonk, NY: IBM Corp.,Version 25.0. Armonk). The p value was considered significant as the following: • The p value 0.05: nonsignificant. • The p value 0.05: significant. • The p value 0.01: highly significant. Figure 4. Anatomical landmarks of periorbital region (10).

382 JOURNAL OF COSMETIC SCIENCE RESULTS DEMOGRAPHIC DATA Mean age of included patients was 42 ± 9 years with a minimum of 25 and a maximum of 55 years. Included patients were 17 males (42.5%) and 23 females (57.5%) 25 patients had skin phototype 3 (62.5%) and 15 had skin phototype 4 (37.5%). With regard to smoking, 13 were nonsmokers (32.5%), 16 were smokers of up to 10 cigarettes per day (40%), and 11 were smokers of more than 10 cigarettes per day (27.5%). Regarding sun exposure, 24 patients reported exposure to the sun of less than 2 hours per day (60%), 13 reported exposure to the sun of less than 4 hours per day (32.5%), and 4 reported exposure to the sun of more than 4 hours per day (7.5%). A total of 29 of patients (72.5%) did not report use of sunblock or cosmetics, 10 patients (25%) reported use of sunblock or cosmetics sometimes, and only 1 patient always used sunblock and cosmetics (2.5%). ASSESSMENT OF TREATMENT RESPONSE USING BLINDED DOCTOR ASSESSMENT This assessment was done by a different observer doctor, who was totally blinded even to the type of treatment used—he was only asked to access the patients through photos. Blinded doctor assessment of patients’ response after 1 month and after 6 months at the right eye revealed that after 1 month, 2 patients had no changes, 18 patients showed mild effects, 18 patients showed moderate improvements, and 2 patients showed marked improvements. After 6 months, 3 patients had no effect, 6 patients showed mild changes, 20 patients showed moderate improvements, and 11 patients showed marked improvements. There was no statistically significant difference between either response (Table I). Blinded doctor assessment of the patients’ response after 1 month and after 6 months at the left eye revealed that after 1 month, 6 patients had no effect, 13 patients showed mild changes, 17 patients showed moderate improvements, and 4 patients showed marked improvements. After 6 months, 4 patients had no effect, 5 patients showed mild changes, 23 patients showed moderate improvements, and 8 patients showed marked improvements. There was a statistically significant better response after 6 months compared to after 1 month (Table II). Table I Blinded Doctor Assessment of Patients’ Response at the Right Eye (PDO) Improvement The p value No Mild Moderate Marked Response after 1 month 2 (5%) 18 (45%) 18 (45%) 2 (5%) 0.182 Response after 6 months 3 (7.5%) 6 (15%) 20 (50%) 11 (27.5%) Table II Blinded Doctor Assessment of Patients’ Response at the Left Eye Improvement The p value No Mild Moderate Marked Response after 1 month 6 (15%) 13 (32.5%) 17 (42.5%) 4 (10%) 0.001 Response after 6 months 4 (10%) 5 (12.5%) 23 (57.5%) 8 (20%)