383 Using the 3D Antera Camera for Accurate Evaluation OVERVIEW SATISFACTION OF PATIENTS Patients’ satisfaction after treatment was assessed by a simple Likert scale, where a score of 1 indicated no satisfaction, and a score of 5 indicated high satisfaction. Satisfaction was higher with plasma gel treatment compared with PDO threads, but without a statistically significant difference. Patients treated with PDO threads who showed satisfaction scores 2, 3, or 4 were 18 patients, 15 patients, and 7 patients, respectively. Meanwhile, patients treated with plasma gel who showed satisfaction scores 2, 3, 4, or 5 were 6 patients, 11 patients, 12 patients, and 11 patients, respectively (Table III). ASSESSMENT OF TREATMENT RESPONSE USING 3D ANTERA CAMERA Assessment of average melanin with PDO threads showed statistically nonsignificant reduction after 1 month of treatment and significant decrease after 6 months of treatment. Average hemoglobin showed statistically nonsignificant reduction after 1 and 6 months of treatment (Figures 5 and 6). eanwhile, assessment of average melanin with the plasma gel showed statistically significant reduction after 1 month of treatment and nonsignificant reduction after 6 months of treatment. Average hemoglobin showed statistically significant reduction after 1 and 6 months of treatment with more reduction after 1 month (Table IV). Average melanin response was better with plasma gel but without statistical significance. Table IV shows the statistically significant reduction of average melanin and hemoglobin after 1 and 6 months of the treatments done. The adverse effects encountered for included patients were mostly in the forms of erythema or bruising. A total of 27 patients (10 PDO and 17 plasma gel) complained of erythema (67.5%), and 12 patients (4 PDO and 8 plasma gel) complained of bruising (30%) (Table V). Antera 3D® (Miravex Limited, Dublin, Ireland) report of study showing infraorbital pictures of right (PDO threads) and left (plasma gel) for treating eyes of patient (1), melanin range level, melanin variation, hemoglobin average level, and hemoglobin variation (0, 1, and 6 months after treatment). DISCUSSION Periorbital hyperpigmentation (POH) may be caused by multiple etiologic factors that lead to postinflammatory hyperpigmentation and dermal melanin deposition. It may be aggravated with anemia, hormonal disturbances, nutritional deficiencies, and skin laxity. Smoking and disturbance in sleeping increase the possibility of POH (12). Environmental factors that may result in dermal melanocytosis include excessive sun exposure and drug reactions (13). Table III Satisfaction Scores by Patients Treatment Satisfaction score The p value 1 2 3 4 5 PDO threads 0 18 (45%) 15 (37.5%) 7 (17.5%) 0 0.399 Plasma gel 0 6 (15%) 11 (27.5%) 12 (30%) 11 (27.5%)

384 JOURNAL OF COSMETIC SCIENCE Figure 5. (A) Right eye treated with PDO threads, and (B) left with plasma gel for case 2