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Treatment of Dark Circles with the New 15 mg/ml Hyaluronic Acid Filler
with Lidocaine
Sir, from Class III to Class 0  within a Madhuri Agarwal
In patients looking for improvement week of treatment and the results were Department of Dermatology,
in under eye dark circles, one of the maintained at 6 months of followup Yavana Aesthetics Clinic,
predominant clinical findings is tear trough [Figures 1c, 2c and 3c]. Hallmark Complex, Mulund
deformity (TTD). Soft tissue hyaluronic West, Mumbai, Maharashtra,
TTD correction with HA filler has India
acid (HA) fillers are an ideal treatment to
limitations as the existing portfolio of fillers
restore the volume loss in the tear trough
can cause high incidence of swelling, uneven
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 a b c
of the face. She was diagnosed to have Figure 1: (Front view) Patient treated for dark circles
with Volbella filler. (a) Baseline clinical picture taken
Class III TTD according to the Hirmand’s before treatment, (b) after a month, and (c) after 6
classification.[1] On the day of treatment months. Improvement in dark circles and tear trough
the patient’s baseline front, left, and right deformity is seen along with sustained results upto 6
months
profile view photographs before treatment
were taken using the Canon SLR camera
[Figures 1a, 2a and 3a]. 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
a b c
the supra‑periosteal plane throughout the
Figure 2: (Left view) – Patient treated for dark circles
circumference of the TTD till optimal
with Volbella filler. (a) Baseline clinical picture taken
correction was visibly appreciable.There before treatment, (b) after a month, and (c) after 6
was an instant, dramatically visible months. Improvement in dark circles and tear trough
improvement in the dark circles of deformity is seen along with sustained results upto 6
months
our patient after treating the TTD with Address for correspondence:
VYC‑15L filler. There was no evidence of Dr. Madhuri Agarwal,
Yavana Aesthetics Clinic,
any immediate or long‑term adverse effects 236‑239, 2nd Floor, Hallmark,
except transient redness and negligible LBS Marg, Mulund West,
swelling. The patient was called for a follow Mumbai ‑ 400 080,
up and the front, left, and right profile Maharashtra, India.
E‑mail: drmadhuri@yavana.in
views photographs were repeated to check
for the efficacy and longevity of the results. a b c
[Figures 1b, c, 2b, c and 3b, c] Show the Figure 3: (Right view) – Patient treated for dark circles Access this article online
results after 1 and 6 months, respectively. with Volbella filler. (a) Baseline clinical picture taken
before treatment, (b) after a month, and (c) after 6 Website: www.idoj.in
The Hirmand’s classification improved
months. Improvement in dark circles and tear trough DOI: 10.4103/idoj.IDOJ_381_18
deformity is seen along with sustained results upto
Quick Response Code:
This is an open access journal, and articles are 6 months
distributed under the terms of the Creative Commons
Attribution‑NonCommercial‑ShareAlike 4.0 License, which
allows others to remix, tweak, and build upon the work How to cite this article: Agarwal M. Treatment of dark
non‑commercially, as long as appropriate credit is given and the circles with the new 15 mg/ml hyaluronic acid filler with
new creations are licensed under the identical terms. lidocaine. Indian Dermatol Online J 2019;10:471-2.

For reprints contact: reprints@medknow.com Received: October, 2018. Accepted: December, 2018.

© 2019 Indian Dermatology Online Journal | Published by Wolters Kluwer - Medknow 471
 Agarwal: Treating dark circles in young patients with new 15 mg/ml hyaluronic acid filler
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.
472
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
1. Hirmand H. Anatomy and nonsurgical correction of the tear
trough deformity. Plast Reconstr Surg 2010;125:699‑708.
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.
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.
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.
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.
Indian Dermatology Online Journal | Volume 10 | Issue 4 | July-August 2019