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Dark Circles. 
Dark circles, is among the most common problems that affect the skin around the eyes. Dark circles are known in medical parlance as Idiopathic cutaneous hyperchromia of the periorbital rim.
The skin of the eyelids is the finest of the whole organism and allows easily to visualize the changes that occur below it.

According to histopathological studies that I made, this discoloring of the skin of the eyes is due in most cases to excess production of melanin and dilated capillaries near the skin surface.

These changes tend to follow the anatomy of the orbicularis oculi muscle surrounding the orbit.

Dark circles treatment
using Fire-Xel laser.


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Predisposing factors.
- Hereditary dark circles, family history: dark circles have a genetic predisposition.
- Dark circles caused by repeated episodes of irritation.
- Dark circles in Patients with diseases such as hyperthyroidism, heart, kidney, etc.
- Dark circles due to skin aging, excessive sun exposure increases melanin eyelids.
- Dark circles lighting effect produced by patients with prominent cheek bones.
- Hormonal changes also affect the color of the skin of the eyelids. Is how dark circles accentuate days before or during the menstrual period and during pregnancy.

Types of Dark Circles.
The color of the dark circles can be brown, purple or black.
Brown and black colours occurs primarily in patients with dark skin. While violet appears on whiter skin patients.
Dark circles can be presented as a single entity in very young patients or associated with fine wrinkles, deep furrows or festoons of skin. It also can occur without excess eyelid or bulging bags of them.
The indication for treatment will be directly related to what type of dark circles you have and your availability to be treated.

What you can do to start reducing dark circles?
- Do not smoke.
- Drink plenty of liquids.
- Try to sleep well.
- Try sleeping with your head slightly elevated to drain fluids.
- Avoid irritating your skin either by the sun or cosmetic products.
- Use sunscreens.
- Eat a healthy diet. Avoid salty foods, increase water retention.
- Moisturize your skin daily. Consult your dermatologist or aesthetician about what products are best suited for you.

Blefaroplasty and dark circles treatment
using laser


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Treatments.
- Moisturizers and Antioxidants.
- Decongestants.
- Lymphatic drainage.
- Peeling with different acids.
- Helios II Laser depigmentation.
- Radiofrequency with micro needles (Scarlet).
- Erbium Laser (Lotus II).
- Carbon Dióxide Laser (Firexel).
- Laser assisted surgery with carbon dioxide.

How you should know what is the most appropriate treatment for you?
If the color of your eyelids is dark but does not show wrinkles, sagging or adipose bags, It is best to begin with a cream based treatment for skin lightening and chemical peels.

If you performed these treatments and did not get all the results you want, perhaps it is best to perform a depigmentation treatment with the Laser Helios II. The Helios II Laser treatment is done monthly or bi weekly. There won't be irritation of the treated skin and you can continue immediately with your activity. From the third session your skin will improve in color, texture and tone.

If you are looking for a fast and effective treatment, then what I recommend is the peeling with the carbon dioxide laser "Firexel".

As we see in this Histopathological study, melanocytes are responsible for the dark color of the skin of the eyelid and are located at the dermal epidermal junction.
MELANIN DEPOSIT
How does the Carbon Dioxide laser works?
The carbon dioxide laser "Firexel" besides having a skin analyzer allows us to choose the depth of ablation. For younger patients, without wrinkles and in which there is only the dark pigmentation of the skin of the eyelid, we use a 600 microns spot tip which allows us to exfoliate to the basal membrane.

In the next image you can see the effect of fractionated laser ablation to the basal membrane.

The compact and darker tone tissue you can see below the basal membrane is produced by the thermal effect of the colagenesis at the dermis.


This Biopsy clearly shows how the ablation occurs only in the outer superficial layer of the skin, more specifically at the level of the basal membrane.

These patients will have a very quick recovery because the thermal effect is superficial and the result will be excellent and durable.


For those patients who also have dark color excess skin from the eyelids, we will use the carbon dioxide laser with 300 micron spot tips, thus, reaching and tightening collagen deeply in the skin.
The tightening effect on the skin increases as months goes by and lasts many years afterwards.
Some comments from patients:
"My eyes had a dark coloration as if I was feeling tired, I thought there was no solution, it was difficult to change the color of the skin, and I could not find another way to fix it other than makeup. Consulting with Dr. Ricardo Hoogstra for surgery of the nose, he suggested to perform removal of the eye bags, he explained to me that there won`t be any scars and that I will recover quickly he also suggested to perform at the same time Carbon Dioxide Laser treatment. After 7 days I had a new skin, brighter and with no traces of pigmentation that I ever had. Following post care directions from the clinic team, evolution was not problematic. I appreciate the suggestion, I'm glad I made along the nose, eyelids, and laser. It seems a lot of treatment but in return my recovery was fast." 
"Dr. Ricardo Hoogstra explained that the excess skin on the upper eyelid was due to a lowering effect on the forehead. He suggested performing an endoscopic lifting procedure, transconjunctival blepharoplasty and whole face carbon dioxide laser. I was sedated during the treatment and felt nothing, except for a small burning that disappeared when I got home. After 10 days my skin felt normal again, so now I can retreat again. It's amazing; I have to see old pictures of myself to recall how my skin looked like. I see myself wonderfully and I have a lovely and w soft texture skin. Even when I do not make any mention of the treatment I did, people around me noticed my change and were surprised."
For more information about this technology:
Wrote:
Dr Ricardo Hoogstra
Ricardo Hoogstra, Medical Doctor ; General surgeon, Plastic Surgeon, Ex.Chief of plastic surgery at Penna Hospital; Proffesor of the University of Buenos Aires, medicine university, Fellow of the International Aesthetic Plastic surgery Society, Fellow of the Argentinian Society of Plastic Surgeons. Dr. Hoogstra has pioneered several new procedures based on Invasive as well as Non Invasive therapy and surgery devices that he help to establish around the world for several manufacturers worldwide). This gave him worldwide acclaim and recognition. He has lectured extensively on techniques to enhance and maintain a better contour of the neck and facelift procedures as well as eyelid and eye bag . In addition, he has also written and devised procedures for aesthetic and reconstructive surgeries using several new laser technologies. Dr Hoogstra continuously travels around the Americas , Europe and Asia giving lectures and workshops on several cosmetic and reconstructive plastic surgery methods. He is internationally renowned and has been invited to lecture and demonstrate surgery in many countries around the world.
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Ciudad de Buenos Aires, Argentina
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