Physician Successfully Eliminates Periorbital Dark Circles with Esthélis

Authors: Welf Prager, M.D.
Esthélis® from Anteis S.A. (Geneva, Switzerland) is not only a very effective dermal filler for the treatment of fine lines, superficial and medium wrinkles, it is also an ideal choice to replenish lost volume in the periorbital area, which is often characterized by dark circles under the eyes.

Developed by Anteis, Esthélis is also distributed by Merz Pharmaceuticals (Frankfurt, Hessen, Germany) under the brand Belotero® in Germany, Italy, Russia, U.K., Switzerland, Austria and the U.S. (Belotero Balance). The product continues to impress physicians and patients worldwide. While Esthélis Soft (20 mg/mL) is used for fine wrinkles and lines, perioral lines and crow’s feet, Esthélis Basic (22.5 mg/mL) is better suited for medium to deep wrinkles, as well as volume enhancement, and is often used to correct dark circles.

According to experts, Esthélis stands alone as the only highly cross-linked hyaluronic acid (HA) dermal filler that can be injected very superficially in the dermis, resulting in both natural and long lasting outcomes. Moreover, unwanted side effects, such as the Tyndall effect, are rare.

Esthélis has become the filler of choice for Welf Prager, M.D., a dermatologist at the Dermatologikum Clinic in Hamburg, Germany. “The properties of this filler make it ideal for the treatment of fine lines and wrinkles in the face and neck, as well as enhancing tissue volume such as in lips and the periorbital region,” he advised.

As a monophasic polydensified dermal filler, Esthélis is based on Anteis’ patented “Dynamic Cross-linking Technology”, which results in a cohesive polydensified matrix (CPM) consisting of different density zones in one cohesive structure. This unique structure gives the gel its ability to optimally diffuse into the targeted tissue and achieve a very even smoothing effect that bio-integrates homogeneously with the surrounding dermal tissue.

“During the aging process, the periorbital area slowly loses fat and collagen, resulting in dark circles and a sunken or hollowed look below the eye. Esthélis works great to replenish the lost volume in this area and has become my go-to dermal filler when correcting this indication,” Dr. Prager said.

Periorbital area before Tx	Periorbital area after Esthélis Tx Photos courtesy of Welf Prager, M.D.

“ Esthélis is the best filler for correcting dark circles. In my experience, no other HA fillers that can be used for this indication achieve results as good as Esthélis.”

When addressing dark circles in the infra-orbital region, Dr. Prager uses a blunt cannula to inject the filler sub-muscularly into the periosteum. Dr. Prager feels blunt cannulas not only help reduce the risk of hematoma, particularly in the periorbital area where the vasculature can be fragile, but also allow for a much more homogeneous distribution of product, helping to achieve smooth contouring results.

Dr. Prager typically uses 0.5 cc or less when correcting dark circles, as an overcorrection can easily occur in this region. “I prefer to slightly under correct and if necessary, perform a touch-up treatment at the follow-up visit. This is the best and safest approach to attain optimal aesthetic outcomes,” he noted. Though the cosmetic effect of Esthélis can last up to one year or longer, Dr. Prager typically has his patients return for follow-up nine months post-injection to determine whether a touch-up treatment is needed.

In Dr. Prager’s opinion, “Esthélis is the best filler for correcting dark circles. In my experience, no other HA fillers that can be used for this indication achieve results as good as Esthélis,” he concluded.