Combination Therapy With Poly D–L Lactic Acid and Autologous Fat Transplantation for Infraorbital Rejuvenation

Background: Multiple approaches exist for treating infraorbital hollowing, including hyaluronic acid fillers and autologous fat transfer. However, traditional single-modality treatments often present limitations such as the Tyndall effect or unpredictable fat retention rates. Objective: To evaluate the efficacy and safety of a novel combination therapy using poly- D , L -lactic acid (PDLLA) with autologous fat transplantation for infraorbital rejuvenation. Methods: Eight patients (8 females) with varying presentations of infraorbital hollowing were treated with a combination of PDLLA and autologous fat transfer. Two formulations of PDLLA were utilized: a standard formulation for dermal injection and a volume formulation for subdermal placement. Fat was harvested using manual aspiration, processed via centrifugation (3000 rpm for 3 min), and injected using a systematic multilayer approach. Follow-up periods ranged from 6 to 14 months. Results: All patients demonstrated significant improvement in infraorbital hollowing and skin quality. The average volume of harvested fat ranged from 20 to 35 mL, with bilateral injection volumes of 1.8 to 3.2 mL. Treatment outcomes showed enhanced fat graft retention and improved skin texture across all cases. No significant complications were observed, and patient satisfaction was consistently high. Conclusions: The combination of PDLLA with autologous fat transfer represents an effective approach for infraorbital rejuvenation, demonstrating superior outcomes compared with single-modality treatments. This technique offers improved fat graft retention, enhanced skin quality, and natural-looking results with a favorable safety profile.