Numerous intrinsic and extrinsic factors, notably the aging process, contribute to the development of infraorbital dark circles. These features, commonly associated with old age and fatigue, are caused by a disruption of dermal melanin and impairment of skin barrier function. Common aesthetic concerns affecting patients with infraorbital dark circles are primarily owing to lean and translucent lower eyelid skin overlying the orbicularis oculi muscle. This study aimed to present a novel technique for correcting infraorbital dark circles utilizing an adipose-derived extracellular matrix concentrate-adipose collagen fragment (ACF)-to correct infraorbital dark circles. Female patients (n = 94) aged 20-38 who presented infraorbital dark circles were enrolled to assess the efficacy of this technique for an eight-month follow-up. Following intradermal injections with ACF filler, the clinical outcome was determined by responses to GAIS and patient satisfaction surveys. Statistical analysis was performed with the one-way ANOVA test, and a p value of < 0.05 was considered statistically significant. Patients (n = 92) completed a single treatment session and underwent an eight-month follow-up. Eighty patients (86%) reported being "highly satisfied" or "satisfied" with the outcome and responded that the technique resulted in brighter, tighter, and smoother infraorbital skin. Over 97% of patients were rated as "improved," "much improved" and "Very much improved" throughout the follow-up on GAIS by three independent surgeons (p < 0.05). The statistical analyses demonstrated the percentage differences among groups are highly significant (p < 0.0001). No irregularity or lump was observed during the follow-up. Two patients were excluded from the study due to having undergone cosmetic eyelid surgery. Intradermal ACF filler represents a novel approach to addressing infraorbital dark circles and yields significantly high patient satisfaction. ACF fillers provide a degree of bio-stimulation, and adipose-derived concentrate is a natural filler with regenerative effects used in periorbital rejuvenation. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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