Correction of infraorbital dark circles using collagenase-digested fat cell grafts.

Background A number of factors, including visibility of the orbicularis oculi muscle through thin skin, can cause dark circles around the eyes. Fat grafts have been used to augment the lower eyelid skin to correct dark circles, but irregularities caused by leaving visible lumps of the fat can occur. We used collagenase-digested fat cell grafts to correct these deformities. Methods and Materials Fat was aspirated from the medial thigh using the Coleman method. After centrifugation, the middle fat layer was segregated, digested using Clostridium histolyticum-derived type II collagenase, and mixed with Hartman's solution. The grafts were injected into the infradermal layer using blunt 22-G needles. Results Eighty-two patients were evaluated for improvement using photographic evidence; 55 (67.1%) showed improvement, 23 (28%) showed no difference, and four (4.9%) had worsened from preoperative findings. There were no visible lumps of fat, contour irregularities, or fat necroses. Postoperative edema and ecchymosis were minimal. Conclusion Collagenase-digested fat cell grafts provide another option for correcting dark circles by augmenting thin skin. Further histologic evaluation of the grafted collagenase-digested fat cells is recommended.