Fat Apoptosis Injection Therapy for Infraorbital Herniated Fat Pads

Background: Infraorbital herniated fat pads (“eyebags”) are a frequent aesthetic concern. Surgical blepharoplasty remains the gold standard but is associated with downtime and potential complications. Fat apoptosis (FA) injection therapy is a novel, minimally invasive approach that selectively induces adipocyte apoptosis, leading to volume reduction without surgical intervention. Objective: To describe the feasibility and short-term outcomes of FA injection therapy for infraorbital herniated fat pads in a small observational case series. Methods: This was an observational case series of 7 patients with infraorbital herniation who underwent FA injection therapy. The FA solution was prepared by combining ascorbic acid and ferrous gluconate in a 1:9 ratio. Injections were administered using a 30- to 32-gauge needle at 3 sites per infraorbital region (0.1–0.2 mL per site). Patients received 1 to 3 treatment sessions at 7- to 14-day intervals, depending on baseline severity and clinical response. Outcomes were evaluated using standardized photographs, physician assessment of contour improvement, patient-reported satisfaction, and documentation of adverse events. Follow-up in this series was short-term (maximum 2–3 wk), and no blinded photographic assessment or validated patient-reported outcome measure was used. Results: All patients demonstrated visible improvement in infraorbital contour. Early changes were observed within 24 to 72 hours postinjection, with progressive refinement over 2 to 3 weeks. Four patients with mild-to-moderate herniation achieved near-complete correction after 1 to 2 sessions. Three patients with severe herniation required up to 3 sessions and showed substantial, though partial, improvement. Adverse events were limited to transient erythema, edema, and tenderness in 7 patients, resolving spontaneously within 72 hours. No necrosis, ulceration, pigmentary alteration, or systemic complications were reported. Patient satisfaction was high, with 5 patients (71%) rating their results as “very satisfactory” and 2 (29%) as “satisfactory.” Conclusion: In this small case series with short-term follow-up, FA injection therapy was feasible and well tolerated and was associated with visible short-term improvement in infraorbital contour. These findings are hypothesis-generating; larger controlled studies with validated outcome instruments (eg, FACE-Q) and longer safety follow-up are required before definitive conclusions regarding efficacy, durability, and late complications can be drawn.