Autologous Fat Grafting for Dark Circle Exacerbation Following Lower Eyelid Blepharoplasty

Background: Lower eyelid blepharoplasty (LLB) is a widely performed cosmetic procedure. Many studies have investigated its postoperative complications; however, most have focused on lower eyelid retraction and malposition, with little attention given to the exacerbation of dark circles. This study aims to analyze the mechanisms underlying this complication and to assess the feasibility and effectiveness of autologous fat grafting as a corrective approach. Methods: Thirty-two patients who developed dark circle exacerbation following LLB underwent autologous fat grafting between May 2023 and May 2025. The procedures included micro-fat harvesting, purification, and precise injection into the infraorbital region to restore volume and alleviate dark circle severity. Patient-reported improvement in dark circles was assessed at the final follow-up visit using a 5-point Likert scale. Results: Postoperative questionnaires showed that the mean dark circle improvement score was 4.19 ± 0.69. In addition, 93.7% of patients perceived improvement in the eyelid–cheek junction, and 68.7% observed improvement in the appearance of the pretarsal roll (aegyo-sal). Conclusions: Autologous fat grafting seems to be a safe and effective approach for managing dark circle exacerbation following LLB, demonstrating high rates of patient-reported improvement. This technique offers a valuable therapeutic option for this challenging postoperative complication.