Hyperdiluted triamcinolone injection therapy for infraorbital herniated fat pads

Abstract

Background: Infraorbital herniated fat pads are a frequent aesthetic concern and are commonly corrected surgically. Some patients prefer minimally invasive options, yet robust non-surgical volume-reduction approaches remain limited. Intralesional triamcinolone acetonide (TAC) is widely used in dermatology and other fields, and localized cutaneous/subcutaneous atrophy and lipoatrophy are recognized adverse effects. Objective: To report outcomes after treating infraorbital herniated fat pads with hyperdiluted TAC prepared at a 1:20 dilution with normal saline and to discuss steroid-related mechanisms affecting adipose tissue. Materials and methods: We conducted a retrospective case series of nine non-aesthetic-treated patients with infraorbital fat pad protrusion requesting non-surgical management. TAC was hyperdiluted 1:20 with 0.9% normal saline and injected as micro-aliquots into the target fat pad at the lid-cheek junction. Patients received 1-3 sessions at 4-week intervals. Standardized photographs were obtained at baseline and follow-up. Two independent physicians graded improvement using the Global Aesthetic Improvement Scale (GAIS), and patients rated satisfaction using a 5-point Likert scale. Adverse events were recorded. Results: Visible reduction of infraorbital bulging was observed in all patients (9/9). Improvement typically became apparent over several weeks and progressed through follow-up. Mild-to-moderate protrusion generally responded after one or two sessions, whereas more advanced bulging required up to three sessions with partial residual fullness. No serious complications were observed; transient edema, erythema, and tenderness resolved spontaneously. Conclusion: Hyperdiluted TAC (1:20 with normal saline) may provide a conservative, minimally invasive approach to reduce small-volume infraorbital fat protrusion, plausibly through controlled steroid-associated adipose atrophy. Given the known risk of unwanted atrophy, dyspigmentation, and contour irregularity with corticosteroid injections, this approach should be considered investigational and applied cautiously with appropriate anatomical expertise and follow-up. (c) 2026 The Authors. Published by Elsevier Ltd on behalf of British Association of Plastic, Reconstructive and Aesthetic Surgeons. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)