Periorbital hyperpigmentation (POH) is a commonly encountered worldwide problem that is characterized by relatively dark coloration around the eyelids. Its difficulty is due to its resistance to treatment, complex pathogenesis, and lacking straight forward long-term therapeutic options. both PRP and adipose-derived stem cells are therapeutic options that could be used as an alternative form of therapy alone or in combination with other conventional treatments of POH. Research has to focus on standardizing the PRP and ADSCs formulations and have a consensus data from the clinical trials from different research groups for better prognosis and to use as an alternative to conventional therapies. In this study, we compare the effect of platelet rich plasma injection , depending on the fact that platelets secrete growth factors and cytokines that have a positive influence on tissue healing and regeneration, versus the effect of adipose derived stem cells , that release important growth factors necessary for wound healing, immune system modulation and reducing inflammation. Regarding the results of this study, Both fat injection and PRP are effective treatments of POH and were associated with improvement. Better response, patients' satisfaction was significantly associated with fat injection when compared with PRP. Patients' satisfaction and physician's evaluation were significantly associated with improvement. Both procedures were tolerated and accepted by the patients. Both modalities are promising and may represent a good temporary solution for the problem of POH.