Objective To analyze the effect of different medical collagen implants combined with polylactic acid on TTRS scores in patients with periorbital aging. Methods A total of 90 patients with periorbital aging treated in Liuzhou Huamei Medical Cosmetology Clinic from August 2025 to October 2025 were selected, and they were divided into the control group, observation group 1 and observation group 2 by the random number table method, with 30 patients in each group. The control group was treated with polylactic acid, observation group 1 was treated with fetal bovine-derived typeⅠ/Ⅲ non-crosslinked active collagen combined with polylactic acid, and observation group 2 was treated with bovine-derived type Ⅰ/Ⅲ non-crosslinked solid microffbrillar collagen combined with polylactic acid. The TTRS scores, PARS grade, GAIS scores and complication rate were compared among the three groups. Results After treatment, the TTRS scores of observation group 1 and observation group 2 were lower than those of the control group (P<0.05). There was no signiffcant difference in PARS grade between observation group 1 and observation group 2 (P>0.05). The PARS grades of observation group 1 and observation group 2 were better than those of the control group (P<0.05). There was no signiffcant difference in GAIS score between observation group 1 and observation group 2 (P>0.05). The GAIS scores of observation group 1 and observation group 2 were higher than those of the control group (P<0.05). There was no signiffcant difference in the incidence of complications among the three groups (P>0.05). Conclusion The two combined regimens show comparable clinical efffcacy in improving periorbital aesthetics, tear trough deformity and aging, and both are superior to polylactic acid monotherapy, without increasing the risk of complications.