Free fat grafting, pearl fat grafting, dermis fat grafting. How does it work? And Is it a good option under eyes?

1) Dermal fat grafting under the eye -- avoid. Nobody does this anymore. Creates deformities.
2) Pearl fat grafting -- avoid. Same as #1
3) Fat grafting (free/micronized) is the gold standard if performed properly. Nano fat is used to improve skin, not volume.

Although different modalities have been used in the past to bring volume to the area of the cheeks and junction between cheeks and eyelid, current standard, at least for cosmetic purposes, is fillers and fat grafts. Small amount of live fat may be provided by transposition of the fat pads from the lower eyelid over the eyelid/cheek junction to smoothen tear trough deformity via transconjunctival lower blepharoplasty. In person consultation with a board certified plastic surgeon, with extensive experience in periorbital fat grafting, is recommended. Good luck.

There are really only two appropriate terms for the procedure of harvesting fat through liposuction and then grafting it in a different area. Technically this is called fat grafting but is often also called fat transfer. anything other than those two terms is some kind of marketing spin.
Personally I would avoid providers who use fancy words to describe procedures. Good doctors usually keep things simple and don’t try to use fancy words or gimmicky names for procedures.
Facial fat grafting is it difficult procedure to do well consistently. Grafting fat is inherently unpredictable and the fat can survive better in certain areas or all the fat can die and become hard lumps.
Success with grafting of any tissue requires a multitude of factors to be aligned correctly.
The biggest problem with fat grafting around the eyes is that the host tissue tends to be very thin so any defect or uneven contour can be easily seen. If the outcome is different than what you expected, then what? Removing grafted fat in this area is extremely difficult and usually requires open excision. This area is not amenable to liposuction and fat necrosis cannot be removed with Liposuction.
We all understand the appeal of fat transfer but many patients do not realize just how difficult and imprecise this procedure is. Creating facial aesthetic attractiveness is also an art form that not all plastic surgeons really know how to do.
For all of these reasons I recommend patients use fillers and if they want longer lasting results go to long lasting fillers.
In comparison to fat transfer, fillers are highly predictable, precise and extremely forgiving.
If you’re going to opt for facial fat grafting then you need to seek out the most talented and experienced provider in your community.
This requires a substantial commitment to time and effort.
It’s not possible to differentiate or find the most talented provider sitting in front of your computer.
It requires multiple in person consultations. During each consultation you need to ask each provider to show their entire collection of before and after pictures for facial fat transfer results especially for the area you’re interested in. you didn’t have to confirm that all after pictures were taken at least three months from the date of the procedure since early fat transfer pictures can look very impressive but do not at all represent final results. unfortunately providers can be tempted to take pictures during early post operative visits when results look plump and perfect but the fed has not dissipated and the final results end up looking very different.
An experience provider should have no difficulty showing you at least 50 sets of before and after pictures of his fairly common procedure.
Ask the provider to show you examples of results that are excellent, average including results that didn’t turn out as well as stay at hoped for. we all have them it’s simply a matter of asking to see them.
Being shown a handful of pre-selected pictures which most likely represent the best results of the providers career is insufficient to get a clear understanding of what average results look like in the hands of each provider.
Finally I recommend staying exclusively with board-certified plastic surgeons or board-certified official plastic surgeons with many years of experience, staying local for your procedure and avoiding virtual consultations.
Consider reading all reviews on various physician review websites avoiding providers with any significant number of justified negative reviews. The absence of justified negative reviews is more important and more telling than having an abundance of positive reviews.
In the end working with fillers is better, easier and as far forgiving if you don’t like the outcome. take a look at the webpage of Dr. David Mobrie in San Francisco. he is a facial plastic surgeon who’s work is exclusively devoted to working with fillers in facial aesthetics. His work is some of the best I’ve ever seen and is the gold standard for what can be achieved using just fillers. he does not offer fat transfer.
Best,
Mats Hagstrom MD