What's the Difference Between Pearl Fat Grafting and Fat Grafting? (photo)

Fat grafting is the procedure.
Pearl fat grafting in a technique.
Fat grafting can be accomplished using injections (closed technique), or surgical transfer (open technique) of pieces of fat with or without skin (dermis). These pieces can vary small to large. The pearl grafting technique uses an open technique with transfer of pearl sized pieces of fat. IT is generally practiced by oculoplastic surgeons.
It maybe that more of the fat survived than you would like. I would address this with your surgeon.

Pearl fat grafts are just what it sounds like - placing pieces of pearl size fat using an open approach. This is to be contrasted with lipoinjection, or structural fat grafting, where small amounts of fat are placed in a layered fashion to encourage better survival. In my experience there is more control and predictability with lipoinjection. 

Probably more important than the technique and the most important factor of all is the skill and experience of the surgeon. Always check out his/her before and after photos and ask to see long term results and most of all that he is trained and a board certified plastic surgeon by the American Board of Plastic Surgery or board certified Oculoplastic Surgeon.

Babyjoe,
Three months is early on in the healing process and the "puffiness" will probably get better. I am not a fan of Pearl Fat Grafting. Pearl Fat Grafting has been advocated by certain specialists. The technique involves inserting small "pearls" of fat as grafts into pockets created under the eyes. I think there are several problems with this approach:
1. The fat pearls are usually too big to have consistent graft survival, meaning there will be variability in the final graft size and thus total graft volume.
2. The fat pearls can be visible under the thin skin around the eye.
3. It is difficult to graft the entire area adequately with pearl grafts.
I prefer "micro fat grafting" to correct the tear trough and infra-orbital areas. The grafts are placed with a small needle-sized cannula with multiple passes from multiple directions and at different levels under the skin. I believe that this technique for volume restoration is superior to pearl fat grafting.

As other physicians have noted, I would agree that microfat transfer is a bit more reliable than Pearl fat grafting, though every physician has their preference and there is no scientific data to promote one over another. I would also agree that 3 months is early on in the healing process and would likely wait about 6 months before undertaking any other corrective procedures.

The photos look better, but I see your concerns. I think that if he filled you a little more in the tear trough you would not be as tired looking. The hyperpigmentation should resoolve with time- sometimes it takes 6 months to see resolution.

Look for doctors who perform the Viafill procedure.