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

Babyjoe,
Pearl fat grafting uses multiple (usually 3) small pieces of fat to plump the hollow eye caused by previous blepharoplasty. Composite fat grafting uses a custom formed whole piece of fat to fit into the hollow deformity. Both work well, and some favor the pearl method because they believe the "take" or survival of the graft will be better.
I use the whole "composite" graft technique because I like the uniformity of the result, and I "overgraft" to compensate for the dissolution of the graft during the time required for the graft to gain new blood supply. Final size and shape of the graft occurs between 4-6 months.
Do not confuse pearl grafting and composite fat grafting with fat injection techniques. Most doctors today are injecting fat through a syringe and calling it fat grafting. It should be called fat injection.
The take of fat that is injected is, in my experience less reliable than with fat grafting and pearl grafting. I believe the injection process damages the fat.
The fullness you note means that the grafts have taken, but I can assure you that they will decrease in size for 3-4 months, possibly longer.
I have my patients massage the swelling of the grafts which I believe helps the grafts settle in-but check with your doctor to make sure he approves of massage.
The hyperpigmentation can be easily removed with IPL treatments-I use the LuxGreen IPL made by Palomar.

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.