Options for Reducing Under Eye Puffiness from Pearl Fat Grafting?

I had Pearl Fat Grafting to correct hollowness after lower Blepharoplasty. However, the area became puffy after the fat grafting. It has been 3 months and so far, there has been no improvement in the puffiness. I'd like to know, what are my options if the puffiness doesn't subside anymore?

Doctor Answers 6

3 months postop pearl fat grafting

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Fortunately, you are 3 months postop and you have another 3 months or so to go before you see a permanent or near permanent result.

You may want to talk to your surgeon about steroid injections or massage.

If this were the 6-month timepoint (which it is not), the problem becomes a little more complex.

In my experience the best method is to perform direct excision of the grafts rather than to perform a transconjuunctival blepharoplasty, liposuction of the fat, etc.

Your eye configuration is a difficult one since the globe is prominent and the cheekbone underneath the eye is somewhat flat, accentuating both hollowness and the bulging of the fat pushed forward by the globe (eyeball).

In my experience, a superficial cheeklift with lateral support along with direct removal of the grafts, and placement of a precise LiveFill (nontraumatized autologous fat-fascial) graft at the eye-cheek junction would suit your situation best. This procedure is technically complex and should be performed by surgeons with a familiarity with midfacial procedures. For a more complete discussion, you may wish to read our book chapter in Mathes on the subject, referenced below.

This solution would minimize the eye-cheek transition, get thicker tissues to cover the under-eye area, and allow precise placement of grafts.

Again, you are at 3 months so in my opinion it is premature to judge a final result, but you should definitely be communicating with your surgeon.

Beverly Hills Plastic Surgeon
4.9 out of 5 stars 195 reviews

Fat Grafting

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It looks as though the fat grafts have taken well. What I see is a hollow below the fat grafts. Perhaps more injections at the inferior border of the grafts would camouflage the area.  I woyuld be ceratin that the fat grafting is done with the viafill system - no overfill is necessary.

Robert M. Freund, MD
New York Plastic Surgeon
4.8 out of 5 stars 34 reviews

Pearl grafts can be contoured or removed after 6-12 months

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I agree that you should wait 6 months as the grafts may shrink a great deal more.

If after 6-12 months the Pearl Grafts are still causing puffiness, they can be contoured or partially removed.

I use a transconjunctival approach using a laser incision on the inside pink portion of the lower eyelid-this does not leave a scar and permits better visualization of the grafts.

I would avoid steroid injections. It is impossible to predict the amount of fat and soft tissue dissolving that occurs after a steroid injection. You may end up with a sunken depression where you now have puffiness, if you have a steroid injection. I have seen patients who have had steroid injections elsewhere and have been left with a divot or hollow area beneath their eye.

Fat grafting to the lower eyelids

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Fat grafting to the lower eyelids is a very effective and powerful procedure. In this area, a small amount of volume goes a very long way. For this reason it is incredibly important to work with a plastic surgeon who is very well versed in fat grafting techniques and blepharoplasty. If you have puffiness after such a procedure, keep in mind that approximate 20% of the fat that was transfer to this area will melt away on its own. You may be well served by being patient and waiting for your final result. If you continue to have small bumps from these fat grafts, it is possible to remove these bumps with a small incision or to inject these bumps with medication to help them contract and be less noticeable.

Pearl grafting for eyes

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I agree with advice to wait about a year.  One of the great limitations of PEARL grafting is that it only addresses the orbital fat but not the underlying cheek fat.  Looking at your pictures you also need to have the cheek (malar) fat augmented.

Sam Naficy, MD, FACS
Seattle Facial Plastic Surgeon
4.7 out of 5 stars 231 reviews

Consider the use of fillers

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It would be best to wait.

However, I would advise that you consider the use of fillers to the persistent tear trough and malar rim to achieve "blending" of the eyelid cheek junction.

The other option is to undergo a transconjucntiival removal of the lower eyelid fat pads.


Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 86 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.