Upper Eyelid Medial Fat Reduction and Pearl Grafting: A Modification and Review of Literature.

Background: With age, there is a progressive volume disparity between the prominent medial fat pad and the atrophic central fat pad of the upper eyelid. We present a literature review of upper eyelid fat redistribution techniques and describe a novel postseptal medial fat pad pearl grafting technique as an adjunct to upper eyelid blepharoplasty. Methods: Retrospective review was conducted of medial fat pad pearl grafting performed by a single surgeon between 2018 and 2024, with a minimum follow-up of 3 months. Medial and central fat pad volumes were graded by a masked observer using the Oh scale. Patient charts were assessed for adverse events such as irregularity, lipogranuloma formation, or revision surgery. Results: A total of 60 patients underwent the procedure, of which 45 met the inclusion criteria (86 eyelids). The median age was 60 years (range 38-90 y), with 91.1% female patients. Follow-up was for an average of 8.2 months (range 3-40 mo). Adjunctive procedures included ptosis repair (41), lower blepharoplasty (16), and other (3). Central fat pad volumes significantly increased from an average grade of 0.92 preoperatively to 1.73 postoperatively ( Conclusions: Medial fat pad postseptal pearl grafting is a useful adjunct to upper eyelid blepharoplasty, with a favorable safety profile, minimal likelihood of lumpiness, and effectiveness in reducing fat pad disparity.