Free autogenous “pearl fat” grafts of 5–6 mm in diameter arc used as a method of soft tissue augmentation for the eyelid. This method is useful in restoring eyelid contour defects, separating the eyelid lamella to lower the upper eyelid crease, and augmenting eyelids in anophthalmos. Graft survival is variable and pretreatment of fat with insulin is used in an attempt to prolong fat survival. The rationale, indications, and surgical procedure are discussed.