In 1969, Peretti began creating new jewelry styles for a handful of fashion designers in Manhattan. Her first design, working with a silversmith in Spain, was a two-inch bud vase made of sterling-silver as a pendant on a leather thong necklace, that was inspired by a find at a flea market. Worn in a runway show by one of Giorgio di Sant' Angelo's models, it was a hit. By 1971, she was designing jewelry for Halston. She continued to use silver, helping shift the material’s standing from "common" to a popular choice for Liza Minnelli and others. Minnelli recalled encountering Peretti’s work after Halston advised her to try wearing silver: “ ‘My god,’ I thought...All I could think of was Albuquerque. But then Elsa brought out all these things...Everything was so sensual, so sexy. I just loved it.”