Currently, periorbital volume restoration can be achieved with the injection of a variety of available dermal filling agents, including hyaluronic acid derivatives (Restylane; Medicis Aesthetics Inc, Scottsdale, Arizona; Juvederm; Allergan Inc, Irvine, California). A calcium hydroxylapatite derivative (Radiesse; Bioform Medical Inc, San Mateo, California) can be effective when placed along the upper midface and malar eminence, but care must be taken when approaching the infraorbital rim given the thicker consistency of the product. Similarly, a poly-L-lactic acid dermal filler (Sculptra; sanofi-aventis, Bridgewater, New Jersey), which was recently approved by the Food and Drug Administration, also must be used with caution given the potential for granuloma formation in the periocular region, but interest has surfaced given its reported potential for longer-term efficacy. Previous authors24 and our group have learned the importance of thorough dilution of poly-L-lactic acid dermal filler with water, as well as avoiding the technique of a depot injection close to the orbital rim to avoid complications. Although the potential for limited recovery using these nonsurgical injections is a distinct advantage, all these dermal fillers are limited by their effective longevity, which ranges from 6 months to 1 year (possibly longer with poly-L-lactic acid dermal filler). Despite the wide availability of these alternative facial volume fillers, the advantages of autologous fat in the rejuvenation of the periorbital region are numerous, such as a sufficient supply of adipose tissue in most patients; lower expense compared with specially prepared synthetic dermal fillers; the biocompatibility, safety, ease of harvesting, and ready availability of fat; minimal tissue reaction caused by fat transfer; and potential longer-lasting effects of volume restoration provided by fat transfer.