The midface of youth is a full, vertically well-supported structure. Aging brings deflation of the midface associated with vertical descent. Reversal of this volume loss with fat grafting or other fillers has become a major recognized goal of aesthetic surgeons today. Fat grafting in reconstructive surgery is not a new concept. Excellent results may be achieved in most reconstructive and cosmetic surgery cases with well-executed lipotransfer. Attention to detail is important for rewarding results. Graft resorption can occur even in well-executed cases and patients should be appropriately cautioned.