Facial fat transfer has become one of the most potent methods for facial rejuvenation. The two notable problems that have limited its widespread acceptance are the perceived absorption and dissipation of the transplanted fat and the risk of difficult complications such as lumps and bulges along the periorbital expanse. This article discusses these concerns and the long-term sequelae, particularly derivative benefits beyond volume contour changes such as textural improvements in the skin, ongoing improvements in the appearance of the grafted fat after months to years, and other structural changes.