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PURPOSE: To evaluate the effect of autologous periorbital fat injections on lower eyelid position. METHODS: Retrospective review of patients treated with autologous periorbital (malar/eyelid tear trough) fat injections for aesthetic purposes by a single surgeon (S.N.) between March 2007 and June 2011. The primary outcome, lower eyelid position as defined by marginal reflex distance 2 and inferior scleral show, was measured by standardizing and comparing pretreatment and posttreatment follow-up digital photos. Photographs were randomized and measured by 2 masked investigators. RESULTS: Seventy patients (5 male; mean age, 53; range, 33 to 77 years) were treated with autologous fat injections to the malar and lower eyelid tear trough for aesthetic purposes. A mean decrease in marginal reflex distance 2 of 0.5 mm in both OS and OD was found when pre- and posttreatment measurements were compared. Primary and secondary mean follow-up period was at 117 and 316 days, respectively. The effect of the autologous periorbital fat injection was not diminished (n=21) between follow-up periods. A mean change in scleral show of 0.5 mm was found when pre- and posttreatment measurements were compared. The overall mean follow-up period for scleral show was 125 days. Minor complications occurred in 7% (n=5) of patients who had postinjection subcutaneous induration. CONCLUSION: Autologous fat injections are well tolerated and have potential to be an effective adjuvant or primary treatment for mild lower eyelid retraction.