The authors describe the outcomes of 173 primary Dermis Fat Grafts (DFGs) and 66 secondary DFGs. Median follow-up for the primary group was 21.5 months and 14 months for the secondary group. Outcome measures included: prosthesis motility, prosthesis fit, patient / parent satisfaction and complications. After primary DFG motility was deemed excellent in 76%, patient satisfaction was excellent in 83% and prosthetic fitting excellent in 81%. After secondary DFG these results fell to: 34%, 57% and 49% respectively. The most common major complication following primary or secondary DFG was graft atrophy (3.5% after primary and 6.1% after secondary). The authors conclude that DFG is a useful option for augmenting orbital volume. The technique may have significant benefit in areas where allograft implants are not available or where implant infection may be a significant risk.