<p>Facial autologous fat grafting is an increasingly popular technique to restore volume and recontour the face by harvesting adipose tissue from the abdomen and thighs, and injecting it across various planes. Accessibility, biocompatibility, and stimulation of endogenous angiogenic and growth factors are thought to be major advantages to fat as a filler material. Here we report a periorbital mass, which enlarged gradually over the course of four years, in a patient with a remote history of autologous fat grafting from the abdomen to the mid face for feminization during a single procedure eight years prior. A transconjunctival approach to biopsy provided definitive diagnosis of lipogranuloma, opportunity to recontour the adjacent tissue, and a scarless outcome. We thus endorse counseling patients considering facial fat grafting on the possibility of delayed lipogranuloma formation, on the scale of years.</p><p><i>Level of Evidence IV</i> This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors <a href="http://www.springer.com/00266">www.springer.com/00266</a>.</p>