The Martius labial fat pad (MLFP) is a pedicle graft of fatty tissue from the labia majora, which can be used as an interposition layer during a variety of vaginal procedures. First described by Martius, the procedure is fairly simple and quick, allowing the surgeon to harvest a well-vascularized fat pad of variable length (typically 8–12 cm) and transfer it where needed to enhance the repair of complex or recurrent urethral or vesical pathology. We will briefly cover the indications and technique for this versatile procedure. However, as with any surgical technique, complications can occur, including hematoma, infection, pain or numbness, sexual dysfunction, and labial distortion. We aim to describe these complications as well as provide what information is available from the literature and our own experience on prevention and management when encountered.