This 22 year-old woman from Las Vegas came to Minneapolis Plastic Surgery for lip enlargement, but wanted permanent, non-lumpy, soft changes. Restylane and other fillers were temporary and costly. She underwent dermal fat grafting to her upper lip from a previous appendectomy scar donor site under local anesthesia. She has a smooth, soft, natural lip with normal sensation, and has maintained fullness for over 10 years. Dermal fat grafts are superior to fat-only injections (dermal grafts “take” uniformly, whereas fat injections can heal with lumps or irregularities and usually require multiple sessions) but dermal grafts do require a scar for tissue harvest. They may be repeated for additional fullness.