Abstract: We introduce a case of blindness after a periorbital fat graft and its resulting court ruling in regard to a surgeon’s liability of compensation. A 19-year-old woman received an injection of preserved autologous fat to her nasal dorsum. During the injections, she complained of pain and lost vision of her right eye. The pupil responded to light but showed a blepharoptosis and a limitation of the extraocular muscle of her right eye. Upon a fundoscopy, a cherry red spot was observed. Brain magnetic resonance imaging and angiography showed an acute infarction of the ophthalmic nerve. Upon an angio–computed tomography, the ophthalmic artery branch was not visualized. Her right eye remained blind 3 weeks after admission. She claimed compensation for damage from the surgeon. The court determined a ruling in favor of the plaintiff (patient); however, the responsibility was limited to 70%. As a result, the defendant has to pay 84,750 US$ to the patient and 6450 US$ to her parents. Roe (the presiding judge) stated that in this case, the injected autologous fat seems to have been put into the ophthalmic artery and the central retinal artery along the vascular countercurrent because of excessive applied pressure. The court also said that because the plaintiff had a history of rhinoplasty, the defendant should have injected the fat more slowly at low pressure to avoid the vascular injury. We think there is a question about “how slowly and how low the pressure should be” for the fat injection. A further study of injection pressure, particle size, temperature, and release in the amount of fat for safe, periorbital, fat grafts should follow this study.