Although there are numerous clinical reports relating to the injection of adipose tissue fragments, only few histological assessments of the histology of these grafts in late follow-up have been made. The authors report a case of adipose tissue harvested with a sharp cannula using low-pressure suction and injection in the lower eyelid areas with subsequent sagging of the graft, although maintenance of volume, after 2 years. The operative corrective procedure consisted of a lower blepharoplasty and removal of the sheathed graft. Histology showed extended oil cysts and a surrounding capsulelike structure. The volume of the graft consisted mainly of oil cysts, and not healthy adipose tissue. The conclusion is that the harvesting procedure damages fragile adipocytes. The outcome of adipose tissue injection thus remains unpredictable. The only reliable guarantee for a good long-term outcome after lipofilling is a specimen biopsy showing healthy adipose tissue.