Dermal and dermal-fat grafts have been utilized in six patients with facial contour defects. Evaluation of these patients and a review of the literature suggest the following principles: (1) Autogenous tissues are preferable to synthetic implants for long-term reconstruction, particularly in children. (2) Dermal and dermal-fat grafts are useful tissues for providing soft, natural appearing bulk to contour deformities of the face. (3) Epithelial cyst formation is rarely of clinical significance. (4) Dermal grafts have predictably less resorption than do dermal-fat grafts. (5) Multi-layered dermal grafts appear to be useful when greater bulk is needed than is provided by a single layer of dermis.