Purpose: To report a new technique in the repair of lower eyelid malposition using dermis fat as a posterior lamellar spacer graft. Design: Retrospective, consecutive, nonrandomized interventional case series. Participants: Eleven patients who underwent surgical correction for symptomatic lower eyelid malposition using dermis fat as a spacer graft. Methods: Patients with symptomatic lower eyelid malposition after blepharoplasty, trauma, craniofacial syndromes, and human immunodeficiency virus-associated lipodystrophy were treated with midfacial lifting combined with dermis fat posterior lamellar spacer grafting. Main Outcome Measures: Preoperative and postoperative measurements of eyelid position, margin-to-reflex distance (defined as the distance from the upper eyelid to the central corneal light reflex and the distance from the lower eyelid to the corneal light reflex), lagophthalmos, corneal staining, presence of ocular surface symptoms, and patient satisfaction. Results: All patients who underwent dermis fat spacer grafting during lower eyelid malposition repair noted improvement in ocular surface symptoms and restoration of normal eyelid position. Conclusions: Dermis fat is a novel posterior lamellar spacer graft and offers numerous advantages over conventional lower eyelid spacer grafts for repair of lower eyelid malposition.