Objective This study was intended to determine the role of microautologous fat transplantation (MAFT) in dealing with severe sunken upper eyelids.Methods The authors performed microautologous fat transplantation (MAFT) procedure,particularly in accurately delivering small fat parcels,to treat 238 patients with sunken upper eyelids with multiple folds.Results The average total injection volume of fat were 1.8 ml in right upper lid (from 1.1 to 2.4 ml) and 1.7 ml in left upper lid (from 1.1 to 2.4 ml) separately.Only 3 cases encountered prolonged swelling more than 2 weeks.There were no severe complications.All patients were satisfied with the final results and 2 patients asked for secondary enhancement procedure.Conclusions The therapeutic effects of MAFT and the long-term clinical results of patients with sunken upper eyelids with multiple folds indicate satisfactory outcomes.