Fig. 5. A. A 20/1000-inch split-thickness skin graft is elevated and a dermal fat graft obtained. B. The fatty portion of the graft is encased within the dermal shell. C. Dermal fat graft is inserted within Tenon's fascia and the four recti muscles are sutured to the dermal surface. D. Anterior Tenon's fascia is brought forward and also sutured to the dermal surface, as is conjunctiva.