Purpose: To report our experience with the use of primary dermis-fat grafts in the pediatric population. Methods: The charts of 12 young patients under the age of 16 years who underwent dermis-fat graft implantation from 1992 to 2004 were reviewed and the functional and cosmetic outcome was assessed. Results: Ten patients had enucleation combined with primary dermis-fat grafting. Age at the time of surgery ranged from 4.7 to 16 years. One patient was lost to follow-up after 1 year; the remaining 9 had follow-up between 3 to 10.2 years. In 8 of them, appropriate orbital soft tissue volume and good orbital symmetry, with a good prosthetic fit and good motility, were observed. In one patient there was hair growth on the graft, managed by laser coagulation. One child developed central graft ulcer that was repaired. Two children experienced abundant growth of their implants, managed by surgical debulking. Two patients had undergone dermis-fat grafting of congenital anophthalmic sockets, age 13.6 years and 10 months, respectively, at time of surgery. The 10-month-old showed adequate orbital soft tissue volume along with deep fornices (follow-up 6.5 years); the second was lost for follow-up. Conclusions: Some minor complications with the use of dermis-fat graft in children occur, but they are easily managed. The dermis-fat graft in young children's orbits appears to grow after implantation. Due to its high degree of safety concurrent with excellent functional and cosmetic results, the dermis-fat transplant appears particularly advantageous for young patients.