Background and Aim: Although grafting of a tympanic perforation with temporalis fascia is the most frequent choice, several authors have used an adipose graft successfully for small tympanic membrane perforations. Fat graft myringoplasty is a suitable method for outpatient surgery with limited postoperative care because it does not require general anesthesia. The aim of this study is to evaluate the success of fat graft myringoplasty under local anesthesia and to elicit discussion of the utilities and advantages of a fat graft in small tympanic perforations.