Ballistic maxillofacial injuries are highly destructive, producing significant morbidity and mortality. Survivors’ defects pose unique reconstructive challenges, such as loss of periorbital bone stock in upper midface injuries. While orbital reconstruction has transitioned from primarily autologous grafts to alloplastic implants, ballistic trauma remains a niche that warrants the use of autologous bone equally with alloplastic materials. We report a case of an upper midface gunshot wound in a 20-year-old male producing bilateral comminuted medial orbital wall fractures. Reconstruction utilized bilateral split-thickness calvarial bone grafts through preseptal transcaruncular transconjunctival incisions. This case illustrates the utility of autologous bone grafts in the setting of lost periorbital bone stock and minimizing foreign body in surgical fields at high risk of infection or complication. Further studies are necessary to refine the indications for autologous bone grafting and its benefit relative to alloplastic implants in ballistic periorbital trauma.Copyright © 2021, Bicak et al.