Fat transfer is a cornerstone to managing facial aging and can represent a stand-alone procedure or be used in conjunction with other surgical treatments. Fat can also be used with fillers or as an alternative to fillers both for the benefit of educating surgeons and for improved patient communication to establish clear expectations of results. The surgeon should discuss these aspects with a patient in a preoperative setting to avoid false expectations. Fat is a bioactive substance and fat transfer should be avoided in very young patients, in those with weight instability, and in cases of asymmetric placement.