The survival of free fat used as an autograft is operator dependent and requires delicate handling of the graft tissue, careful washing of the fat to minimize extraneous blood cells, and installation into a site with adequate vascularity. There is evidence that fat cells will survive and that filling of defects is not from the residual collagen following cell destruction. There is some loss of fat after transplant and most surgeons tend to overfill the recipient site. The history of fat transfer survival is discussed with contributions from many physicians over 100 years.