Autologous adipose tissue has been used for tissue augmentation for over a century. The technique still remains controversial and some investigators have given up on fat transfer. The authors' objective is to improve the retention of the fat graft by using less traumatic methods to collect the fat, to concentrate it, and to reinject it to obtain more reliable augmentations for the cosmetic improvement of tissue defects. The fat is collected from the donor site following tumescent infiltration of the tissue. A Mercedes cannulae is used with a vented syringe. The fat is centrifuged to remove excess tumescent fluid or demineralized bone powder is added if a more dramatic, firmer augmentation is required. Small filaments of fat are placed in multi-layers throughout the area of the desired contour change. Residual processed fat is frozen for second and third injection sessions, if needed. These fat transfer methods yield retentions of 20% to 120% of the injected volume. After 60 to 90 days the implant is stabilized and becomes permanent. Other than bruising, a rare case of bacterial infection, or an occasional divot at the donor site, the autologous fat transfer has proved a useful method to improve contour defects.