The use of fat grafting as a treatment for radiation and thermal injury is a recent application of a historically well-described operation. The autologous transplantation of fat has been used to treat reconstructive and cosmetic concerns for the past century. In those suffering from tissue fibrosis, contractures, and deformity, the importance of fat grafting is exaggerated because of the relative paucity of alternative solutions. Adipocytes recently have been popularized for their ability to regenerate and transform. Although large-scale randomized studies have not been performed to examine the effects of autologous fat transfer in patients suffering from thermal injury and tissue damage, smaller in vivo and in vitro studies have demonstrated reliable and reproducible improvements in tissue quality after fat grafting has been performed. The goal of this review of fat grafting in thermal injury is to describe the development of this technique from its historical roots to its current state using in vivo and in vitro models, to delineate the clinical indications for use, to describe variations in techniques, and to shed light on future applications of this seemingly simple, yet multifaceted management strategy.