Autologous fat graft transplantation has become increasingly popular in recent years. The recognition that soft tissue volume loss contributes to the aging of the face has driven the use of this procedure. Tumescent lipoaspirate provides ready accessibility of tissue for this transplantation, despite some perceived deficiencies in the predictability of volume maintenance with this method. We report our experience with immediately processed sedimented fat transfer for facial grooves and volume correction. A retrospective review of a consecutive series of 75 autologous fat transfers from October 2008 to July 2011 in 8 female patients between ages 46 and 73 years was conducted at Georgia Health Sciences University. The grafting was performed to improve facial aesthetic contours. Twenty-two were performed for correction of grooves and creases: 12 for nasolabial fold, 4 glabella, and 6 nasojugal. Fifty-three transfers were performed for volume augmentation: 17 malar, 14 submalar, 11 lip, 8 temple, 2 chin, and 1 jowl. A tumescent technique with manual syringe harvest was used. The abdomen was the most frequently used donor site. The tumescent was decanted from the lipoaspirate. Oil and nonviable fat were excluded. Care was taken to reduce the time from harvest to transplantation, with no syringe transfers, minimizing potential oxidation and injury of the tissue. The mean volume of fat transferred was 24 mL (range, 4–54 mL). Mean follow-up was 25 months (range, 6–36 months). A second session of fat transfer was required in a small percentage. Complications included minor asymmetry in 1 patient (resolved with graft manipulation) and prolonged swelling in another. No postoperative cellulitis or fat necrosis was reported. Clinical evaluations and patients reported a satisfactory result 88% of the time. Patients universally reported (100%) a desire to have the procedure performed again. Autologous fat transfer for facial soft tissue contouring is simple, safe, inexpensive, and effective. Its ready availability, natural integration into host tissues, and potentially permanent correction make it particularly useful for this application. All patients were satisfied with the soft, natural appearance.