Scars may represent more than a cosmetic concern for patients; they may impose functional
limitations and are frequently associated with the sensation of itching or pain, thus impacting both
psychological and physical well-being. From an aesthetic perspective, scars display variances in
color, thickness, texture, contour, and their homogeneity, while the functional aspect encompasses
considerations of functionality, pliability, and sensory perception. Scars located in critical anatomic
areas have the potential to induce profound impairments, including contracture-related mobility
restrictions, thereby significantly impacting daily functioning and the quality of life. Conventional
approaches to scar management may suffice to a certain extent, yet there are cases where tailored
interventions are warranted. Autologous fat grafting emerges as a promising therapeutic avenue in
such instances. Fundamental mechanisms underlying scar formation include chronic inflammation,
fibrogenesis and dysregulated wound healing, among other contributing factors. These mechanisms
can potentially be alleviated through the application of adipose-derived stem cells, which represent
the principal cellular component utilized in the process of lipofilling. Adipose-derived stem cells
possess the capacity to secrete proangiogenic factors such as fibroblast growth factor, vascular
endothelial growth factor and hepatocyte growth factor, as well as neurotrophic factors, such as
brain-derived neurotrophic factors. Moreover, they exhibit multipotency, remodel the extracellular
matrix, act in a paracrine manner, and exert immunomodulatory effects through cytokine secretion.
These molecular processes contribute to neoangiogenesis, the alleviation of chronic inflammation,
and the promotion of a conducive milieu for wound healing. Beyond the obvious benefit in restoring
volume, the adipose-derived stem cells and their regenerative capacities facilitate a reduction in pain,
pruritus, and fibrosis. This review elucidates the regenerative potential of autologous fat grafting
and its beneficial and promising effects on both functional and aesthetic outcomes when applied to
scar tissue.