Bakground <p>Autologous fat grafting (AFG) is a popular, minimally invasive method for facial rejuvenation, offering both volume restoration and improved skin quality. This systematic review and meta-analysis aimed to evaluate AFG for facial rejuvenation by examining volume retention, patient satisfaction and complication rates.</p> Methods <p>We followed PRISMA guidelines and registered the protocol with PROSPERO. A comprehensive literature search was conducted across six major databases to May 2025. We included randomised controlled trials, prospective or retrospective cohort studies and case series of adult patients undergoing AFG for facial rejuvenation that reported efficacy (volume retention, aesthetic improvement, satisfaction) and/or safety (complications, adverse events). Data were extracted into a structured spreadsheet and methodological quality was assessed using standard tools. Meta-analyses were performed using R software with random-effects models and the I² statistic to assess heterogeneity.</p> Results <p>The safety analysis showed a generally favourable complication profile. The pooled proportion of haematoma was 15.4% (95% confidence interval [CI] 10.7–21.7%). Palpable nodules occurred in 11.0% (95% CI 6.9–17.1%) of cases and fat over-grafting in 10.5% (95% CI 2.9–31.6%), with substantial heterogeneity (I²=86.0%). Chronic oedema was found in 7.1% (95% CI 3.1–15.4%), also with significant heterogeneity (I²=80.3%). Patient satisfaction was consistently high across 17 studies, with an overall pooled rate of 82.8% (95% CI 71.1–90.4%). Sensitivity analysis confirmed the robustness of high patient satisfaction, increasing to 86.4% (95% CI 82.0–89.8%) after removing outliers and notably reducing heterogeneity (I²=59.8%).</p> Conclusions <p>AFG appears to be an effective option for facial rejuvenation that is associated with high patient satisfaction in the available studies, but the predominance of observational designs and heterogeneity in techniques and outcome definitions limit the certainty of these safety and efficacy estimates. While complications such as hematoma, palpable nodules, over-grafting, and chronic edema do occur, their rates in the included studies were generally low to moderate; however, they appear higher than those reported in large multicentre registries and should therefore be interpreted with caution. High study heterogeneity underscores the need for standardized techniques and reporting in future research to improve comparability and inform clinical practice. Level of Evidence: Not gradable</p>