Abstract
Introduction: Orthognathic surgery (OS) is an important tool for correcting facial deformities. Autologous fat injection enables precise contouring and volumization in conjunction with OS to optimize aesthetics. Objective: To present key considerations regarding orthognathic surgery and aesthetics. Methods: The study followed PRISMA guidelines for systematic reviews and AMSTAR 2 criteria for methodological quality. Searches were conducted between May and July 2026 across the Web of Science, Scopus, PubMed, LILACS, EBSCO, SciELO, and Google Scholar databases. Study quality was assessed using the GRADE tool, and risk of bias was analyzed using the Cochrane tool. Results and Conclusion: A total of 137 articles were identified. Fifty-seven articles were evaluated in full, with 36 included and analyzed in this systematic review. Clinical studies showed homogeneity in their results, with a Chi-square (X²) value of 71.6% (>50%). Regarding the Cochrane risk-of-bias tool, the overall assessment identified 15 studies with a high risk of bias and 20 studies that failed to meet GRADE and AMSTAR-2 criteria. According to the Cochrane tool, the risks of bias did not compromise scientific progress. It was concluded that volume augmentation with adipose tissue can be a viable intervention for mild to moderate facial deficiency following orthognathic surgery. Most studies analyzed in this review demonstrated that fat grafting in orthognathic surgery is a safe and effective tool for improving healing and aesthetic outcomes, as well as for providing anti-inflammatory effects and reducing edema.