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Autologous fat in both fresh and frozen forms has been used for many years as a filler for various dermatologic conditions. However, it is not clear whether fat that has been frozen survives as well as, and gives aesthetic results similar to, fresh fat. The efficacy of frozen fat has been debated in the literature.To evaluate the clinical aesthetic appearance and longevity of fresh fat versus frozen fat in a side-by-side two-hand comparison in the same patient.Ten patients underwent fat augmentation on their hands, utilizing 10 cc of fresh fat in one hand and 10 cc of frozen fat in the contralateral hand within 17 days of fresh fat placement. Follow-up evaluation was conducted at 1, 3, and 5 months in a randomized, double-blind comparison study. Physician-determined aesthetic preference, prominence of veins, and depth of metacarpal spaces were evaluated. Photographs were taken of both hands during each patient follow-up visit.All three areas of physician-assessed gradation: aesthetics, vein prominence, and depth of metacarpal space were superior for the hand injected with frozen fat at 1-, 3-, and 5-month follow-up visits.This pilot study supports the use of autologous frozen fat for equivalent to improved results regarding longevity and aesthetic appearance versus fresh fat at 1, 3, and 5 months for fat augmentation of aging hands.