Localized and circumferential atrophies of the lower extremities have been difficult to treat with few simple autologous solutions available. The aim of this study was to analyze the efficacy of fat grafting in lower limb atrophies. There were 20 patients (17 females and 3 males) at an average age of 33 years. Twelve patients had localized and 8 patients circumferential atrophies of various etiologies: traumatic (60%), congenital (25%), and iatrogenic (15%). The average number of fat injections was 1.1 per patient (range 1-2) for localized atrophies and 2.2 per patient (range 1-3) for circumferential atrophies. The average follow-up period was 2 years. The average volume injected at each stage was 79 mL for localized atrophies and 137 mL for circumferential atrophies. In the cases of circumferential atrophies, an average augmentation of 1.9 cm (range 1-6 cm) of the limb perimeter per injection was achieved. The overall satisfaction of the patients was high. Autologous fat grafting is a reliable technique for lower limb atrophies.