Abstract
<title>Abstract</title> <p>Background Revision after aesthetic gluteal fat grafting is poorly standardized because subsequent procedures may represent corrective revision, elective enhancement, touch-up treatment, or planned staging. We evaluated whether current evidence supports a five-year cumulative revision incidence and summarized reported indications. Methods The verified evidence set comprised 159 records identified across PubMed, CINAHL, and Google Scholar through Jul 28, 2026. Eligible adult primary aesthetic gluteal fat-grafting studies reported a derivable revision, reoperation, repeat, or touch-up outcome. Strict and expanded outcomes were analyzed separately. Study-specific proportions and Wilson 95% confidence intervals were displayed without pooling. Results Seven Level IV studies (1,555 patients) were included. Five reported strict revision/reoperation counts and all seven reported expanded repeat/touch-up counts. No study provided complete five-year follow-up or a time-to-event estimate sufficient for five-year cumulative incidence. Strict and expanded study-specific proportions each ranged from 0.0% to 40.9%. Among 48 classifiable procedures, 35 (72.9%) addressed additional volume or undercorrection, 10 (20.8%) asymmetry or contour, 2 (4.2%) excess lateral volume, and 1 (2.1%) marked resorption. All studies were judged overall high risk of bias. Conclusions Current evidence cannot establish a reliable five-year revision incidence. Standardized definitions and longitudinal time-to-event reporting are required to distinguish corrective revision from elective or staged repeat treatment. Level of Evidence: No level assigned (Review Article).</p>