Systemic sclerosis is a rare autoimmune disease characterized by progressive fibrosis, microvascular dysfunction, and chronic inflammation, leading to significant functional and aesthetic impairments, particularly in the face and hands. Current therapeutic strategies are limited in their ability to reverse established skin fibrosis, prompting interest in regenerative approaches such as autologous fat grafting. Lipofilling and nanofat techniques, originally developed for volume restoration and skin rejuvenation, have demonstrated promising outcomes in improving skin texture, elasticity, and vascularization through mechanisms involving adipose-derived stem cells and stromal vascular fraction. This editorial reviews the available randomized controlled trials evaluating nanofat and lipofilling in the treatment of cutaneous manifestations of systemic sclerosis. A literature search identified four randomized controlled trials meeting inclusion criteria, primarily focused on facial fat grafting with or without platelet-rich plasma in corticosteroid-resistant patients. Although subjective improvements in skin quality were reported, methodological variability, small sample sizes, and non-standardized techniques limit the generalizability of findings. Given the autologous and minimally invasive nature of fat grafting, it represents a potentially valuable adjunct treatment for systemic sclerosis. However, further research, including multicenter registries and standardized protocols, is essential to better define its clinical utility and optimize outcomes in this complex disease.