Autologous fat transplantation is indicated for the correction of wrinkles, depressed or atrophic areas in the face  and volume loss in the aging process . Fat injections are more successful in facial areas due to the availability of a richer vascular supply . Autologous fat implant is readily available, inexpensive, host compatible and can be harvested easily and repeatedly when needed, without promoting allergies or foreign body reactions . However, the disadvantages of using this material are its high viscosity and lower rates of success, especially when used for changes that occur due to aging .
Longevity of the correction is unpredictable, depending on the harvesting and transfer techniques of the fat . Undesired dislocation of the prosthetic material to more superficial parts of the lips could be attributed to frequent movement in this area [3, 6] and ptosis induced by gravity. The lipofilling used in facial sites shows a very high risk of developing nodules of adipose tissue and other visible irregularities  that cause undesirable cosmetic effects, as occurred in this case. The amount of fat transferred can play a role in the degree of volume retention and in the onset of contour problems . In addition, fat has an unpredictable resorption rate in the perioral region [2, 3, 7].
Differential diagnosis of this case was unsatisfactory esthetic treatment and double lip. Double lip is a rare oral abnormality, characterized by a deformity of the lip, in which a fold of labial mucosa is evident at rest or smiling . Double lip, blepharochalasis and thyroid enlargement are features of Ascher Syndrome . Microscopically, it presents as hyperplasia of the salivary gland and of squamous epithelium . In this study, the patient only presented the appearance of “double lip”. Monhian et al.  have reported inflammatory response and fibrotic tissue without the presence of adipocytes in biopsies from local implantation of autologous fat graft. In this report, mature adipocytes and muscle fibers were observed. The final diagnosis was based on clinical exam and microscopic evidence.
Surgical treatment was performed for esthetic concerns. However, the treatment of patients with similar clinical appearance could be necessary due to alterations in phonetics, mastication and difficulty in wearing a prosthesis . The patient decided not to perform surgery on the contralateral side and she was satisfied with the outcome.