Importance In addition to the physical deformity, there is often great psychological burden of facial scars for patients. In this study, we use condensed nanofat combined with fat grafts in a novel technique to improve atrophic facial scars by raising both the surface and the bottom of the affected area. Objective To assess whether the use of condensed nanofat combined with fat grafting can be effective in treating atrophic facial scars from both an aesthetic and a functional perspective. Design, Setting, and Participants In this prospective case series of 20 patients with 25 atrophic facial scars, each scar was treated with condensed nanofat combined with fat grafts at the Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, Zhejiang, China. Postoperative results were evaluated by the patients themselves and by 3 senior plastic surgeon observers. Main Outcomes and Measures Multiple preoperative and postoperative examinations included the use of the Patient and Observer Scar Assessment Scale (POSAS) to evaluate both the functional and aesthetic aspects of the atrophic facial scars. Punch biopsy specimens were stained for the presence of melanin, elastic fibers, and cytokeratin (CK) 14 and CK19. Images were analyzed using ImageJ software, and the data were analyzed by paired sample t test. Results Twenty patients (6 men and 14 women; mean age, 38.25 years; age range, 21-62 years) with a total of 25 atrophic facial scars were treated between March 2014 and December 2016. The patients' mean (SD) scar assessment scores were significantly decreased postoperatively in the final examination for color, 6.40 (0.51) vs 2.40 (0.24) (P < .001); stiffness, 7.20 (0.37) vs 3.20 (0.20) (P < .001); thickness, 5.80 (0.73) vs 1.80 (0.37) (P = .001); and irregularity, 5.20 (0.49) vs 2.20 (0.37) (P = .003); and the observers' scores were also significantly decreased for pigmentation, 4.40 (0.51) vs 2.00 (0.32) (P = .004); thickness, 3.00 (0.32) vs 1.80 (0.20) (P = .03); relief, 4.40 (0.51) vs 2.40 (0.24) (P = .003); and pliability, 4.20 (0.37) vs 1.40 (0.24) (P < .001). In the final follow-up examinations, a significantly improved overall POSAS score was found among both patients, 28.80 (1.02) vs 12.20 (0.80) (P < .001), and observers, 18.00 (0.71) vs 9.20 (0.37) (P = .001). Enhancement of Fontana-Masson staining of melanin in the basal cell layer was observed postoperatively, and a significant postoperative change was detected for the mean (SD) values of average optical density from the preoperative measurement, 0.671 (0.083) vs 0.844 (0.110) (P = .01). The sebaceous glands and sweat glands that were not found in the preoperative images were seen postoperatively by immunohistochemical staining with CK14 and CK19. Conclusions and Relevance Our preliminary clinical and pathological results indicate that the use of condensed nanofat combined with fat grafts may be an effective approach to treating atrophic facial scars from both an aesthetic and a functional perspective. Level of Evidence 4.