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Abstract: Objective: To assess the efficiency of autologous fat transfer (AFT/Coleman procedure) in the management of velopharyngeal insufficiency (VPI). Settings: Tertiary academic center, retrospective case series over a 4year period. Pre- and post-speech assessment by a speech pathologist using the Borel-Maisonny scale. Patients and method: Twenty-five (25) procedures were performed on 22 patients during the considered period. Mean age at surgery was 12.4±4.1years-old. Main associated conditions were 22q11 deletion (n =6 including 2 with cleft palate), isolated cleft palate (n =3), and Robin sequence (n =2). Indications were VPI grade 2a (n =5), 2b (n =11) and 3 (n =6), despite prolonged speech therapy (pre-op mean duration: 4.2years) and previous surgery (velopharyngoplasty, n =13). Four patients had a contraindication of velopharyngoplasty (aberrant internal carotid arteries). Results and conclusion: Fat harvesting sites were umbilicus (n =23) and buttock (n =2). Mean injected fat volume was 7.8ml, in the posterior wall of the pharynx (n =25) the soft palate (n =15), the peritonsillar arches (n =3), and the pre-existing flap (n =3). Mean follow-up was 17months. Two patients relapsed once and one patient twice, requiring additional injections. Final post-operative examination 1year after the last procedure showed an improvement of speech in 90% of cases (grade 1, n =2; 1/2a, n =5; 2a n =10; 2b, n =5). AFT is a safe technique indicated in the primary and secondary management of VPI, with stable results on speech. However, if a complete return to normal is difficult to achieve, its simplicity allows multiple procedures in the same patient. [Copyright &y& Elsevier]