Objective To evaluate the efficacy and safety of autologous fat grafting combined with waist-abdominal liposuction for gluteal contouring. Methods A retrospective analysis was conducted on 80 female patients with waist-abdominal adiposity and poor gluteal contour treated at our hospital from January 2024 to December 2025. Based on the actual surgical procedure, patients were divided into an observation group and a control group, with 40 cases in each. The control group underwent liposuction of the waist, abdomen, and upper buttocks, while the observation group received simultaneous autologous fat grafting to the buttocks in addition to the same liposuction procedure. Waist circumference, hip circumference, waist-to-hip ratio, patient satisfaction, and complications were compared between the two groups preoperatively and at 6 months postoperatively. Results No statistically significant differences were found between the two groups in preoperative waist circumference, hip circumference, or waist-to-hip ratio (all P > 0.05). At 6 months postoperatively, the observation group had a significantly greater hip circumference and a lower waist-to-hip ratio than the control group (P < 0.05), while the difference in waist circumference between the two groups was not statistically significant (P = 0.232). The satisfaction rate in the observation group was 92.50%, which was significantly higher than the 75.00% in the control group (P = 0.034). There was no statistically significant difference in the overall incidence of complications between the two groups (P = 0.499), and no severe adverse events were observed in either group. Conclusion Simultaneous autologous fat grafting combined with waist-abdominal liposuction can further improve waist-to-hip ratio and gluteal contour, enhance patient satisfaction, and demonstrate acceptable short-term safety.