SIGNIFICANCE: Stromal vascular fraction (SVF) isolated from adipose tissue includes stem cells, growth factors, and other cellular components. Its regenerative potential and ease of procurement make SVF a potentially useful treatment for alopecia. AIM: To evaluate evidence on the efficacy and safety of autologous adipose-derived SVF for treatment of noncicatricial alopecia. METHODS: A systematic review of the literature was conducted utilizing MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials from inception to November 2020 for interventional and observational studies of SVF or similar adipose-derived stem cell (ADSC)-containing derivatives for patients with noncicatricial alopecia. Ongoing clinical trials were identified through ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform. FINDINGS: Of 4131 records, and 14 met inclusion criteria: 8 completed studies, including 3 randomized controlled trials and 5 case series or case reports, and 6 ongoing clinical trials. Collectively, 196 patients were treated in the 8 completed studies, and there were no reports of serious adverse events (AEs). Pain, headache, bruising and edema were the most frequently reported AEs. 7 studies reported increased hair density for patients treated with SVF, with mean change from baseline of 2.78 to 32.4 hairs/cm2. In 6 studies, this increase in hair density was statistically significant, though in some studies it was dependent on severity of alopecia and time post-treatment, suggesting that individual patient characteristics and treatment frequency may be important considerations. Ongoing clinical trials are assessing outcomes such as safety, hair density, and patient satisfaction. CONCLUSION: While the quantity and quality of evidence is limited, SVF may be an effective and safe treatment for alopecia. More clinical trials evaluating safety as well as optimal patient characteristics for treatment are needed.