The present prospective study was designed to analyze the results achieved with intracordal autologous fat injection for aspiration in a series of 20 patients with recurrent laryngeal nerve paralysis. Swallowing was documented by having each patient swallow puréed food colored with methylene blue during nasofibroscopy. No laryngeal adverse effects were associated with the intracordal injection of fat. One patient developed an abdominal hematoma at the donor site. The intracordal injection of autologous fat after 1 year resulted in an 85% successful rehabilitation of swallowing. One of the three patients who failed the initial rehabilitation of swallowing was managed successfully with reinjection of autologous fat, resulting in a 90% definitive successful rehabilitation of swallowing. In all patients, speech and voice were immediately improved after the intracordal injection of autologous fat. Objective acoustic recordings documented the improvement in selected speech and voice parameters when compared with pretreatment data. Our presented experience shows that the intracordal autologous fat injection is a safe and valuable treatment option in patients with aspiration after recurrent laryngeal nerve paralysis.