Plant-based fat analogs are important alternatives to animal fats proposed in response to the strategy of low fat, low saturation, and sustainable development. Apart from possessing solid or semi-solid fat-analog structural properties, plant-based fat analogs also exhibit ideal rheological properties, making them highly suitable for food 3D printing. By utilizing 3D printing technology, it is feasible to personalize both the external (color and shape) and internal (nutrition and flavor) aspects of food, as well as plant-based fat analogs. Therefore, this review focuses on the research progress of plant-based fat analogs prepared based on 3D printing technology in the custom design of low-fat healthy food. This paper comprehensively reviews the latest advancements in manufacturing plant-based fat analogs from three perspectives: food hydrocolloids, oleogels, and emulsion gels. Then, starting with the printability of plant-based fat analogs, the food 3D printing technology and the printing characteristics of plant-based fat analogs are introduced. Next, strategies to adjust the printing stability of plant- based fat analogs to improve their plasticity and fidelity are discussed. Finally, the application prospects and limitations of plant-based fat analogs prepared by extrusion 3D printing technology in meat products, bakery goods, chocolates, and aerated food are discussed, which provides a reference for expanding the application of 3D printing in the field of fat-reducing and healthy food.