Progressive hemifacial atrophy, also known as Parry-Romberg syndrome (PRS), is a rare disease characterised by atrophy of the skin, subcutaneous tissues, cartilage and mimetic muscles of the hemiface. More severe cases lead to degeneration of the bony framework and can be accompanied neurologic and ophthalmologic complications, alopecia areata and changes in hair colour. The resultant asymmetry can have considerable psychological sequelae and treatment aims to reconstruct the soft tissue destruction and restore facial symmetry [1]. PRS is classically treated with microvascular free flaps as the gold standard, however this is associated with significant donor site morbidity, extended operative time, and risk of major complications such as flap failure. Furthermore there is a loss of sensation, poor skin colour match and multiple debulking procedures are required to improve the aesthetic outcome [1,2]. Autologous fat grafting is gaining prominence as the preferred method of soft tissue reconstruction. The soft nature of the graft results in a natural contour and improved skin quality, using a procedure that is safe, inexpensive and repeatable, making it the ideal filler [2]. However the successful reported use of fat transfer to treat hemifacial atrophy as a soft tissue filler are limited due to the concerns of effective fat graft survival.

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We present a 48-year-old female patient who presented with features consistent with acquired partial lipodystrophy (APL) also known as ‘Barraquer-Simons syndrome’. It is a rare disease characterised by a gradual and progressive onset of lipoatrophy limited to the face, neck, upper limbs, thorax and abdomen and sparing the lower extremities. The resultant physical appearance can have significant psychosocial sequelae, further compounded by misdiagnosis and delay in recognition and management. Treatment is aimed at surgical correction of soft tissue destruction. Autologous fat transfer is an established plastic and reconstructive procedure that is safe and minimally invasive and can be used to reconstruct a variety of soft tissue defects and has shown to be an effective treatment modality in patients with APL.