Autologous Fat Grafting Provides Good Outcomes as a Soft-Tissue Replacement in Hemifacial Atrophy

Abstract

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.

Feasibility study of stem-cell enriched autologous lipotransfer to treat oro-facial fibrosis in systemic sclerosis (Sys-Stem): Protocol for open-label randomised controlled trial

“…Oro-facial fibrosis is recognised as a cause of significant concern in SSc patients and yet there has been no effective treatment to target skin fibrosis. Emerging studies reporting clinical improvement after autologous lipotransfer are encouraging and support the use of this well-established surgical technique as a novel therapeutic approach in these patients [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] . It is postulated that antifibrotic effects are mediated by adipose-derived stem cells (ADSCs).…”

“…Autologous lipotransfer is a minimally invasive surgical technique that is used for correcting volumetric deficits and soft tissue, however is now finding a role in fibrotic conditions [9] , [10] . Our group and others have suggested that it may improve skin fibrosis in different conditions including hypertrophic scars, burns, radiation-induced fibrosis, lichen sclerosis, and hemifacial atrophy [11] , [12] , [13] , [14] . Autologous lipotransfer has been also reported in small cohorts of SSc patients with facial or hand involvement [15] , [16] , [17] , [18] , [19] .…”