Autologous Fat Grafting in Management of Patients with Progressive Hemifacial Atrophy

Abstract

Background: Progressive hemi facial atrophy or Romberg disease is a rare neurocutaneous syndrome characterized by slow progressive atrophy on one side of face involving skin, subcutaneous and connective tissue. Various methods have been described for soft tissue augmentation in patients with progressive hemi facial atrophy. Autologous fat, dermofat, fascial grafts have been used for grade 1,2 and 3 atrophy. Free flaps, cartilage and bone grafts are described for grade 3 and 4 atrophy. Aims and objectives: To study efficacy of autologous fat graft in patients with grade 1, 2 and 3 hemi facial atrophy. Strategies to reduce fat absorption and to calculate approximate amount of fat required required by facial mask template. Observations: It is a prospective study conducted in Department of plastic surgery, Bangalore Medical college and Research Institute, Bangalore in 10 patients with grade 2 and 3 Progressive hemi facial atrophy. All patients with stable non-progressive atrophy were graded for severity of disease and face-mask templates were prepared by pro-sthodontists to know approximate amount of fat required for injection. Fat was aspirated by low-pressure small suction cannulas manually and infiltrated at multiple points and in multiple planes after sedimentation and separation of fat. Five of the patients with grade 2 and 3 of patients with grade 3 atrophy were satisfied with symmetric face and with emotional betterment. Two patients needed repeat fat grafting after 2 years of follow-up. Conclusion: Autologous fat grafting is a simple and safe method for augmentation of soft tissue in patients with grade 1, 2 and 3 Progressive hemi facial atrophy. Aspiration of fat with low-pressure small cannulas and infiltrating in multiple planes improves fat survival. Preparing face-mask templates gives an idea of approximate volume of fat required. Keywords: Progressive hemifacial atrophy, Autologous fat grafting, Face-mask templates, Strategies for decreased fat absorption.