A microsurgical approach combined with lipoinjection in the treatment of progressive hemifacial atrophy from Parry-Romberg syndrome.

Parry Romberg's syndrome is a rare condition characterized by an acquired, idiopathic, self limited, unilateral atrophy of the face. The etiology of the disorder remains poorly understood. The onset is slow and progressive; Romberg's disease usually begins during the first two decades of life and is more common in the female population (female-to-male ratio of 1.5 to 1). The atrophy is unilateral in 95% of cases. The right and left sides of the face are involved with equal frequency. Usually the soft-tissue loss persists from 2 to 10 years, following which the process seems to enter a burn out phase and becomes stable. The only available treatment is surgical. Progressive hemifacial atrophy can manifest in different grades of severity and the main symptoms usually are: wasting of subcutaneous fat (malar region, lateral mental region, brow, paramedian forehead, sclerodermia areas, pigmented and atrophic skin, bone hypoplasia (Rx), facial muscolature atrophy (e.g. temporal muscle), facial musculature spasms (e.g. masseter), ophtalmpathies (papillary disturbances, exudative neuroretinopathy, optic nerve dysfunction), autoimmunitary diseases, and neuropathies. Most patients accept only soft-tissue augmentation, refusing surgical treatment of the involved bones. Many different reconstructive techniques directed at augmentation of deficient soft-tissue volume have been reported in Parry Romberg syndrome surgical correction. To avoid the disadvantages found in most of the techniques, we used, like other authors, a reconstructive technique based on a de-epithelialized parascapular free flap combined with autologous fat graft lipoinjection, as described by Coleman in the treatment of a severe case affected by Parry-Romberg syndrome. Free parascapular flap transfer combined with Coleman's lipoinjection is in our opinion the procedure of choice for facial contour restoration. These operative procedures are synergic: together they can provide an excellent reconstructive solution directed at restoration of the facial morphology in terms of natural appearing and long-lasting results with minimal donor site morbidity.