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Autologous lipoinjection in Parry-Romberg syndrome.

Parry-Romberg syndrome (PRS), or progressive hemifacial atrophy, is characterized by focal and progressive atrophy of facial skin and soft tissue. It usually affects one side and may include medial canthal malposition, enophthalmos, and skin hyperpigmentation. (1,2) PRS often presents during the first and second decades of life, affects women more than men, and may continue to worsen for another decade before reaching a stable phase. (3) Its etiology remains unknown but may be related to autoimmunity, viral infection, trauma, and/or inherited genetic mutation. (1)

A 28-year-old woman presented to us with right facial atrophy but with normal movement and sensation. She was diagnosed with PRS and underwent abdominal fat harvest and lipoinjection to the right face. Her preoperative appearance is shown in figure 1.

The procedure was as follows: 2 ml of 1% lidocaine with 1:100,000 epinephrine was injected along the inferior aspect of the umbilicus. Then, 100 ml of 0.25% lidocaine with 1:400,000 epinephrine was injected along the lower abdomen. After 10 minutes, a 10-ml syringe with a fat harvesting cannula was used to extract fat under low manual negative pressure through a 1-cm incision. The cannula was fanned evenly throughout the lower abdomen in the fat layer. A total of 60 ml of fat was harvested.

The harvested fat was transferred to several 10-ml syringes and centrifuged for 3 minutes. The supernatant and infranatant were discarded, and the bottom 2 ml of fat left in the syringes was transferred to 1-ml syringes. Several stab-incision ports were made in the face with an ophthalmic blade. Using various sized cannulas, the fat was transferred to the right face in multiple layers, including the supraperiosteal, subcutaneous, and subdermal layers (total 12.5 ml).

During a second procedure 4 months later, 20 ml of fat was grafted, and 46 ml was grafted during a third procedure 5 months after the second injection, using the same technique. The patient reported great satisfaction (figure 2).

While autologous fat grafting has been used to treat PRS for decades, its outcomes can be unpredictable. Variables affecting outcomes include quality of fat, quantity injected, and distribution of transferred fat. How fat is separated after liposuction also may play a role. Survival is thought to be influenced by how much blood supply is in physical contact with grafted fat. Thus, fat survival is a matter of striking a balance between the number of procedures and fat grafted each time. (1)

Our technique of slow injection in different layers over a wide region is time-consuming, but it can achieve a smooth contour along with potentially higher fat retention. Our method of increasing injected volumes is opposite that of other reports. One reason we did this was that the patient had greater retention than expected each time, perhaps due to our injection technique or unknown patient factors. It is also possible that fat injection in the face stimulates the development of vasculature, which allows a greater fat-carrying capacity over time.

References

(1.) Sterodimas A, Huanquipaco JC, de Souza Filho S, et al. Autologous fat transplantation for the treatment of Parry-Romberg syndrome. J Plast Reconstr Aesthet Surg 2009;62(11):e424-6.

(2.) Slack GC, Tabit CJ, Allam KA, et al. Parry-Romberg Reconstruction: Beneficial results despite poorer fat take. Ann Plast Surg 2014;73(3):307-10.

(3.) Pagnoni M, Bartoli D, Terenzi V, et al. Lipostructure in Parry-Romberg disease. J Craniofac Surg 2012;23(6):e621-3.

Alana Harp, BS; Yuan F. Liu, MD; Jared C. Inman, MD; Farhad Ardeshirpour, MD

From Loma Linda University School of Medicine (Ms. Harp), and the Department of Otolaryngology-Head and Neck Surgery, Loma Linda University Medical Center (Dr. Liu, Dr. Inman, and Dr. Ardeshirpour), Loma Linda, Calif.

Please Note: Illustration(s) are not available due to copyright restrictions.

Caption: Figure 1. Photos show the appearance of the patient's face before lipoinjection.

Caption: Figure 2. The patient's appearance is greatly improved, as shown in these photos taken 5 months after the second procedure.
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Title Annotation:FACIAL PLASTIC SURGERY CLINIC
Author:Harp, Alana; Liu, Yuan F.; Inman, Jared C.; Ardeshirpour, Farhad
Publication:Ear, Nose and Throat Journal
Article Type:Case study
Date:Jun 1, 2018
Words:662
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