Abstract
The clinical features of this rare syndrome are severe progressing hemifacial atrophies of the facial soft tissues that can include all tissue planes, including fat and muscle as well as underlying bone in different grades of severity. Parry-Romberg syndrome (PRS)-related contour deformities cause severe aesthetic impairments, and often functional limitations in the face. It may also cause socio-emotional, psychological, and behavioral problems. The only evidence-based therapy is surgical. Parry-Romberg syndrome may also cause socio-emotional, psychological, and behavioral problems. The only evidence-based therapy is surgical.
This chapter reviews the method of fat grafting in PRS, examines fat grafting as a standardized treatment modality, and challenges the classic indication and timing of the treatment. We present cases of Parry-Romberg syndrome treated with autologous fat grafting. The chapter comes with a 3D animation video of a patient with severe PRS treated with fat grafting showing the facial volume distribution 1 year after fat grafting compared to the preoperative status. We emphasize the early multistaged treatment of Parry-Romberg syndrome and favorize fat grafting in mild or moderate cases whereas in severe cases free flap transfer with consecutive fat grafting can be of advantage.
From 2009, we treated 16 patients with obvious PRS contour deformities. Patients' age ranged from 5 to 37 years. The abdomen and thighs were the most commonly chosen donor sites for autologous lipotransfer. The patients' satisfaction index regarding the face and their whole body increased considerably postoperatively. The fat survival rate was high even on a 10-year follow-up. In consideration of the severeness of the PRS, we suggest that the treatment plan and the applied combinations of techniques must be individually set in each case.
In consideration of the timing of the treatment of the PRS, we suggest that the treatment should be applied or started with early onset of the syndrome, and obvious contour deformities as soon as age 6–7 with lipofilling. Early and multistaged lipofilling contributes to the more normalized growth of the face and decreases the chance for facial asymmetry formation. The use and eventual combinations of other techniques, e.g., free flaps are suggested after adolescent age and must be individually set in each case.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Buonaccorsi S, Leonardi A, Cavelli E, et al. Parry-Romberg syndrome. J Craniofac Surg. 2005;16(6):1132–5.
Tolkachjov SN, Patel NG, Tollefson MM. Progressive hemifacial atrophy: a review. Orphanet J Rare Dis. 2015;10:39.
Wong M, Phillips CD, Hagiwara M, Shatzkes DR. Parry Romberg syndrome: 7 cases and literature review. Am J Neuroradiol. 2015;36(7):1355–61. https://doi.org/10.3174/ajnr.a4297.
Schultz KP, Dong E, Truong TA, Maricevich RS. Parry Romberg syndrome. Clin Plast Surg. 2019;46(2):231–7. https://doi.org/10.1016/j.cps.2018.11.007.
Madasamy R, Jayanandan M, Adhavan UR, et al. Parry Romberg syndrome: a case report and discussion. J Oral Maxillofac Pathol. 2012;16:406–10.
Tollefson MM, Witman PM. En coup de sabre morphea and Parry-Romberg syndrome: a retrospective review of 54 patients. J Am Acad of Dermatol. 2007;56:257–63.
Yamaguchi K, Lonic D, Ko EW, Lo LJ. An integrated surgical protocol for adult patients with hemifacial microsomia: methods and outcome. PLoS One. 2017;12:e0177223.
Romberg H. Trophoneuronsen. Klinische Ergebnisse 1846:75Y81
Xu M, Yang L, Jin X, Xu J, Lu J, Zhang C, Tian T, Teng L. Female predominance and effect of sex on Parry-Romberg syndrome. J Craniofac Surg. 2013;24(4):1195–200. https://doi.org/10.1097/SCS.0b013e318299759e. Review
Shah JR, Juhasz C, Kupsky WJ, et al. Rasmussen encephalitis associated with Parry-Romberg syndrome. Neurology. 2003;61:395–7.
Stone J. Parry-Romberg syndrome: a global survey of 205 patients using the internet. Neurology. 2003;61:674–6.
Przybilski R, Lemperle G. Potential for operative correction in progressive facial hemiatrophy. Z Plast Chir. 1979;3(4):216–25. [Article in German]
Agostini T, Spinelli G, Marino G, Perello R. Esthetic restoration in progressive hemifacial atrophy (Romberg disease): structural fat grafting versus local/free flaps. J Craniofac Surg. 2014;25:783–7.
Berenguer B, Gallo H, Rodríguez Urcelay P, Marín Guztke M, González Meli B, Enríquez de Salamanca J. Free fat flap for the treatment of Parry-Romberg disease in children. Cir Pediatr. 2005;18(1):49–51. [Article in Spanish]
Longobardi G, Pellini E, Diana G, Finocchi V. Rhytidectomy associated with autologous fat transplantation in Parry-Romberg syndrome. J Craniofac Surg. 2011;22:1031–4.
Sinno S, Wilson S, Brownstone N, Levine SM. Current thoughts on fat grafting: using the evidence to determine fact or fiction. Plast Reconstr Surg. 2016;137:818–24.
Lu SM, Bartlett SP. On facial asymmetry and self-perception. Plast Reconstr Surg. 2014;133:873e–81e.
Loderer Z, Janovszky A, Lazar P, Piffko J. Surgical management of progressive hemifacial atrophy with de-epithelialized profunda artery perforator flap: a case report. J Oral Maxillofac Surg. 2017;75:596–602.
Xie Y, Li Q, Zheng D. Correction of hemifacial atrophy with autologous fat transplantation. Ann Plast Surg. 2007;59:645–53.
Delay E. Lipomodeling of the reconstructed breast. In: Spear SE, editor. Surgery of the breast: principles and art. 2nd ed. Philadelphia: Lippincott Williams and Wilkins; 2006. p. 930–46.
Mojallal A, Auxenfans C, Lequeux C, Braye F, Damour O. Influence of negative pressure when harvesting adipose tissue on cell yield of the stromal-vascular fraction. Biomed Mater Eng. 2008;18(4-5):193–7.
Blitstein MK, Vecchione MJ, Tung GA. Parry-Romberg syndrome. Appl Radiol. 2011;40:34–6.
Modarressi A. Platelet Rich Plasma (PRP) improves fat grafting outcomes. World J Plast Surg. 2013;2(1):6–13.
Acknowledgments
to Prof. Dr. József Piffkó and Dr. Huba Bajusz in the management of Patient 4.
Special thanks to Alexandra Valéria Sándor for the general research support, writing assistance, translation, language editing, and proofreading.
3D animation video by courtesy of Dr. Kálmán Czeibert. Thanks to my assistant Dr. Botond Mihalovits for the photo selections.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
1 Electronic Supplementary Material
Video 58.1
SUPPLEMENT Animation preop PAT 1 (MPG 37714 kb)
Video 58.2
SUPPLEMENT Animation preop PAT Compare_face (MPG 28696 kb)
Video 58.3
Supplement Patient 4 -B55A4293 (MPG 104816 kb)
Rights and permissions
Copyright information
© 2022 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Pataki, G., Kalatovics, A., Lóderer, Z. (2022). Parry-Romberg Syndrome Treatment with Microstructural Fat Grafting of the Face. In: Kalaaji, A. (eds) Plastic and Aesthetic Regenerative Surgery and Fat Grafting. Springer, Cham. https://doi.org/10.1007/978-3-030-77455-4_58
Download citation
DOI: https://doi.org/10.1007/978-3-030-77455-4_58
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-77454-7
Online ISBN: 978-3-030-77455-4
eBook Packages: MedicineMedicine (R0)