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.
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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.
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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)
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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
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DOI: https://doi.org/10.1007/978-3-030-77455-4_58
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