Indian Journal of Dermatology
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CASE REPORTS
Year : 2005  |  Volume : 50  |  Issue : 3  |  Page : 150-151
Hemifacial atrophy treated with autologous fat transplantation


Department of Dermatology, UCMS & GTB Hospital, UP, India

Correspondence Address:
Vijay Gandhi
A-242 Surya Nagar, Ghaziabad-201 011
India
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Source of Support: None, Conflict of Interest: None


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   Abstract 

A 23-year-old male developed right hemifacial atrophy following marphea profunda. Facial asymmetry due to residual atrophy was treated with autologous fat harvested from buttocks with marked cosmetic improvement.


Keywords: Hemifacial atrophy, Morphea, Fat transplantation


How to cite this article:
Gandhi V, Chatterjee A K, Khurana S. Hemifacial atrophy treated with autologous fat transplantation. Indian J Dermatol 2005;50:150-1

How to cite this URL:
Gandhi V, Chatterjee A K, Khurana S. Hemifacial atrophy treated with autologous fat transplantation. Indian J Dermatol [serial online] 2005 [cited 2019 Dec 8];50:150-1. Available from: http://www.e-ijd.org/text.asp?2005/50/3/150/18929



   Introduction Top


Morphea occurring on one half of the face results in sclerosis and atrophy of subcutaneus tissue which causes a marked difference in contour of one half of the face resulting in hemifacial atrophy. The disease activity can be arrested by medical management with corticosteroids (topical and intralesional), retinoids, antioxidants and immunosuppressants (methotrexate). However, the residual lipoatrophy is a major cosmetic problem and cannot be reversed with drugs. We report a patient with post­morphea residual hemifacial atrophy treated with autologous fat transplantation with gratifying results.


   Case report Top


A twenty three year old north Indian male presented with an indurated plaque over the forhead and right cheek for one year. He was diagnosed to have morphea profunda which was subsequently confirmed histopathological. He was treated with potent topical steroids, chloroquine and vitamin E for one and a half years resulting in arrest of the disease activity. However the residual lipoatrophy persisted [Figure - 1]. He was on regular follow up for one year without any drugs during which time there was no appreciable difference in residual atrophy. Since this was a source of anxiety to him, we decided to do an autologous fat transplantation.

The procedure was carried out under local anesthesia using tumescent anesthetic technique.[1] The fat was harvested from the buttocks using a 10cc syringe to which a 16 G lumbar puncture needle was attached. After inserting the trocar and cannula in the donor site, the trocar was removed and the syringe was attached. The donor site was stabilised with one hand. While fat was harvested by a 'to and fro' movement of the LP needle in the subcutaneus plane (tunneling approach). Continuous suction was applied to the syringe attached to LP needle resulting in aspiration of fat mixed with serosanguinous fluid. The nondominant hand was used to squeeze the fat around the tip of the canula. The filled syringe was detached from the LP needle and allowed to stand in a test tube stand. This separated out the fat in the supernatant layer and the serosanguinus fluid in the lower layer, which was discarded. The prepared fat was injected into the target area in the subcutaneous plane with a 16 G needle in a retrograde manner depositing ribbons of fat in the desired area. Some degree of over correction was made to compensate for subsequent resorption. The injected fat, which was pliable, was sculpted into the designed contour by manual pressure. Patient was given oral antibiotics and anti-inflammatory drugs postoperatively for one week .At present the patient is on monthly follow up and the correction has persisted to an appreciable extent for eight months.


   Discussion Top


Soft tissue augmentation is a technique, which involves injection of biological /synthetic filler substances in the skin and subcutaneus tissue in order to correct tissue defects. A variety of synthetic ( Gore-Tex, Hylan) and biological (Zyderm Collagen, Zyplast Fibril) substances are available. These are highly variable in price, substantivity and indications of use. In addition heterologus biological fillers like bovine collagen may give rise to allergic reactions. Autologus fat transplantation has the advantage of using patient's own excess fat and thus is an economical and well tolerated procedure. Moreover, it can be combined with liposuction from areas of excess fat, thus giving dual benefit. This technique has been used in lipoatrophy, morphea, acne scars and large dermal defects. Whether the actual fat, which is transplanted survives or it is the fibroblast response elicited which fills up the defects is still not resolved.[3],[4] The simplicity of technique, lack of adverse reactions and economy of the procedure makes it an attractive option for correction of dermal and subcutaneus defects with satisfactory result. However, some degree of resorption of transplanted fat occurs which makes it necessary to do a 'touchup procedure' at variable intervals of a few months to one year.



 
   References Top

1.S Coleman III, William P. Soft tissue augmentation. In: Ratz Johnhoursed eds. Textbook of Dermatologic Surgery. Lippincott Publishers, Philadelphia:New York. 1998:565-77.  Back to cited text no. 1    
2.Clark David P. Anaesthesia.. In: Ratz Johnhoursed eds. Textbook of Dermatologic Surgery. Lippincott Publishers, Philadelphia: New York. 1998:38.  Back to cited text no. 2    
3.Pinski KS, Roegnik HH. Autologus fat transplantation: long term follow up.J Dermatol Surg Onco 1992; 18:179-81.  Back to cited text no. 3    
4.Christos N,Dimitra D.Dermal filler materials and botulin toxin. Int J Dermatol 2001 ;40:609-21.  Back to cited text no. 4    


Figures

[Figure - 1], [Figure - 2]



 

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