Hemifacial Atrophy

About Hemifacial Atrophy

Hemifacial atrophy, also known as Romberg syndrome or Parry-Romberg disease, is a rare disorder in which the skin and soft tissues of one side of the face progressively shrink. The affected side appears sunken and asymmetric, and in occasional cases the limbs on the same side may also be involved. The process is slow, highly variable in extent and largely unpredictable in its early years.

Symptoms typically appear in the first or early second decade of life, almost always before the age of twenty. After several years of progression the condition usually stabilises, leaving residual deformity that varies from mild flattening of the cheek to deep loss of facial fat, muscle and bone. The exact cause remains unclear, but autoimmune, vascular, neurogenic and post-infective theories have all been proposed.

Diagnosis at our Lucknow clinic is mainly clinical, supported by photographs, MRI and CT to map soft tissue thickness and any bony involvement. Because no medication reliably halts progression once it has started, treatment focuses on reconstruction after the disease has burnt out, ideally with at least two years of stability. Children are observed and counselled until the right surgical window is reached.

Dr. Agarwal, FRCS Edinburgh, plans the procedure according to severity. For mild flattening, autologous fat grafting harvested from the abdomen or thighs is gently layered to even out contour. Multiple sessions, usually two to three at three to six month intervals, are typical because some grafted fat resorbs. This approach avoids extra scars on the body while delivering reliable, soft results.

Severe atrophy with very thin, tight skin needs a microvascular free flap, often from the back of the thigh, transferred with its artery and vein and reshaped over the cheek and temple. Where the orbit, maxilla or mandible are also affected, osteotomies and bone grafting realign the skeletal base. Combining these techniques produces durable, natural-looking restoration of facial volume.

What to expect

• Detailed photographic and 3D imaging review
• Staged plan based on severity and stability
• Fat harvest from the abdomen or thighs for grafting
• Microvascular free flap surgery for severe cases
• Bony correction with osteotomy or bone graft when indicated
• Hidden incisions and meticulous closure
• Long-term follow-up to assess volume retention

Recovery

• Swelling and bruising settle over three to four weeks
• Light activity within a few days of fat grafting
• Hospital stay of three to five days for free flap surgery
• Avoid heavy massage to grafted areas early on
• Touch-up sessions planned three to six months apart
• Final contour visible after several months of healing