Surgical correction of progressive hemifacial atrophy with onlay bone graft combined with soft tissue augmentation.

[OBJECTIVE] Moderate-to-severe Parry-Romberg syndrome involves progressive atrophy of facial bony structures as well as changes in skin and subcutaneous tissue. To correct facial asymmetry in PRS patients, it is important to restore facial bony alignment and obtain a symmetrical appearance.

[METHODS] The authors propose a new combination method of onlay bone grafting and adipofascial free flap. Applying this technique, we performed rib bone graft with concomitant free flap transfer in 10 patients. All patients showed moderate-to-severe findings of PRS, involving skull deformity. Both male and female were 4 and 6 patients each, and the age of the patients at which they received surgery ranged from 10 to 52 years, with an average of 24.8 years of age. During the follow-up period, ancillary procedures including dermofat graft and hyaluronic acid filler injections were performed to achieve fine facial contour and facial symmetry.

[RESULTS] There were no severe complications such as infection or postoperative bleeding. All patients were satisfied with the result, and postoperative CT scanning revealed successful uptake of grafted bone.

[CONCLUSIONS] Onlay frame bone graft by using rib bone as donor material, with combination of facial fat free flap transfer can be an excellent choice in restoring facial symmetry in severe cases of progressive hemifacial atrophy.