Research Article| Volume 60, ISSUE 10, P1138-1144, October 2007

Minimal invasive reconstruction of posttraumatic hemi facial atrophy by 3-D computer-assisted lipofilling

Published:March 19, 2007DOI:


      Facial hemi atrophy is seen after trauma, Parry-Romberg syndrome and on other rare occasions. Since the aesthetic deficit is very obvious and irritating, facial reconstruction is often requested by these patients. In most cases the only option for sufficient reconstruction is free flap reconstruction, which represents the standard treatment. Recently in plastic surgery, various new techniques have been developed with the potential for multiple applications. Lipofilling has been presented primarily for the correction of cosmetic lesions or the reconstruction of minor soft tissue defects, but even reconstruction of larger soft tissue deficits is possible. The concept of using 3-D technology in facial reconstruction has multiple advantages. Primarily, the ideal final aesthetic outcome can be simulated by virtual reconstruction. Mathematic calculations deliver exact numbers in volume deficits, enabling precise planning of soft tissue substitution especially in lipofilling, ideally avoiding unnecessary corrections. Since autologous soft tissue reconstruction represents a dynamic process with periods of swelling as well as atrophy, quality control is required for achieving optimal results. Use of 3-D scanning has the advantage of reliable visualisation in soft tissue reconstruction without the limitations of harmful side effects.
      We present the history of a female suffering from the posttraumatic consequences of head injuries related to a car accident and the successful correction of her hemi facial atrophy by autologous lipofilling. Technical details and the potential of 3-D scanning in plastic surgery are discussed.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Plastic, Reconstructive & Aesthetic Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Watzinger F.
        • Wanschitz F.
        • Wagner A.
        • et al.
        Computer-aided navigation in secondary reconstruction of post-traumatic deformities of the zygoma.
        J Craniomaxillofac Surg. 1997; 25: 198-202
        • Talmor M.
        • Hoffmann L.A.
        • La Trenta G.S.
        Facial atrophy in HIV-related fat redistribution syndrome: anatomic evaluation and surgical reconstruction.
        Ann Plast Surg. 2002; 49: 11-17
        • Hodgkinson D.J.
        Facial atrophy in HIV-related fat redistribution: anatomic evaluation and surgical reconstruction.
        Ann Plast Surg. 2003; 50: 328
        • Gueganton C.
        • Chavoin J.P.
        • Boutault F.
        • et al.
        Treatment of facial lesions in Perry-Romberg and Barraquer-Simons syndromes: report of 12 cases.
        Ann Chir Plast Esthet. 2000; 45: 436-451
        • Kawano Y.
        • Araki E.
        • Arakawa K.
        • et al.
        A case of progressive hemifacial atrophy with Pourfour de Petit syndrome which was successfully treated by stellate ganglion block.
        Rinsho Shinkeigaku. 1999; 39: 731-734
        • Mazzeo N.
        • Fisher J.G.
        • Mayer M.H.
        • et al.
        Progressive hemifacial atrophy (Parry-Romberg-Syndrome). Case report.
        Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1995; 79: 30-35
        • Gambichler T.
        • Kreuter A.
        • Hoffmann K.
        • et al.
        Bilateral linear scleroderma “en coup de sabre” associated with facial atrophy and neurological complications.
        BMC Dermatol. 2001; 1: 9
        • Roddi R.
        • Riggio E.
        • Gilbert P.M.
        • et al.
        Progressive hemifacial atrophy in a patient with lupus erythematosus.
        Plast Reconstr Surg. 1994; 93: 1067-1072
        • Kovacs L.
        • Zimmermann A.
        • Brockmann G.
        Three-dimensional recording of the human face with a 3D laser scanner.
        J Plast Reconstr Aesthet Surg. 2006; 59: 1193-1202
        • Kovacs L.
        • Zimmermann A.
        • Wawrzyn H.
        • et al.
        Computer aided surgical reconstruction after complex facial burn injuries - opportunities and limitations.
        Burns. 2005; 31: 85-91
        • Siebert J.W.
        • Anson G.
        • Longaker M.T.
        Microsurgical correction of facial asymmetry in 60 consecutive cases.
        Plast Reconstr Surg. 1996; 97: 354-363
        • Longaker M.T.
        • Siebert J.W.
        Microsurgical free-flap correction of severe hemifacial atrophy.
        Plast Reconstr Surg. 1995; 96: 800-809
        • Lutz B.S.
        • Toussaint S.
        • Wei F.C.
        Bilateral lipoatrophy secondary to connective tissue panniculitis treated with two microsurgically transplanted latissimus dorsi muscles.
        Ann Plast Surg. 1998; 40: 302-307
        • Beck J.
        Implantation method: Plastic surgery of the nose and ear.
        in: Loeb H. Operative Surgery of the Nose, Throat, and Ear. CV Mosby, St Louis1917 (p. 3)
        • Miller C.
        The limitations and use of paraffin in cosmetic surgery.
        Wis Med Recorder. 1908; 11: 277
        • Rogers B.
        A chronologic history of cosmetic surgery.
        Bull N Y Acad Med. 1971; 47: 265
        • Brown J.B.
        • Fryer M.P.
        • Randall P.
        Silicones in plastic surgery.
        Plast Reconstr Surg. 1953; 12: 374-376
        • Rees T.D.
        • Ashley F.L.
        Treatment of facial atrophy with liquid silicone.
        Am J Surg. 1966; 111: 531-535
        • Hinderer U.T.
        • Escalona J.
        Dermal and subdermal tissue filling with fetal connective tissue and cartilage, collagen and silicone.
        Aesthet Plast Surg. 1990; 14: 239-248
        • Peer L.A.
        Loss of weight and volume in human fat grafts.
        Plast Reconstr Surg. 1950; 5: 217
        • Moscona R.
        • Ullmann Y.
        • Har-Shai Y.
        • et al.
        Free-fat injections for the correction of hemifacial atrophy.
        Plast Reconstr Surg. 1989; 84: 501-507
        • Niechajev I.
        • Sevcuk O.
        Long term results of fat transplantation: clinical and histological studies.
        Plast Reconstr Surg. 1994; 94: 496-506
        • Ellenbogen R.
        Invited comment on autologous fat injection.
        Ann Plast Surg. 1990; 24: 297
        • Ersek R.
        Transplantation of purified autologous fat: A 3-year follow-up is disappointing.
        Plast Reconstr Surg. 1991; 87: 219-227
        • Illouz Y.G.
        Fat injection: a four-year clinical trial.
        in: Hetter G.P. Lipoplasty: The Theory and Practice of Blunt Suction Lipectomy. Little Brown, Boston1990: 239-246
        • Coleman S.R.
        Fettunterspritzung (Lipostructure).
        Lemperle-Ästhetische Chirurgie. VI-2.1. 1999 ([ecomed, 3. Erg Lfg])
        • Kovacs L.
        • Zimmermann A.
        • Brockmann G.
        • et al.
        Three-dimensional surface scanning of the facial region with the Minolta Vivid-910® 3D Scanner: a survey of examining conditions, precision and accuracy using a dummy model.
        IEEE Trans Med Imaging. 2006; 25: 742-754