The Northeastern Society of Plastic Surgeons

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Is Fat Grafting Becoming the Standard of Care for Parry Romberg Syndrome? A Systematic Review of the Literature
Vasanth S. Kotamarti, MD1, Joshua A. David, BS2, Alvaro L. Cansancao, MD3, Alexandra Condé-Green, MD4.
1Division of Plastic Surgery, Department of General Surgery, Albany Medical Center, Albany, NY, USA, 2Hansjörg Wyss Department of Plastic and Reconstructive Surgery, New York University Langone Medical Center, New York City, NY, USA, 3Department of Plastic Surgery, Universidade Iguaçu, Hospital da Plástica, Rio De Janiero, Brazil, 4Division of Plastic Surgery, Department of General Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA.

Background: Parry-Romberg syndrome is characterized by progressive hemifacial soft tissue atrophy that may involve muscles and bones. Pedicled and free flap reconstruction have proved useful in restoring facial contour but are associated with large donor site scar and morbidity as well as increased cost and risks. Autologous fat grafting is a promising alternative for soft tissue augmentation, and its use in Parry-Romberg-associated deformities has been reported with increased frequency. The purpose of our study was to assess whether autologous fat grafting is becoming the standard of care for Parry-Romberg syndrome.
Methods: A systematic review of the literature was performed in August 2017 with a search of twelve terms on the PubMed and Medline databases. Two hundred thirty-three articles were subject to evaluation by predetermined inclusion and exclusion criteria. Statistical analyses were performed with Mann-Whitney U and Kruskall-Wallis tests.
Results: Two articles of level II evidence, three articles of level III evidence, 14 articles of level IV evidence, and 28 case reports were selected. A total of 323 patients with Parry-Romberg were treated with fat grafting alone or in combination with other reconstruction methods including free flaps and bone reconstruction. Fat was harvested most often using the Coleman technique from the abdomen and thighs. Lipoaspirate, in the majority of cases, was centrifuged and injected within the subcutaneous tissue and below the superficial muscular aponeurotic system. Stromal vascular fraction, cultured adipose-derived stem cell, or bone marrow-derived stem cell supplementation of fat were described in four studies. Overcorrection ranged from 10-45%, and increasing disease severity was associated with greater number of lipotransfer sessions (p<0.0001). Augmentation peaked at 1-2 weeks postoperatively and subsequently decreased before stabilizing after three months. Improvements in skin color were noted in three articles. A nonsignificant trend towards reduced mean overall complication rate was observed in patients undergoing fat grafting alone (5.2%) compared to those undergoing fat grafting with additional procedures (12.2%) (p=0.412).
Conclusions: Lipotransfer is effective for improving facial symmetry in patients with Parry-Romberg syndrome, however reconstruction often requires multiple sessions. Supplementation with stromal vascular fraction may improve volume retention, reducing the need for secondary procedures. More invasive options may still be necessary to correct severe clinical presentations. Randomized control studies are needed to assess factors to optimize the predictability and durability of augmentation.

ReferencesLevel of EvidenceJournal
Prospective comparative studies
Chang et al. 2013
IIDermatologic Surgery (English)
Koh et al. 2012
IIAnnals of Plastic Surgery (English)
Retrospective comparative studies
Jianhui et al. 2014
IIIAnnals of Plastic Surgery (English)
Slack et al. 2014*
IIIAnnals of Plastic Surgery (English)
Slack et al. 2012*
IIIJournal of Craniofacial Surgery (English)
Case series
Qiao et al. 2017IVJournal of Craniofacial Surgery (English)
Jiang et al. 2016
IVJournal of Plastic, Reconstructive & Aesthetic Surgery (English)
Yang et al. 2015
IVAnnals of Plastic Surgery (English)
Song et al. 2015
IVJournal of Craniofacial Surgery (English)
Raposo-Amaral et al. 2014**
IVRevista Brasileira de Cirurgia Plástica (Portuguese)
Arana et al. 2013
IVCirugía Plástica Ibero-Latinoamericana (Spanish)
Nasser et al. 2013IVRevista Brasileira de Cirurgia Plástica (Portuguese)
Raposo-Amaral et al. 2013**
IVAesthetic Plastic Surgery (English)
Benchamkha et al. 2012
IVAnnales de Chirurgie Plastique Esthétique (French)
Cedrola et al. 2011IVRevista Brasileira de Cirurgia Plástica (Portuguese)
Hu et al. 2011
IVJournal of Craniofacial Surgery (English)
Yu-Feng et al. 2008
IVJournal of Reconstructive Microsurgery (English)
Xie et al. 2007
China, USA
IVAnnals of Plastic Surgery (English)
Roddi et al. 1994
Netherlands, Italy
IVJournal of Craniomaxillofacial Surgery (English)

*These two studies, while using the same data, analyzed different outcomes.
**The later study was an update on the same patient sample from earlier article.

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