A Pilot Study of Synergistic Autologous Fat Grafting and Dermal Transplants in Progressive Hemifacial Atrophy

Progressive hemifacial atrophy (PHA) is a progressive, irreversible disorder characterized by unilateral facial soft tissue atrophy. Conventional treatments, such as isolated fat grafting or synthetic fillers, are often limited by high resorption rates and insufficient structural support. To address these challenges, a staged surgical protocol integrating autologous fat grafting (AFG) and autologous dermal grafting was implemented to optimize outcomes in moderate-to-severe cases. This study evaluates the synergistic efficacy of combined AFG and dermal grafting in the treatment of PHA. Two patients underwent sequential procedures: initial AFG using the Coleman technique with abdominal fat harvest, followed by dermal grafting from the gluteal region to address residual deep depressions. Postoperative evaluations, including long-term follow-up (up to 20 months), assessed volumetric retention, complications, and patient satisfaction. Results demonstrated significant improvements in facial symmetry and contour, with dermal grafts providing durable structural reinforcement in areas where fat resorption persisted. No major complications were observed, and both patients reported high satisfaction with aesthetic outcomes. The staged integration of AFG and dermal grafting offers a minimally invasive, biocompatible solution for complex PHA reconstruction, leveraging dynamic adaptability and natural tissue integration. This dual-modality approach presents a promising strategy for recalcitrant soft tissue defects, particularly where traditional fat grafting alone proves insufficient.