Facial Fat Grafting Before & After Photos

This patient is seen shortly after his first round of fat grafting.

Parry Romberg syndrome (aka progressive hemifacial atrophy) is a condition where usually half of a person’s face begins to waste away.

This may involve skin and fat only, or can also affect the muscle, bone, and cause pain.

Sometimes only a part of the face is involved, like the forehead or the cheeks. Other times, migraine headaches, changes in pigment, or shrinking of half of the tongue is seen.

Most commonly Parry Romberg syndrome begins at puberty. We have seen patients of all ages affected, though, often after a viral infection or trauma.

Treatment most commonly involves fat grafting. This involves liposuction of fat from an unaffected area like the flank, and transferring the fat in small amounts to the affected area.

Typically anywhere from 1/3rd to 2/3rds of the transferred fat takes hold and persists.

Treatment may involve multiple rounds of grafting to achieve reasonable symmetry, and sometimes is repeated over the years as facial fat and the transferred fat may age differently.

Other options for treatment are available as well, including implants, soft tissue grafts, bone grafts, and free tissue transfer.

Parry Romberg syndrome (aka progressive hemifacial atrophy) is a condition where half of a person’s face begins to waste away.

This may involve skin and fat only, or can also affect the muscle, bone, and cause pain.

Sometimes only a part of the face is involved, like the forehead or the cheeks. Other times, migraine headaches, changes in pigment, or shrinking of half of the tongue is seen.

Most commonly Parry Romberg syndrome begins at puberty. We have seen patients of all ages affected, though, often after a viral infection or trauma.

Treatment most commonly involves fat grafting. This involves liposuction of fat from an unaffected area like the flank, and transferring the fat in small amounts to the affected area.

Typically anywhere from 1/3rd to 2/3rds of the transferred fat takes hold and persists long-term.

Treatment may involve multiple rounds of grafting to achieve reasonable symmetry, and sometimes is repeated over the years as facial fat and the transferred fat may age differently.

Other options for treatment are available as well, including implants, bone grafts, and free tissue transfer.

This patient is seen 1 month after her second round of fat grafting. Photos, as always, shared with verbal and written consent.

This man came to us with severe facial asymmetry even after over 10 surgeries elsewhere for Parry Romberg Syndrome.

Those surgeries included 2 free flap surgeries, but he still had a fair amount of asymmetry and tightness of the upper cheeks and soft tissue on the entire left side of his face.

He has since gone through two surgeries with us.

He is a full year since a dermal-fat graft to the cheek, and fat injections around the eye and cheek. The grafting has held up well, with no further fat grafting nor fillers since then.

More recently, a few weeks ago we performed a septorhinoplasty with cartilage and acellular dermal grafting, via a closed approach (no incision across the columella).

Some cartilage did come from his ear, and in the process that ear was intentionally set back to improve that ear symmetry despite the severely asymmetric bony base.

His breathing has improved as well, and he is happy with the improvements we’ve been able to make!

The smile says it all!

About 1 in 3 patients with cleft lip and palate benefit from jaw surgery. Aligning the upper and lower teeth helps people fully chew their food, and reduces wear and tear on the TMJ’s.

We also consider facial balance and harmony when planning the surgery and final outcome.

Jaw surgery can often be done in a single surgery, sometimes involving just the upper jaw, and sometimes with the lower jaw as well.

Here, the amount of advancement was well over 10mm, which is the point at which we usually move towards distraction over a single surgery.

Distraction involves cutting the bone and freeing up scar tissue, but then gradually moving from the starting position by 1mm per day.

New bone is deposited in the space made as the upper jaw moves forward. The surrounding blood vessels, lining, and old scar tissue all expand and accommodate the new bony position.

We usually keep the hardware in place (much more comfortably after finishing advancement!) for 3 months while the new bone hardens.

At that point, minor adjustments can be made as needed with additional movement or augmentation, or just removal of the hardware.

Here, we performed some fat grafting to the upper lip, expecting about half of the fat to reabsorb and half to stay long term.

He is seen here at about a month after that surgery — we look forward to sharing more photos as all the swelling comes down!

This man is breathing well at 7 weeks after his cleft rhinoplasty and fat grafting to his upper lip.

Septoplasty and spreader grafts, with tensioning of the upper lateral cartilages over the grafts, helped his breathing. This is like having an internal Breathe Right strip people use for snoring and nasal collapse.

His contour and projection match his face well, with his dorsum straighter and tip projection increased.

An onlay alar graft and tip graft helped to soften his alar groove, and added to his tip support.

Finally, the fat graft to his upper lip acts as a permanent filler, balancing the thinner upper lip with the more full lower lip. I generally prefer using fat over dermal fillers, as I like giving the longest-lasting results with the fewest number of procedures. Plus, insurance will cover the fat graft procedure, and fillers are paid cash out of pocket.