Treatment of facial lipodystrophy syndromes. Lipofilling versus free flap surgery

Abstract

Facial lipodystrophies are characterized by a progressive atrophy of the subcutaneous fat of the face. The aim of our study, which includes two types of facial lipodystrophy (Barraquer–Simons (BS) and Parry–Romberg (PR) syndromes), was to compare the results of treatment with lipofilling and with free flaps and to evaluate the long-term outcome. Eighteen patients (seven cases of BS and 11 cases of PR), issued from four different plastic surgery departments, underwent surgery from 1986 to 2004. The average follow-up period was 5.25 years. Of seven patients who had free flap surgery, four presented satisfying results and three bad results. Dissatisfaction in this group was mainly due to ptosis and a partial atrophy of the flaps. Three good and nine excellent results were seen in patients treated with lipofilling. The results in this group were technique-related, with the nine patients treated with lipostructure (Coleman’s technique) presenting the best outcome. Lipofilling, as an alternative of free flaps, seems to offer superior results. This technique is simple, not expensive, and minor compared to free tissue transfer. It allows the treatment of two areas in one-stage procedure without leaving scars. Lipostructure fills all the conditions to become the technique of choice in the treatment of facial lipodystrophies.