Autologous adipose tissue transfer in progressive hemifacial atrophy: From simple volume to regenerative cell therapy

Progressive hemifacial atrophy (PHA), including en-coup-de-sabre morphea and Parry-Romberg syndrome, is a rare condition characterized by unilateral atrophy of facial tissues. The etiology of PHA remains unclear, though it is generally considered to be an autoimmune disease. Current treatment approaches typically involve systemic immunosuppression to stabilize the disease, followed by reconstructive surgery to restore facial symmetry, ranging from complex flap reconstruction to autologous fat transfer (AFT) and allogenic fillers. Recent evidence supports AFT not only as a volumetric filler but also for its immunomodulatory and angiogenic properties, making it a promising supplement or even alternative to systemic immunosuppressive therapy.

We present four cases of PHA treated with AFT in Dakar, Senegal, and Geneva, Switzerland. A comprehensive review of evidence supporting AFT as a cellular therapy in patients with PHA was performed discussing its potential as an effective stand-alone therapeutic option.

There is growing evidence that AFT has regenerative effects in fibrotic autoimmune disease, including scleroderma and PHA. This is in line with our results showing not only improved facial contours and a restoration of symmetrical fullness but also improved overall tissue quality after AFT.

We advocate AFT to be a safe and reliable therapy in PHA, offering not only a substitute to the lost tissue but also local immunomodulatory benefits useful for tissue regeneration. Besides the benefits of combining local immunomodulatory cell therapy with the reconstructive volume restoration, this technique offers a low risk profile, cost-effectiveness and excellent accessibility, particularly relevant in low-income settings.