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Facial Soft Tissue Augmentation Using Lateral Thoracic-Based Free Flaps in Autoimmune-Related Facial Lipoatrophy.

Youn Hwan Kim¹, Seung Eun Hong², Daihun Kang²

¹Department of Plastic and Reconstructive Surgery, Hanyang University Seoul Hospital, College of Medicine, Hanyang University.

The Journal of Craniofacial Surgery

|May 18, 2026

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This summary is machine-generated.

Lateral thoracic flaps, including serratus anterior muscle (SAm) and thoracodorsal artery perforator (TDAP) flaps, provide effective facial soft tissue augmentation for autoimmune lipoatrophy. These flaps ensure stable volume and symmetry with minimal complications.

Area of Science:

Plastic Surgery
Reconstructive Surgery
Autoimmune Disease Treatment

Background:

Facial soft tissue atrophy from autoimmune diseases presents significant reconstructive challenges.
Traditional methods like fat grafting and alloplastic augmentation are often inadequate due to inflammation and tissue destruction.
Lateral thoracic-based free flaps are explored for facial lipoatrophy reconstruction.

Purpose of the Study:

To evaluate the clinical outcomes of facial soft tissue augmentation using serratus anterior muscle (SAm) and thoracodorsal artery perforator (TDAP) flaps.
To assess the efficacy and safety of these flaps in patients with autoimmune-related facial lipoatrophy.
To compare the suitability of SAm and TDAP flaps based on defect characteristics.

Main Methods:

Keywords:

Autoimmune disease facial lipoatrophy free tissue transfer lupus panniculitis rheumatoid panniculitis serratus anterior muscle flap thoracodorsal artery perforator flap

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Retrospective review of 7 patients with autoimmune-related facial lipoatrophy treated between 2012 and 2025.

Flap selection (SAm or TDAP) based on defect size, volume needs, and pedicle length.

Analysis of demographic data, operative details, complications, and follow-up outcomes.

Main Results:

All 7 patients were female, with diagnoses including lupus and rheumatoid arthritis panniculitis.
SAm flaps were used in 4 patients, TDAP flaps in 3; no flap-related complications occurred.
Mean follow-up was 18.9 months, showing stable volume, satisfactory symmetry, and minimal need for secondary procedures.

Conclusions:

Lateral thoracic-based free flaps (SAm and TDAP) are reliable for facial augmentation in autoimmune lipoatrophy.
SAm flaps suit smaller defects, while TDAP flaps are better for larger volume or skin requirements.
Both techniques offer efficient reconstruction with concealed donor sites and acceptable operative times.