Treatment for progressive hemifacial atrophy: paradigm shift from 2D photograph to 3D stereophotogrammetry

Progressive hemifacial atrophy is a rare craniofacial disease that commonly involves withered skin, soft tissue, cartilage, or bone on one side of the face. The author proposed a therapeutic algorithm tailored to PHA's severity, which revealed a paradigm shift from subjective evaluation on 2D photographs to more objective assessment using 3D stereophotogrammetry.

This retrospective observational study comprised all patients diagnosed with PHA between February 2000 and August 2025. Patients were categorized into three tiers according to deficits in soft tissue, facial skeletal contour, and occlusal function. Photographs, three-dimensional laser scanning, and computed tomography were obtained if needed to evaluate facial asymmetry, the defective area, and depth.

186 patients were treated. Thirty - three patients (17.7%) had concurrent linear scleroderma (mainly en coup de sabre). 59.7% underwent sequential autologous fat grafting as the primary therapeutic method. 29.6% underwent adipofascial tissue transplantation combined with subsequent procedures, including graft debulking or lipofilling. 10.8% had bony and soft tissue reconstruction approaches. The complication rate (3.8%) was acceptable with rational treatment.

Treating PHA is a challenge, and 3D stereophotogrammetry is a useful adjunct for formulating therapeutic modalities. The authors shared their personal experiences and proposed a therapeutic algorithm. Although there is no "perfect" strategy, hopefully, this algorithm will enrich the current body of literature and inspire further thoughts.