Treatment of Mild-to-moderate Progressive Hemifacial Atrophy by Acellular Dermal Matrix Combined With Preoperative Digital Evaluation

Abstract

Background: Progressive hemifacial atrophy (PHA) is a rare condition marked by the gradual degeneration of skin, soft tissues, muscles, and, in advanced stages, bone. The primary approach for managing PHA involves surgical interventions to reconstruct and restore the facial contour. The current treatments each present several limitations. Therefore, there is a critical need for innovative therapeutic methodologies for PHA soft-tissue reconstruction.

Methods: Eight patients diagnosed with Guerrerosantos II and III PHA were included in the study. Preoperative 3-dimensional facial scans were digitally analyzed, and corresponding 3-dimensional-printed models were generated to assess soft-tissue deficiencies. Based on this evaluation, acellular dermal matrix (ADM) was tailored to a stepped, multilayered composite dermis of a specific shape and size. It was then anatomically anchored at precise locations and supplemented with volume filler and ligament-mimicking repairs.

Results: The location, volume, and thickness of the ADM postoperatively were highly compatible with preoperative evaluations, significantly improving the facial contour and morphological and volumetric differences. All patients achieved good healing without other complications and reported improved postoperative scores on the FACE-Q craniofacial modules (P < 0.05).

Conclusions: Structural repair of PHA using ADM, guided by preoperative digital assessments, provides a safe, effective, and relatively stable outcome. This approach is innovative for achieving precise facial reconstruction.

Fig. 1.

A graph that shows digital analysis and 3D printing of preoperative soft-tissue deficits in case 1, along with postoperative digital analysis of the soft-tissue augmentation: Preoperative assessment revealed a maximum soft-tissue depression of approximately 6.9 mm, with a surface area of about 1085 mm² where the depth exceeded 4 mm. Postoperative analysis showed a maximum soft-tissue gain of approximately 7 mm. A, Orthostatic view of preoperative patient scan data. B, Size measurement and depth distribution of facial defects. C, One-to-one 3D modeling of defects. D, Frontal view of postoperative changes relative to preoperative changes. E, Thickness analysis of the increased portion of the postoperative relative to the preoperative period. F, Partial fluoroscopic view of postoperative changes relative to preoperative changes.

Fig. 2.

A photograph of a 31-year-old woman presented with type II PHA, as classified by Guerrerosantos, who underwent ADM implantation. The patient is shown preoperatively (A, B), 1 week postoperatively (C, D), and 4 months postoperatively (E, F).

Fig. 3.

A photograph of a 12-year-old boy presented with type II PHA, as classified by Guerrerosantos, who underwent ADM implantation. The patient is shown before first-stage surgery (A, B), 1-month after first-stage surgery (C, D), 6 months after first-stage surgery (E), 1-year after first-stage surgery (F), 1-day after second-stage surgery (G), and 1-week after second-stage surgery (H).