Secondary Treatment of Facial Asymmetry in Hemifacial Microsomia

Abstract

Hemifacial microsomia is most often diagnosed at birth and comprises varying degrees of malformations of one side of the face. Depending on the malformations involved, multiple procedures are required as primary treatment approaches, often embedded in an interdisciplinary concept from birth to adolescence. However, with regard to the symmetry of the face, soft tissue and bony discrepancies between the normal and the affected side often remain recognizable or even persist after surgery, resulting in lasting disturbed facial harmony. Such patients may have a high burden of disease. In our case report, we present the clinical course of a 39-year-old female with hemifacial microsomia, who was suffering persistent facial asymmetry after primary treatment comprising surgery on the mandible and soft tissue augmentation with the use of a free muscle flap. By means of virtual planning tools and patient-specific implants for genioplasty and bony augmentation in a first step followed by soft tissue augmentation with autologous fat cells in a second step, a very satisfactory result was achieved for both patient and medical staff. Hence, for secondary treatment of facial asymmetry in adulthood, a combined and step-by-step therapy addressing both soft and hard tissue seems to be the key to success.