Achieving Facial Symmetry In 274 Patients With Hemifacial Microsomia
JOHN Reinisch, MD1, Kyohei Itamura, MD2, Caitlin Pray, PA-C2, Youssef Tahiri, MD2, Maarten Vijverberg, MD3.
1University of Southern California, Los Angeles, CA, USA, 2Cedars-Sinai Medical Center, Los Angeles, CA, USA, 3Radboud UMC, Nijmegen, Netherlands.
Purpose Hemifacial Microsomia (HFM) is the second most common congenital facial anomaly. Most of these patients have mild to moderate facial asymmetry without functional compromise. Mandibular distraction may initially improve symmetry but increases the burden of care without providing long term facial balance or eliminating the need for eventual orthognathic surgery. We studied the ability of fat to provide permanent facial symmetry to HFM children. Methods A prospective study of patients having fat grafting at the time of ear reconstruction between January 2008 and August 2021 was conducted. Demographic data, volume of fat, HEAR MAPS scores, complications, and photos were recorded. Results Of 1360 ear reconstruction, 274 (20.1%) had simultaneous abdominal fat grafting of the ipsilateral hypoplastic face. The mean volume of fat infiltrated was 14.3 ml. Female patients and patients with facial nerve weakness were more likely to receive fat grafts. Twelve percent of patients had additional fat injected (10.4ml) for residual asymmetry at a subsequent procedure. There were no initial complications following fat infiltration. With long term follow-up, hypertrophy of the grafted fat requiring subsequent liposuction occurred in 9 (3.2%) patients. Conclusions Despite the presence of bony asymmetry HFM, soft tissue augmentation is an economical way to achieve facial symmetry minimal complications in the period before skeletal maturity. 
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