Digitally Guided Precision Fat Grafting for Progressive Hemifacial Atrophy

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Abstract
Background Autologous fat grafting (AFG) is widely used to treat progressive hemifacial atrophy (PHA), but accurate measurement of tissue defects in PHA patients remains a challenge due to varied facial defects and complex anatomy. Methods This retrospective study monitored patients undergoing AFG over 12–16 months. Using 3D computed tomography (CT), the midsagittal plane of the face was scanned, mirror-image analysis (MIA) was carried out, and soft tissue volume loss was predicted across facial regions. The patients were evaluated at four intervals (preoperatively and at 3, 6, and 12 months postoperatively) by calculating the asymmetry index (AI), asymmetry rate (AR), preoperative soft tissue volume deficiency (Preop STVD), volume deficiency rate (VDR), and percentage volume maintenance (PVM). Patient characteristics, satisfaction, and outcomes were also analyzed. Results Fifteen patients (mean age 22) underwent an average of 1.9 AFG surgeries. Preoperative soft tissue defect volume was measured at 101.96 ± 82.52 cm3, with an average fat injection volume of 93.38 ± 73.71 cm3. Tissue defect rates ranged from 1.43 to 10.16% (mean 4.42 ± 3.47%), and volume maintenance varied from 35.60 to 79.16% (average 56.64 ± 13.48%). Postoperatively, defect rates ranged from 0.78 to 4.86% (mean 2.11 ± 1.66%), with volume maintenance between 52.36 and 71.74% (average 63.50 ± 8.09%). Significant improvements in facial symmetry and patient satisfaction were noted, with no complications reported. Conclusion Digitally guided precision fat grafting is a promising method for predicting soft tissue loss and improving facial symmetry in patients with progressive hemifacial atrophy. Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

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