How Can I Treat The Loss Of Fat In My Face?

Q: Dr. Eppley, I have been struggling with what i think is Parry Romberg on both sides of my face for the past year. It has been mentally and emotionally draining and is affecting my everyday life. nPlease help!!

A: Thank you for sending your pictures. While you do have a grade III or IV facial lipoatrophy condition this is definitely not Parry Romberg syndrome. Parry Romberg syndrome follows the distribution of the trigeminal nerve and has a very linear pattern of atrophy. It also tends to only occur on one side. of the face. What you have is an overall  lipoatrophy which has affected all of the fat compartments from the temporal down to the buccal spaces resulting in this classic gaunt facial appearance.  Once the fat is lost it is lost and the body is not going to restore it. This is a reflection of a more systemic cause such as significant weight-loss, certain medications and various medical conditions.

Regardless of the cause there’re various methods to treat this type of facial lipoatrophy. The most obvious treatment is that of fat injections into the temporal and submalar/lateral areas of the face provided one has enough donor sites to harvest the needed fat. One could argue how well will fat survive in areas where fat originally was and disappeared. That is a logical debate but the benefit of fat injections is that they are  autologous and have no known medical side effects…. not because it is the most assured treatment. But it remains as a first-line treatment for those patients who are so motivated. The alternative are temporal and submalar cheek implants which provide a more assured and sustained result. These will do well in those two major areas but will not provide any augmentation in the lower facial areas from the mouth along back to the ear. This area can be concomitantly treated with either fat injections or there are various tissue banks tissue grafts and even thin implants that can be placed into this soft tissue area.

Dr. Barry Eppley

World-Renowned Plastic Surgeon