Q: Dr. Eppley, I have hyperpigmentation and a loss of facial tissue on my left chin from scleroderma. I’ve been looking at achieving asymmetry through fat grafting and remove overlying dark scar tissue which looks like a birthmark. I have attached my chin pictures for your review.
A: Thank you for sending your linear scleroderma chin pictures. Your scleroderma chin defect is very common as well as the hyperpigmentation that goes with it. You have two treatment options. It can be treated by injectable far grafting to improve the contour. This will not remove the hyperpigmentation and may require multiple fat grafting sessions to get the best contour. But it is a ‘scarless’ approach to your linear scleroderma. The second option is to complete cut out the hyperpigmented skin and close over the contour defect with a dermal-fat graft. This is the only method to eliminate the hyperpigmentation and is a one-step approach to create the most filled in contour. But it will result in a vertical fine line scar down the side of the chin and may or may not require a scar revision based on how it heals and how wide the scar mat become.
Dr. Barry Eppley