Parry Romberg Syndrome

Q: Dr. Eppley, are you familiar with or have you ever had experience with Parry Romberg syndrome? I’m a 38-year-old male patient (victim) with this disease. I had a muscle flap surgery in my 20s which failed and have had no other procedures since. There is a significant asymmetry as my right cheek has major atrophy in the soft tissue. I was wondering if a custom implant could be made to improve my looks. I’ve never wanted to go through surgery again but I was hoping new technologies may hold some hope for me.

A:  I am very familiar with Parry Romberg syndrome and have seen and treated many cases of it. Thank you for sending your pictures, you did very good with them. It appears most of the atrophic defect is in the soft tissue and not involving the underlying bone.  

You have a couple of options that would be far simpler that the initial free muscle transfer that was tried years ago. They include the following:

1) Dermal-Fat Graft placed through a nasolabial fold incision. I can’t tell if there is a scar along the nasolabal fold more not.

2) Dermal-Fat graft placed intraorally.

3) Injection fat grafting to the whole right cheek area

4) Custom midface implant (although the defect does actually involve bone. The concept is to try and push out the overlying soft tissue.

The easiest and probably first option to try is #3, injectable fat grafting. While unknown back in the time when you had your muscle transfer surgery, this is common today and is a standard approach for facial soft tissue defects of almost any kind and location. Its success in Romberg’s disease is variable because of the thing atrophic tissues.

Dr. Barry Eppley

Indianapolis, Indiana