Q: Dr. Eppley, My right leg and buttock is smaller then my left due to scleroderma. Is there anything that can be done to improve their appearance and make them look more symmetric?
A: One of the main effects of scleroderma is the shrinking of all soft tissues in the skin dermatome that it involves. Why it causes significant subcutaneous fat atrophy and even skin thinning is not known but its effects are quite clear, particularly when its involvement is severe. The most effective treatment is to restore soft tissue volume through fat augmentation, most commonly through an injection technique. A fat injection approach allows large areas to be treated and substantial volumes to be added rather easily. Despite the uncertainty of how much fat will survive, it is very effective at the time of surgery. Repeat fat injections may be required for additional volumes or for touch-ups. The only limitation to using fat injections is whether one has enough fat to harvest. While not all scleroderma patients are thin, many are and this may preclude this treatment approach for them.