Q: I have scleroderma which over time has caused atrophy and asymmetry to my face. I’m interested in plastic surgery to help fill my face out and not make it look so narrow. So if you could please just send me some more information about this that would be great. Thank you.
A: Scleroderma that affects just one side of the face (most commonly) is known as linear scleroderma or Romberg’s disease. It is a rare facial condition that often does not start until late childhood or early adolescence and then burns itself out by early adulthood. It is not known what causes it or why it stops. It is currently thought there is a neurogenic basis for it. It results in soft tissue atrophy, with loss of subcutaneous fat, thinning of the overlying skin, and occasionally loss of some of the underlying bone. (most notably the mandible with loss of the jaw angle and shortening of the jaw line) This creates one-half of the face that is thinned and asymmetric. The forehead may have just a vertical line atrophy. Romberg’s disease comes in all variations from just a single area of atrophy to an entire facial half that is severely withered.
The key to reconstruction in Linear Scleroderma is soft tissue replacement or augmentation. I have done numerous Romberg patients and have used allogeneic dermal grafts, dermal-fat grafts, fat injections and even vascularized free flaps. Since the problem is largely soft tissue loss, the focus on reconstruction should be soft tissue-based. Occasionally, I have used a synthetic implant in the jaw angle but one should generally avoid placing implants is areas of thin soft tissue coverage. Which one of these soft tissue replacements is best on based on the location and degree of the facial atrophy. Each of their own advantages and disadvantages and combinations of two or more of them are usually needed.