What Is The Best Way To Treat Scleroderma Defects Of The Face?
Q: Dr. Eppley, I have had deformity to my face due to scleroderma. I am now in remission, but the damage is done. Tightening around the mouth and jowls make me appear to be so much older than I am. I see you have replied to several people who have the same disease. Have you helped people with scleroderma and what type of procedures do feel would help me? Thank you.
A: I have seen many variations of the effects of scleroderma on the face from a small area to an entire hemifacial region. In the facial areas of scleroderma involvement, the subcutaneous fat is lost, the overlying skin is thinner, and in severe cases even the underlying bone can be notched or atrophic. In the treatment of scleroderma, the fundamental principle is to add volume which almost always is fat. Because it is injectable and can be placed anywhere, liposuction-aspirated fat is a mainstay of treatment today. While it’s success (survival) is not always assured, and scleroderma defects are more challenging than normal tissues due to less vascularity, the versatility of fat injections makes it a preferred method in most cases. There are indications for other augmentation methods, such as dermal-fat grafts, allogeneic grafts, and onlay bone implants, but there use is more limited.
For involvement around the mouth and jowl area, the use of fat injections would be the best treatment choice. It may require more than one injection session to get the ideal result but adding volume will relieve that tight feeling and make it look rejuvenated as well.
Dr. Barry Eppley