Your Questions

Q: Dr. Eppley, My 19 year old daughter has some facial deformity and atrophy secondary to scleroderma. Although we are still in the early stages of diagnosis and treatment we are beginning to look for an experienced cosmetic surgeon that has dealt with this unfortunate condition. She has one side of her chin that is considerably smaller than the other. She also has some thinning of the upper lip unilaterally and a small amount of wasting to the same side cheek area. Again, we are still in the early stages but this appears to be a limited scleroderma with morphea traits. I would expect a chin implant would give her the best results but I would be very concerned to have any foreign substance placed in her at this time with the possibility of reactivating the condition. So I would expect “fat injections” to be the next best option?? Thanks for any insight you may be able to give.

A: Your daughter’s case sounds very classic in my experience and fortunately fairly ‘limited’. (I am certain she does not feel that way) You are correct in your assumption that fat injections are one good treatment option as that is the tissue that is largely missing/absorbed.  Concentrated fat injections have one significant advantages, the introduction of stem cells with the fat that may help soft tissue rejuvenation. Often I will use PRP (platelet-rich plasma) with the fat injections to get optimal fat cell survival and perhaps stem cell stimulation. Although depending upon the degree of soft tissue indentation and its location I would not exclude the possibility of bone augmentation with an implant or even a dermal-fat graft. The best facial recontouring results come from using any of these available techniques based on the size and location of the defects. There is no evidence that treating this form of scleroderma reactivates or exacerbates the condition no matter what treatment is done. While it’s etiology is very poorly understood, it is believed to be of neural origin and of an automimmune nature.

Dr. Barry Eppley

Indianapolis, Indiana