Two- and Three-Dimensional Quantification of Facial Symmetry After Fat Grafting and Free Flap Reconstruction in Hemifacial Atrophy

Two- and Three-Dimensional Quantification of Facial Symmetry Following Fat Grafting Versus Free Flap Reconstruction in Hemifacial Atrophy: A Retrospective Observational Study

Hemifacial atrophy causes one side of the face to become smaller, leading to facial asymmetry. Surgeons often restore facial volume using either autologous fat grafting or free-flap reconstruction. However, it is not fully clear how much facial symmetry improves after surgery when measured objectively using two-dimensional (2D) photographs and three-dimensional (3D) surface scans.

This is a single-center, retrospective observational study of patients with hemifacial atrophy treated between January 2020 and December 2023 at [Plastic Surgery Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College]. We will quantify facial symmetry before surgery and at the first follow-up visit occurring at or beyond 6 months after the initial surgery. Symmetry outcomes will be assessed using standardized 2D photographs for all included patients, and 3D surface scans for a subset of patients. Complications will also be assessed at the first ≥6-month follow-up visit. We will compare changes in symmetry between patients treated with fat grafting and those treated with free-flap reconstruction.

Study Overview

• Status: Completed
• Conditions: Hemifacial Atrophy

• Study Type: Observational
• Enrollment (Actual): 60

Contacts and Locations

Study Locations

• China
  • Beijing Municipality
    • Beijing, Beijing Municipality, China, 100144
      • Plastic Surgery Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

Patients with hemifacial atrophy treated at a single center between January 2020 and December 2023 who underwent initial facial volume restoration using autologous fat grafting or free-flap reconstruction. Outcomes were assessed preoperatively and at the first follow-up visit ≥6 months postoperatively. Three-dimensional surface scan analysis was performed in a subset with available 3D data.

Description

Inclusion Criteria:

Diagnosis of hemifacial atrophy (Parry-Romberg syndrome).

Underwent initial soft-tissue augmentation with either autologous fat grafting or free-flap reconstruction at the study center between January 2020 and December 2023.

Availability of standardized preoperative assessment and postoperative assessment at the first follow-up visit occurring ≥6 months after surgery (2D photographs required).

Exclusion Criteria:

Follow-up <6 months after the initial surgery.

Missing key imaging/photographic data required for outcome assessment.

Any additional facial augmentation or revision procedure performed before the first ≥6-month follow-up visit.

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort
Fat Grafting; Patients with hemifacial atrophy who underwent autologous fat grafting as the initial soft-tissue augmentation procedure. Outcomes were assessed preoperatively and at the first follow-up visit occurring ≥6 months postoperatively.
Free Flap Reconstruction (ALT); Patients with hemifacial atrophy who underwent anterolateral thigh (ALT) free-flap reconstruction as the initial soft-tissue augmentation procedure. Outcomes were assessed preoperatively and at the first follow-up visit occurring ≥6 months postoperatively.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in 2D Facial Symmetry Ratio	Facial symmetry ratio calculated from standardized frontal 2D photographs using computerized photogrammetric analysis. The primary endpoint is the change from preoperative baseline to the first postoperative follow-up visit occurring at or beyond 6 months after the initial surgery.	Baseline (preoperative) and first follow-up visit 6 months postoperatively

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in 3D Volumetric Discrepancy Between Hemifaces	Three-dimensional (3D) volumetric discrepancy between the affected and unaffected hemiface measured from 3D surface scans in the subset of participants with available 3D data. Change from baseline to the first ≥6-month follow-up visit.	Baseline (preoperative) and first follow-up visit 6 months postoperatively

Collaborators and Investigators

• Sponsor: Peking Union Medical College
• Collaborators: The Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College

Study record dates

Study Major Dates

• Study Start (Actual): January 10, 2020
• Primary Completion (Actual): December 29, 2023
• Study Completion (Actual): December 29, 2023

Study Registration Dates

• First Submitted: December 13, 2025
• First Submitted That Met QC Criteria: December 24, 2025
• First Posted (Actual): December 26, 2025

Study Record Updates

• Last Update Posted (Actual): December 26, 2025
• Last Update Submitted That Met QC Criteria: December 24, 2025
• Last Verified: December 1, 2025

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Mouth Diseases; Stomatognathic Diseases; Nervous System Diseases; Cranial Nerve Diseases; Facial Nerve Diseases; Facial Hemiatrophy
• Other Study ID Numbers: 2024-344 (Other Identifier: Institutional Review Board of the Plastic Surgery Hospital, Chinese Academy of Medical Sciences)

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No