Minimally invasive cosmetic reconstruction of facial deformities has always been a challenge in maxillofacial surgery. Hemifacial atrophy is an autoimmune disorder characterized by progressive degeneration and shrinkage of connective tissues, muscles beneath the skin usually on one side of the face. Autogenous fat transfer to restore the normal facial contour is a minimally invasive technique in comparison to other microvascular reconstructive options. The authors present a case of a 25 year old female patient with Hemifacial atrophy who presented with atrophy of the skin and underlying tissues over the right side upper and lower lip, cheek, angle of mouth and chin with skin hypopigmentation, eyebrow and temporal alopecia. A minimally invasive treatment was planned where abdominal liposuction and lipofilling of the facial defect was undertaken. Overfilling of the defect was done calculating the post operative resorption that can occur. The results were immediate and satisfactory thereby making fat grafting a more promising and minimally invasive cosmetic reconstructive option in hemifacial atrophy cases. INTRODUCTION Progressive facial hemiatrophy is also known as Parry-Romberg syndrome (PRS) is a rare, acquired, neurocutaneous syndrome of unknown etiology which is characterized by a progressive yet self- limited atrophy of fat, skin, connective tissue, muscle, and sometimes bone on one side of the face1,2,3,4,5. The condition was first reported by Parry in 1825 and was later on described as a syndrome by Romberg in 18466,7. The exact etiology of this disease is unclear, but various theories have been postulated to explain it as autoimmunity, trigeminal theory and so on4 . It may overlap with a condition called as linear scleroderma- “en coup de sabre” which is characterized by a pathological vertical or diagonal line of cutaneous sclerosis on the forehead8 . Atrophy is mainly confined to one side of the face and cranium with changes in the eyes (enopthalmos) and hair, but can occasionally involve the neck, limbs on the same side, with various opthalmological and neurological complications9,10,11. Neurological complications like trigeminal neuralgia, migrane, seizures, epilepsy have also been found to be associated with this condition8 . Radiographically the teeth on the involved side can appear smaller with short root forms12. PRS onset is insidious and usually manifest in the first or second decade of life with skin changes initially resembling scleroderma13,14. The disease process is rapid from two to ten years and then it stabilizes with minimal atrophy in the later years4 . PRS occurs sporadically with some familial distribution. Female predilection is more commonly seen (3:2)2,15,16,17. Published trials on the treatment of facial hemiatrophy are limited, however reconstructive options includes autogenous fat transfer, silicon implants, dermis fat graft, pedicle or microvascular flaps, and bone implants. Autogenous free fat transfer is a widely accepted technique for reconstruction of soft tissue defects because of it is biocompatible, natural-looking, versatile, non-immunogenic, inexpensive and easily obtainable with low donor site morbidity18. The limitations of free fat grafting can be because adipocytes are extremely sensitive to mechanical damage during harvesting and require an excellent vascular bed with even distribution pattern in the recipient site for excellent uptake and adipocyte survival. Fat graft can undergo resorption, replacement with fibrous tissue; oil cyst formation whic
