Full-Face Dermal Fat Grafting for Scleroderma-Related Facial Fat Loss in a 35-Year-Old Male

A 35-year-old male with a known history of an autoimmune connective tissue disorder, scleroderma, presented with progressive loss of facial fat that had left his cheeks and mid-face visibly hollowed and gaunt. The fat loss was a direct consequence of the underlying disease process rather than ageing or weight loss, and no filler or skin-only treatment could address the structural volume deficit. Dr. Harikiran Chekuri at Redefine Clinic performed a free dermal fat graft to both cheeks through an intraoral approach, with grafting extended across the full face to restore a more even facial contour. The procedure was completed in 1 hour 30 minutes under close intraoperative monitoring, the patient tolerated it well, and there were no post-operative complications.

PATIENT PROFILE

The fat loss had crept in gradually, in step with the underlying scleroderma, rather than arriving all at once. What began as subtle flattening under both eyes and along the cheeks progressed into a visibly gaunt, aged appearance that no longer matched how he felt or how old he was. The skin over the cheeks lay closer to the underlying bone than it should, and the natural convexity of a healthy mid-face was gone on both sides.

This kind of fat loss is a recognised feature of scleroderma and related autoimmune connective tissue disorders, where fibrosis and microvascular changes in the skin and subcutaneous tissue lead to progressive atrophy of the fat layer. Topical treatment has no effect on this process, and conventional dermal fillers carry real limitations in scleroderma-affected skin: the tissue is often less compliant, has a compromised blood supply, and does not always tolerate synthetic filler material predictably.

He wanted his facial volume restored in a way that would hold up over time and would not be undermined by the same disease process that had caused the loss in the first place. He came to Redefine to explore whether a surgical, tissue-based option existed for a condition his own physicians had told him was largely unresponsive to medical treatment.

Assessment findings

• Clinical examination: bilateral cheek and mid-face soft tissue atrophy confirmed, consistent with the known scleroderma diagnosis. Skin quality, elasticity, and vascularity assessed across the affected zones.
• Disease status review: current activity of the underlying autoimmune condition reviewed in coordination with the patient’s existing medical management before surgical clearance.
• Anaesthetic assessment: completed by the anaesthetist with the autoimmune status specifically factored into fitness-for-surgery evaluation.
• Donor site evaluation: suitable donor area assessed for harvesting free dermal fat graft material.
• Approach planning: intraoral access route selected for the cheek grafting to avoid any external facial incision or visible scar.
• Extent of grafting confirmed: bilateral cheek grafting extended to a full-face grafting plan once the pattern of volume loss across the face was mapped.
• Patient goals discussed: restoration of natural facial fullness, a durable result, and no visible external scarring.

Why Free Dermal Fat Grafting Was Chosen

• Scleroderma-related facial lipoatrophy is a structural loss of the fat layer, not a skin-surface problem, so the correction needed to replace actual volume rather than tighten or resurface the skin.
• A free dermal fat graft is a form of autologous fat and tissue grafting that uses the patient’s own dermis and fat, which integrates into compromised, less vascular tissue more reliably than some synthetic filler options in autoimmune-affected skin.
• The intraoral approach allowed the surgical access for the cheek grafting to be made from inside the mouth, leaving no external incision or visible scar on the face.
• Grafting was extended across the full face rather than the cheeks alone, since the atrophy pattern was not confined to a single zone and an isolated correction would have left visible contour mismatch between treated and untreated areas.
• The procedure was performed as a single session of 1 hour 30 minutes, with the patient tolerating it well throughout and no post-operative complications recorded.

Post-operative photographs show the patient immediately after full-face dermal fat grafting, taken in the recovery area, along with follow-up clinical images documenting the restored facial fullness across both cheeks and the mid-face.

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• Patient assessed and prepared for surgery with the underlying scleroderma diagnosis factored into anaesthetic planning throughout.
• Free dermal fat graft material harvested from the selected donor site.
• Intraoral incisions used to access both cheeks, avoiding any external facial incision.
• Dermal fat grafts placed and contoured across the bilateral cheek pockets to restore soft tissue volume lost to the underlying disease process.
• Grafting extended beyond the cheeks to cover the full face, addressing the broader pattern of atrophy rather than treating an isolated zone.
• Wounds closed via the intraoral approach, with no external facial scarring.
• Total operative time 1 hour 30 minutes. The patient tolerated the procedure well throughout surgery, with no intraoperative or post-operative complications.

The patient tolerated the procedure well and moved through the immediate post-operative period without complication. Because the surgical access was entirely intraoral, there was no external facial wound to manage, which simplified early recovery considerably. Follow-up clinical images show a visibly fuller, more even facial contour across both cheeks and the mid-face compared with the pre-treatment hollowing, with the restored volume tracking closely with the areas that had been affected by the disease-related fat loss.

This case study is for informational purposes only and does not constitute medical advice. Individual results may vary based on the severity and activity of the underlying autoimmune condition, donor and recipient tissue quality, and individual healing response. A thorough medical and anaesthetic assessment, coordinated with the patient’s treating physician, is required before any facial fat grafting procedure is undertaken in a patient with an autoimmune connective tissue disorder. Consult a qualified plastic surgeon to assess your specific condition and understand what outcome is realistic for your presentation. Patient identity withheld per confidentiality guidelines.