Restoring balance in a growing face: Two-stage dermal fat grafting for pediatric hemifacial microsomia

Hemifacial microsomia (HFM) is the second most common congenital craniofacial malformation, characterized by unilateral hypoplasia of the first and second branchial arch derivatives. Dermal fat grafting (DFG) provides a reliable option for soft tissue augmentation in growing children. We report a 6-year-old male with left-sided HFM (orbit, mandible, ear, nerve, soft tissue classification O 1 M2AS 1 E 2 N 0 ) who underwent planned two-stage DFG using bilateral groin donor sites. The first stage reconstructed the lower lateral temporal and middle cheek compartments; the second stage, performed 6 months later, targeted the mandibular body. A thread-pull suture stabilization technique secured intraoperative graft positioning. At 6 months following the second procedure, an estimated 75–80% graft volume retention was observed clinically (assessed by standardized serial photography and clinical palpation) with stable facial symmetry and no complications. Two-stage, compartment-based DFG with intraoperative stabilization is safe and effective for soft tissue reconstruction in pediatric HFM.