Parry-Romberg syndrome: a novel treatment algorithm derived from long-term follow-up and more than 40 years of surgeon's experience.

Parry-Romberg syndrome (PRS), or progressive hemifacial atrophy, is a rare, heterogeneous disorder characterized by unilateral facial atrophy affecting the skin, subcutaneous tissue, muscle, and sometimes osseocartilaginous structures. Due to its variability in severity and unclear treatment timing, a standardized surgical approach remains controversial. A retrospective review was conducted of patients diagnosed with PRS who were evaluated or treated by the senior author between 1978 and 2018. Inclusion criteria required availability of complete medical records and photographs. Patients were classified into four severity types based on a previously published grading system. Demographic, clinical, and surgical data were reviewed. Surgical approaches included fat grafting, dermal fat grafts, free flaps, and orthognathic surgery. A treatment algorithm was developed based on long-term outcomes and clinical experience. A total of 22 patients (17 women and five men; mean follow-up 197.7 ± 172.4 months) met the inclusion criteria. According to the severity classification, four patients were type 1, two were type 2, eight were type 3, and eight were type 4. Twenty patients (91%) underwent surgical reconstruction, while two declined treatment. A stepwise treatment algorithm was established, incorporating both soft and hard tissue reconstruction methods tailored to disease severity and progression. This study introduces a comprehensive and experience-based surgical treatment algorithm for PRS, developed over four decades of clinical practice. It provides a practical framework to support individualized surgical planning and may improve aesthetic and functional outcomes in patients with PRS.