Copyright @ 200 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited. 8 Reconstruction With Galeal Frontalis Flap of Depressed Forehead Region in Progressive Hemifacial Atrophy Ahmet Duymaz, MD, Furkan Erol Karabekmez, MD, Zekeriya Tosun, MD, Mustafa Keskin, MD, Mehtap Karamese, MD, Nedim Savaci, MD Konya, Turkey Parry-Romberg syndrome is characterized by pro- gressive hemifacial atrophy that is the lack of tissue (generally soft tissue and rarely bone and muscle) in the atrophic area of the face. The etiology and the incidence of this pathologic process are uncertain, but it is relatively rare and self-limited. The objective of this study is to present 21-year-old female patient with progressive hemifacial atrophy who was reconstructed with composite galeal frontalis flap. Although many reconstructive meth- ods have been described, reconstruction of both eyebrow deficiency and forehead atrophy with composite galeal frontalis flap was not described before. Key Words: Galeal flap, progressive hemifacial atro- phy, reconstruction P rogressive hemifacial atrophy (PHA), also known as the Parry-Romberg syndrome, was first described by Parry in 1825 and later by Romberg in 1846. Progressive hemifacial atrophy that involves skin and underlying soft tissues, cartilage, and bone usually begins in the first 2 decades of life. Characteristically, the atrophy progresses slowly during many years, and then, it becomes stable. It is more frequent in women, with a female-male ratio of 1.5:1. Both sides of the face are involved with equal frequency. The atrophy is unilateral in 95% of cases. Pathogenesis of the disease is still unknown. Reconstruction of contour and symmetry is the principal goal in cases of PHA. Several different reconstructive techniques have been described for augmentation of deficient soft tissue volume. 1Y6 However, filling of the atrophy and reconstruction of eyebrow simultaneously have not been reported. In our case, supratrochlear and supraorbital ar- tery pedicled composite galeal frontalis island flap was successfully performed for restoration of depres- sion on the frontal area and deficiency of the eyebrow. PATIENT A 21-year-old female patient was admitted to our department because of an asymmetry on her face. In her history, the family had first realized an asymmetry on her face when she was 4 years old. The progressive atrophy of both soft and bony tissue stopped when she was 7 years old. In physical examination, we detected facial asymmetry with a marked hypoplasia of the left side of the face with blepharophimosis and absence of the medial half of the left brow (Figs 1 and 2). A composite galeal frontalis island flap based on supratrochlear and supraorbital artery from the right frontoparietal area was planned for augmentation of the atrophic site of the left forehead. Hairy part of the scalp was added to the distal part of the galeal frontalis flap for brow reconstruction. Before the surgery, supratrochlear and supraorbital artery course was marked by using a manual handheld Doppler ultrasonography. Hair- bearing skin island measuring approximately 15 40 mm was designed from the end of the forehead region (Fig 3). After hemicoronal incision, immediate tissue expansion was performed on the depressed area by using a Foley catheter. Dissection was carried out in just below hair-bearing skin. Atrophic area was undermined for galeal frontalis flap adaptation. After a transverse incision on nonYhair-bearing eye- brow, the flap was completely harvested and then transposed subcutaneously to the defective area (Fig 4). The galeal part of the flap was used to fill 1104 From the Department of Plastic and Reconstructive Surgery, Meram Medical School, Selcuk University, Konya, Turkey. Address correspondence and reprint requests to Furkan Erol Karabekmez, MD, Plastik ve Rekonstruktif Cerrahi AD, Meram Tip Fakultesi, Selcuk Universitesi, Konya 42080, Turkey; E-mail: furkanerolkarabekmez@yahoo.com