Treatment of hemifacial atrophy presents a challenge for reconstructive surgeons. Previous studies have described numerous methods for the correction of facial asymmetry. We present our experience with treatment of hemifacial atrophy using a microsurgical anterolateral thigh adipofascial flap procedure and other adjunctive measures. This method is similar to that used for the free anterolateral thigh flap, but only the deep fascia of the anterolateral thigh and subcutaneous fatty tissue above the fascia were harvested. This flap procedure was used in 32 patients with moderate or severe hemifacial atrophy. In the first stage, the anterolateral thigh adipofascial flap procedure was used in all the patients, of whom eight accepted a porous polyethylene implant along with the anterolateral thigh adipofascial flap to reconstruct the skeleton. In the second stage, ancillary procedures including porous polyethylene implantation, liposuction debulking, fat injection and flap re-suspension were performed to refine the outcome in 28 patients. The anterolateral thigh adipofascial flap is advantageous in that it can provide a reliable vascular pedicle with relatively thin, pliable soft tissue and direct primary closure of the donor site.