Lipoatrophy Syndrome & Facial Lipoatrophy 
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Since the advent of anti-HIV therapy there have been increasing reports of changes in body composition among
people living with HIV.
Facial lipoatrophy, or commonly known as facial wasting, is rapidly becoming an important issue in the
lives of those living with HIV. The confidentiality of a person's HIV status is being compromised by
their appearance.a virtual Scarlet Letter.
Out of despair and necessity, many HIV positive people are searching for restorative treatments that
could improve their appearance.
In This Section:
What Causes Lipoatrophy?
Lipoatrophy is believed to be caused by long-term HIV infection or as a result of
taking certain anti-HIV drugs. Exactly how HIV or medications to treat HIV causes fat
loss remains unknown, though some suspect damage to the energy source of cells (called
mitochondria) may play a role. Lipoatrophy appears to affect white men more than women
and African Americans.
How Do Medications Affect Lipoatrophy?
The evidence to-date hints that lipoatrophy develops either slowly or more quickly depending on
the choice of anti-HIV medications. Fat loss may be more rapid and noticeable with d4T, somewhat
slower with ddC and ddI, but still possible with any NRTI combination. Several studies strongly
suggest that combining d-drugs (d4T, ddI, ddC) can lead to faster, more extensive lipoatrophy.
It may be possible to decrease your risk of lipoatrophy by avoiding d-drugs in your regimen, but
decreased risk certainly doesn't mean zero risk. Lipoatrophy has been seen in people on a wide variety
of anti-HIV drug regimens, including those not containing d-drugs as well as among people who have never
taken medication at all. It is also important to note that other drug combinations may slow the evidence
of facial wasting, however, these combinations have their own side effects that are just as debilitating.
Can It Be Reversed Once It Has Started?
Unfortunately, lipoatrophy cannot be reversed. It can be corrected with restorative procedures,
but the ability for your own fat to replenish does not occur in the facial area.
Are There Restorative Procedures?
A variety of proven cosmetic procedures have been tried to treat facial wasting. In general, these approaches can be divided
into short-term or long-term solutions and now permanent solutions. Short-term solutions often involve injecting materials
under the skin, which will eventually (5-7 months) be absorbed by the body. Long-term solutions include more permanent
implants of material or injections of substances that are not absorbed by the body.
Short-Term Solutions
Collagens (Zyderm/ZyplastT, CosmoDerm/CosmoplastT) and hyaluronic acid products
(RestylaneT, PerlaneT, HylaformT, JuvedermT) are biodegradable and their benefits
will disappear over time. Costs range from $500+ per ml. An average of 15 to 40 ml
is required for a lipoatrophy case.
Longer-Term Solutions
ArtecollT: A cosmetic surgeon carefully injects tiny inert beads (polymethylmethacrylate beads)
mixed with collagen - just like the naturally occurring collagen in your body - beneath your skin.
Since your natural collagen soon takes over, the beads act as a filler under the skin. The issue
with treating lipoatrophy with this product is that, besides cost, this product is not designed for
the volumes necessary to treat lipoatrophy.
SculptraT or NuFillT: SculptraT (poly-L-lactic acid) has been safely used outside the United States
since 1999 in over 150,000 patients under the trade name New-FillT. This product is not legally available
under any condition within Canada.
SculptraT is injected into the skin for restoration and/or correction of the signs of facial fat
loss (lipoatrophy) in people with human immunodeficiency virus. Complete correction of the
lipoatrophy indication may take 3 to 6 treatments over a 6 to 12 week period.
SculptraT is composed of poly-L-lactic acid, a synthetic material. SculptraT is not made from
human or animal sources and does not require a skin test. Poly-L-lactic acid (PLLA) is a biocompatible
(does not harm the body), biodegradable (able to be broken down by the body) material. The effects are
long-lasting; they were shown in a clinical study to last for up to 2 years after the first treatment session.
You should not use SculptraT if you are allergic to any ingredient of SculptraT. SculptraT should
not be injected while you have an active skin infection or inflammation in the treatment area.
Side effects of SculptraT may include the delayed appearance of small bumps under the skin in
the treated area. Generally these bumps are not visible and may only be noticed when pressing
on the treated area. Other side effects may include injection-related events at the site of
injection, such as bleeding, tenderness or discomfort, redness, bruising or swelling.
Fat Grafting or Lipo-Sculpting
Fat is liposuctioned from one area of the body and then injected into the areas of concavity in the face.
This requires a relatively modest surgical procedure to 'harvest' fat. Some of the harvested fat is injected
at that time, and the rest is frozen to use as needed on subsequent office visits. Comment: Some patients
may not have sufficient fat to be transferred to the face. Furthermore, the transferred fat seems to get
absorbed quickly by the body, so additional procedures are required. General anesthesia and an overnight
hospital stay are required.
Permanent Solutions
Silicone Injections
This product is not legally available under any condition within Canada.
Although a non-biodegradable substance, the adverse effects of liquid silicone injections have
included movement of the silicone to other parts of the body, inflammation and discoloration of
surrounding tissues and the formation of granulomas (nodules of granulated, inflamed tissue).
However, there is a protocol currently in design face for the use of silicone micro- droplets
(SilSkin)(a seemingly safer method).
Bio-AlcamidTM
Bio-Alcamid is a medical device designed for the correction of small and large soft tissue deficits. It
is made of a synthetic gel substance (approximately 4% polyalkylimide) and non-pyrogenic water
(approximately 96%). Bio-Alcamid does not contain any animal protein.
Bio-Alcamid has recently made its Canadian debut under provisions of Health Canada's Special Access
Program and for those involved with a Toronto based clinical study. This means that once you have
decided to have treatment, your doctor will apply to Health Canada.
Bio-Alcamid is defined as a soft tissue 'endoprosthesis' because once implanted, Bio-Alcamid,
unlike other injectable fillers, becomes covered by a very thin layer of collagen (0,02 mm)
which completely surrounds the gel, like a capsule, isolating it from the host tissues and
making it a real endogenous prosthesis. Bio-Alcamid can be used to correct small or large
deficits. Once injected it has been scientifically proven that Bio-Alcamid cannot move
spontaneously from the site of implantation because the capsule surrounding the implant is
made of collagen fibers which bind the endoprosthesis to the host tissue.
How Much Bio-Alcamid is injected in a procedure?
The volume of material used is determined by the severity, or degree of lipoatrophy one has. Severity is
typically put on a scale from Grade 0 to 4, Grade 4 being most severe. Grade 1 would use approximately
10-15ml and Grade 4 would use 30-40ml. Due to the exceptional biocompatibility of Bio-Alcamid, this volume
has presented very few complications. In fact, the product has been used in volumes of 300-500 ml for
restoring fat and muscle in other parts of the body (glutes, shoulders, calves).
What is the post-operative course?
For several hours after the procedure, the skin will be somewhat swollen. Sometimes, one can develop
a bruise or minor swelling, which will remain visible from a few days to 2 or 3 weeks. This bruise is
easy to camouflage quite easily but can cause some afterpain. The filler will remain perceptible for
around 7 to 10 days after the procedure and will then acquire the same consistency as the skin tissue.
During this period, the treated area can be rather sensitive. You may not apply firm pressure to
the treated area since this could cause the Bio-Alcamid to shift. During this period, you may not
undergo any other procedures, especially those by a dentist.
How much does it cost?
The product is priced most commonly by volume (per ml). In other cases the doctor will add
their fee to the cost of the material. The procedure can cost approximately CAD$2,800 to $6,000.
There are financing options through MedicardT and subsidized pricing that is offered to those that
qualify through Face Forward. Please see Financial Assistance.
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