Learn what is facial lipodystrophy and how it can be treated

Facial lipodystrophy is the abnormal distribution of body fat, with increases in some areas and/or losses in others. This could result in: an increase in the waist, an increase in the breasts; accumulation of fat in the back of the neck and upper back; accumulation of fat around the neck and double chin; loss of facial fat, especially in the cheeks; loss in the buttocks; prominent veins in the arms and legs (due to fat loss).

Who are the most likely to suffer from facial lipodystrophy?

In HIV‑positive people, facial lipodystrophy is common. It does not compromise life, but it is one of the most stigmatizing complications of the AIDS virus.

What other effects does lipodystrophy cause in people?

It has been shown that facial lipodystrophy has harmful effects on self‑esteem and quality of life, and it can lead the patient to suffer from depression. Because lipoatrophy is believed to be a side effect of antiretroviral therapy (ARV), this can affect a person’s “relationship” with their medication, which could result in poor adherence or treatment interruption, even when the drugs maintain an undetectable viral load and a healthy immune system.

The most notable features of facial lipodystrophy are:

1. Sunken cheeks
2. Marked facial musculature
3. Sunken temples
4. Decrease in fat around the nasolabial region (nose and mouth), creating very deep folds

How is facial lipodystrophy treated?

The United States Food and Drug Administration approved two facial fillers: poly‑L‑lactic acid (Sculptra) and calcium hydroxylapatite (Radiesse), specifically for HIV‑positive people with lipoatrophy; in addition, other facial fillers are currently being studied and used experimentally around the world.

Facial fillers are injectable products (or ones that must be inserted surgically) that can be used to fill depressions in the face, such as those caused by lipoatrophy. Both temporary and permanent facial fillers are available. Temporary fillers usually last between three and twelve months (sometimes a little longer) and, in general, touch‑ups are required to maintain their results. Semi‑permanent facial fillers provide long‑lasting benefits.

Radiesse, BioForm Medical, has designed a patient assistance program (PAP) to provide the filler at a reduced cost to those HIV‑positive patients who meet the eligibility requirements. This filler is Sculptra, a product that contains poly‑l‑lactic acid and has long been used in reconstructive surgery (Sculptra was approved for the correction of HIV‑associated lipoatrophy in August 2004).

Can it only be treated with Sculptra?

No, people with facial lipoatrophy can also opt for other types of treatments, such as:

1. Lipofilling: This procedure consists of extracting fat from one part of the body (buttocks, hips, inner part of the thighs or the abdomen), cleaning, filtering and injecting it into another part of the body, for example in the face. It is considered to be one of the most natural facial fillers, and the remaining extracted fat can be stored in case touch-ups are needed in the future.
2. Permanent fillers: Polymethylmethacrylate (PMMA; Artefill, Precise, Metacrill): PMMA is better known for its use in the production of non-flexible contact lenses and Plexiglas. These products contain small particles (microspheres) of PMMA. Artefill also contains bovine collagen.
3. Polyalkylimide (Bio-Alcamid): It is a synthetic product that can be injected in large volumes. It has been used in Europe, Canada and Mexico for cosmetic and reconstructive purposes. There have been reports of infections in the tissue cavity that contains Bio-Alcamid, even years later; it has also been reported that Bio-Alcamid can migrate downward, toward the jawbones. Removal of Bio-Alcamid is possible if necessary.
4. Polyacrylamide hydrogel (Aquamid): Aquamid is a synthetic product that binds to water molecules and has been used mainly to fill areas of small to moderate size. It is said to be permanent, although the longest studies only last 11 years. Aquamid is not approved in the United States, but it has been used mainly in Europe. Studies in people with HIV-related lipoatrophy have shown good results in Italy and Spain. The product can be removed immediately after application if necessary.
5. Expanded polytetrafluoroethylene (ePTFE) implants (Gore-Tex, Gore): These solid implants require minor surgery, through a small incision, under local anesthesia. They have been used for many years to help restore deep facial defects and could be useful for HIV-associated lipoatrophy, as fillers for large sunken areas. Some experts believe that ePTFE should be used in combination with other fillers, particularly those that stimulate collagen production.

Unfortunately, for many HIV-positive people with facial lipoatrophy, these treatments are very expensive and have to be paid for privately.

The surgeon who performs these procedures must have extensive experience, since techniques in HIV cases require skill and great anatomical knowledge, as well as knowledge of the different types of fillers.

If you want to consult our expert, Dr. Fernández Blanco, request your appointment at contacto@drfernandezblanco.com or through our Facebook or Instagram social networks.