NEW YORK (Reuters Health) – The characteristic loss of facial fat in many patients being treated for HIV infection can be effectively rectified with autologous fat transplantation or injection of fillers such as hyaluronic acid or silicone.

The topic is the subject of a comprehensive review in AIDS online October 21, by Dr. Esteban Martinez at the University of Barcelona, along with colleagues in Spain, Italy and Denmark.

“Facial lipoatrophy is characterized by loss of the buccal and/or temporal fat pads, leading to facial skeletonization with concave cheeks, prominent naso-labial folds, periorbital hollowing, and visible facial musculature,” the authors note in their introduction. The condition is stigmatizing, they add, with a negative psychosocial impact and impairment of quality of life.

Facial lipoatrophy can be classified as mild (with just malar flattening but no noticeable naso-labial folds), to moderate (fat wasting of cheeks and temporal regions with prominent naso-labial bands), to severe (extreme hollowing resulting in visible facial bony prominences).

“Plastic surgery seems to be up to now the mainstay of treatment,” Dr. Martinez and colleagues state, “offering either lipofilling, or biodegradable, or nonbiodegradable filler injections.” Usually treatment is considered for moderate or severe cases.

After discussing the procedures available in some detail, the team notes that while most filling agents are well tolerate, all of them confer some risk of adverse reactions. For example, chronic low-grade infection can occur from bacteria growing in filler hydrogels. Antibiotic treatment may be attempted, but if it fails surgical evacuation is necessary.

Lipofilling and biodegradable and nonbiodegradable fillers all give “excellent” aesthetic results, so the choice of procedure depends largely on the expertise of the provider. Patients should also participate in the decision, Dr. Martinez and associates advise.

“Plastic surgery seems to be a well tolerated, feasible tool to treat HIV-related face lipoatrophy,” they conclude. “It has proved to be effective even in managing the psychological consequences of lipodystrophy, and in improving patients’ quality of life.”

Reference:

Surgical correction of HIV-associated facial lipoatrophy

AIDS 2010.