A common and distressing manifestation of long-term HIV infection is known as facial lipoatrophy. The layer of fat beneath the patient’s facial skin erodes over time, causing dramatic changes in appearance and subsequent loss of self-esteem. This loss of self-esteem can lead to a substantially lower quality of life due to the increased difficulty in social relationships that it causes. It can also have lethal effects on the HIV patient’s health due to the decrease in medication compliance that often results.

The standard treatment for this condition, called thymidine-based nucleoside analog cessation, is only mildly effective and works extremely slowly. The present report provides a review of the literature on cosmetic and plastic surgery procedures for restoring this lost facial fat mass.

Injectable Cosmetic Filling Agents

Researchers have examined both permanent cosmetic filling agents, as well as biodegradable filling materials. The main benefit of the biodegradable agents is their safety profile: patients who receive this type of treatment have few major complications. However, the biodegradable products must be reinjected over time to maintain the cosmetic benefits. While the permanent facial filling agents last much longer and are available at a lower cost, the types of adverse effects that patients experience can sometimes be severe and long-lasting.

The authors of this paper note that although options for cosmetic augmentation of soft tissue are increasingly available and affordable, very few good studies have tested interventions for HIV-related facial fat loss. This means that we actually have very little data concerning the long-term safety of any treatments for this condition. An additional complication stems from the basic difficulty of measuring the severity of the condition due to its variable presentation and gradual onset.

What is currently known is that most currently available cosmetic filling agents are relatively safe in the short term, and can definitely provide aesthetic improvements for HIV-infected patients. This improvement in facial appearance tends to improve the patients’ overall well-being and quality of life, and to restore much of the lost social functioning we see in sufferers of facial lipoatrophy. However, the authors note that there is still a great need for additional research in this area, and a particular need for study designs that include “objectively assessed endpoints.”

The authors of this report hold that plastic surgery for men has traditionally focused on “function over form,” since male plastic surgery patients were not often as concerned with their appearance as their female counterparts. It has historically been much more uncommon for men to consider facial rejuvenation surgery, or a face lift, than it has been for women. Typically, when a man requested this type of cosmetic plastic surgery, he would do so because of functional concerns that were arising due to the effects of aging.

In recent years, this is less and less the case, according to the authors. They report that plastic surgeons are receiving an increasing number of requests for minimally invasive cosmetic plastic surgery procedures, such as dermal fillers or injectable skin impants.

The motives of men opting for these types of facial plastic surgeries is also changing. Increasingly, male patients cite a youthful image and competitiveness in the workplace as the concerns leading them to opt for cosmetic plastic surgery. Undergoing these types of procedures is also becoming increasingly socially acceptable, and this is lowering barriers for men who have concerns about their facial appearance and functionality but might otherwise feel too self-conscious to seek out a cosmetic surgeon.

The authors stress that a shift in the patient population should prompt a renewed focus on patient selection and male facial anatomy. These considerations can help to ensure that facial plastic surgery for men retains the effectiveness and reputability that cosmetic plastic surgery for women has attained.

Facial cosmetic plastic surgery procedures of all types are rapidly gaining popularity. However, the authors of this report cite research from the American Society of Aesthetic Plastic Surgery which estimates that nearly 80% of all cosmetic procedures currently performed in the United States are non surgical procedures.

That still leaves almost two million cosmetic plastic surgery procedures being performed annually in this country alone. However, while the utilization of cosmetic plastic surgery procedures has increased a very respectable 19% over the past five years, non-surgical cosmetic procedures have increased a tremendous 47%.

The authors note that a substantial shift is also occurring in the demographics of patients seeking cosmetic procedures. Traditionally, both cosmetic plastic surgery and non surgical cosmetic procedures have been the domain of female patients concerned with their physical appearance. Over the last five years, more and more men have sought these types of treatments. This increase is plastic surgery for men could indicate not only a dramatic shift for providers of cosmetic surgery, but also a significant shift in US cultural values as a whole.

Over the last few decades cosmetic plastic surgeries have been gaining popularity in the Hispanic community, both in the U.S. and abroad. A large percentage of the surgeries being undertaken for women and for men in these communities are facial surgery procedures, often rhinoplasty. As demand for cosmetic surgeries among latinos escalates, it becomes increasingly important to understand the unique needs of this population in order to offer them the best available options in plastic surgery that fit the social and cultural demands that are arising.

This is doubly true because of the rapid growth of the Hispanic community in general; they are among the fastest growing ethnic groups in numerous geographical regions. The authors of this paper point out that the emphasis for providing services to this group increasingly falls into the arena of understanding the range of their natural facial characteristics. This includes the particular types of aesthetic problems and difficulties that Hispanic individuals may tend to encounter and the types of cosmetic plastic surgery interventions that are best suited to correcting them.

Rhinoplasty, the authors contend, is a particularly good example of this need. The “nose job” is one of the most common elective procedures in the cosmetic plastic surgery arsenal, and is in particular one of the most popular facial surgery operations for members of the various Hispanic communities.

The authors conclude that facial aesthetic surgery such as rhinoplasty should be performed only after conducting a full evaluation of the patient’s unique individual facial geography. Any problems or unusual characteristics that the patient present should be accounted for in the planning stages of the cosmetic plastic surgery.

Furthermore, the authors assert that the final goals of treatment should be carefully aligned not only with the unique existing characteristics of the Hispanic patient, but also with their unique aesthetic ideals. A relatively full understanding of the cultural and aesthetic values of the Hispanic community in a plastic surgeon’s area of practice will therefore be helpful in providing services to this population.

The authors of this paper contend that the media play a major role in educating the public about medical and surgical treatment options. Because the media typically portrays only cosmetic plastic surgery, as opposed to reconstructive and medically necessary aesthetic surgery, the authors believe that the true scope of this medical specialty is ultimately misrepresented. A false public perception of this type could potentially hinder patients and even physicians from recognizing the types of reconstructive cosmetic plastic surgery options that may be available to them.

UK Media Portrayal of Reconstructive and Cosmetic Plastic Surgery

The purpose of the present study was to determine whether such a skewed public perception actually exists, and to what extent. To do this, the authors performed a search of every newspaper article published in the UK during the year 2006 which contained the term “plastic surgery.” Of the nearly twelve hundred newspaper articles that the researchers analyzed, almost 90% referred strictly to cosmetic plastic surgery. Only 10% of the articles they found referred to reconstructive plastic surgeries.

The researchers did find, rather unsurprisingly, that articles which included quotes from plastic surgeons who were members of the UK’s General Medical Council tended to have a somewhat more balanced view than articles which did not. However, articles which included quotes from these non cosmetic plastic surgeons were much more likely to include mentions of potential plastic surgery complications and risks. Overall, the authors concluded that the medical profession needs to go to greater lengths to educate the public and members of the media about applications of aesthetic surgery procedures that go above and beyond cosmetic plastic surgery.