Restorative Cosmetic Plastic Surgery for HIV
Citation: Restorative Interventions for HIV Facial Lipoatrophy. AIDS Review. 2008 Apr-Jun;10(2):116-24. Authors: Carey D, Liew S, Emery S
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.”