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Preference of Facial Fillers
May 16, 2011

Dr. Pierone,

I am a 25 yo wm +/on ARV's x2yrs. Atripla x1yr then Isentress/Truvada x1yr. I have read some past responses regarding the use of Radiesse/Sculptra for treatment of lipoatrophy and one in particular from 2008 noting your preference for Radiesse for deep under eye atrophy correction. Three years later, Juvederm/Restylane are popularly being used in this area with less 'lumpy-bumpiness" reported than Sculptra/Radiesse with many using the latter two more for nasolabial/chin/cheek augmentation. Has your practice shifted use to either of these? I understand Juvederm/Restylane are not approved for HIV related facial atrophy nor is there a PAP, so if one were needing patient assistance for dark circles+lower lid atrophy/sunken eyes yet wanted to minimize the risk of "lumpy-bumpiness" what are your current recommendations?

Also, as a side question- as I said above I changed from Atripla 2/2 rapid development of b/l gynecomastia with extreme tenderness around treatment month 9/10 (I know, a rarely reported s/e). No m/j use, family history, obesity and hormone levels all wnl x2. This ceased after changing ARV regimens except now there is the residual sub-areola tissue I am wanting to take care of. Do you think I would have any luck asking BMS-Gilead or Blue Cross Blue Shield for assistance?

Thank you for your time and I really appreciate your continued involvement with the Ask The Experts Forum.

Response from Dr. Pierone

Hello and thanks for posting. My approach for treating the under eye area has changed in a major way. My preference is to use Artefill for region. Artefill is a hybrid product which contains PMMA (the permanent part) and bovine collagen (not permanent). This product is very unlikely to produce nodules and may be injected in the superficial under eye location as well. Although it takes several Artefill treatments over the course of a year or so, the results are long-term. For individuals who are afraid of Artefill because of its permanent component , my next choice would be Juvederm. This filler also is rarely associated with nodules. Many patients cannot afford Artefill or Juvederm so we will access treatment with Radiesse or Sculptra through the patient assistance program. Of these two, I have moved more towards Sculptra in the under eye region. By using a more dilute final product, the risk of Sculptra nodules is much lower. Radiesse is now my last choice because inadvertent injection in the superficial under eye region may result in visible white filler surrounded by reddish inflammation.

With regard to the gynecomastia, the Sustiva (efavirenz) component of Atripla was the likely culprit. This a BMS drug, but I doubt the company would get involved and offer compensation. You might have more luck with BC/BS, but they would likely view the gynecomastia as a cosmetic procedure and you would have to fight to get coverage. Good luck!



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