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Sculptra inquiry
Nov 13, 2004

Dear Dr. Bob, Thanks for your information in your recent response to a question about New Fill or Sculptra from Saggy Puss in SFO. Being diagnosed positive in 1989, I am obviously a long-term nonprogressor, and doing exceptionally well. My viral load is <50, with a stable t-cell count of 600. I have been taking antivirals from day one, starting with 8 years of AZT. Currently, I am taking Kaletra & Epivir, as well as oxandrine. My health has greatly improved with this latest regimen, however, due to wear & tear from years of drugs & the virus, I am experiencing medium facial wasting, particularly in my once fat cheeks. As a recipient of Medicare, Medicaid, & SSI, I am interested in your personal experience, as well as costs, with your procedure with Sculptra. Your response & recommendations would be greatly appreciated. Craig

Response from Dr. Frascino

Hi Craig,

Congratulations on being a long-term survivor! For many years, I wore my facial lipoatrophy wrinkles, nooks and crannies proudly as HIV battle scars from fighting the war against the epidemic. Steve told me it gave my face "character." However, one day I had trouble getting onboard an international flight, because the security agent said I did not look like my passport photo. He was right. I looked more like a Shar Pei!

After considerable research, I decided to proceed with polylactic acid (PLA) injections. It was called New Fill at the time; the new FDA-approved product is now called Sculptra. Because PLA was not FDA approved at the time, I had to obtain it from sources outside the U.S. A San Francisco plastic surgeon (Michael Echavez, MD), who had considerable experience with PLA injections, treated me over a series of months. Like magic, my passport photo began to look lime me again (so to speak)! I am now over two years out from the first treatment, and I remain very pleased with my results. I believe the key to optimal results is in large part due to the skill and experience level of the physician performing the procedure.

The cost of Sculptra therapy is significant. Each kit is priced at $960, and that does not include the cost of the procedure. We are trying to get reimbursement for Sculptra therapy from insurers as a "reconstructive" rather than "cosmetic" procedure. There is no doubt, in my opinion, that correction of facial lipoatrophy is indeed a reconstructive procedure. So far, the third-party payers haven't seen it that way. And so we'll continue to encourage them to be more reasonable, and hopefully the treatment will eventually be reimbursed like all other reconstructive procedures. The cost of your specific treatment will depend on the number of injections you'll need to get your Tom Cruise/Brad Pitt looks back in place.

Hope that helps.

Dr. Bob


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