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Silicone Injections for HIV-Facial Lypoatrophy?
Nov 28, 2006

Dear Dr. Bob, I have had a recent consultation with a local expert on what appears to be the most promising, cost effective and seemingly permanent correction of facial lypoatrohpy. Everything, thusfar, leads me to what is called "highly purified 1000-cSt Silicone Oil "microinjections"using a 30-gauge metal hub needle - using "Silikon 1000" and a "serial puncture technique". I'm certain all of this "medical-talk" means more to you than most people. The problem is not with undergoing the treatment, which I understand may be aprx. 8-10 sessions, but with the overall expense of $900 per session. I have lived with an HIV diagnosis for over 22 years and, like many people in my situation, depend on social security disability as our primary source of income. As a matter of fact, my monthly benefits aren't much more than what "1" session would cost. Are you aware of any insurance that will pay for this or perhaps a "patient assistance" program of some kind through Alcon Labatories, the manufacturer?!! I spend a fair amount of time in Palm Springs, away from my home in L.A., and (just maybe) a dermatology "expert" there, whose knowledge and compassion outshines his motivation for profits, would be a better alternative to the L.A.-area physicians. This would truly be a blessing and I sincerely appreciate your prompt response.

Response from Dr. Frascino


Yes, I'm well aware of "Silikon 1000" and the serial puncture technique. As with several other facial fillers for lipoatrophy, I've seen some good and some not-so-good results with this product. As to whether it's the "most promising," well that depends on whom you are speaking with! Also, the $9,000 price tag doesn't really qualify as "cost effective." Finally, there is ongoing discussion as to whether a "permanent correction" is really optimal. For instance, what if we gain a better understanding of the pathogenesis of lipoatrophy and can develop a treatment that stops the fat loss and may even regenerate lost fat? If your cheeks are already puffed up with more silicone than a Vegas showgirl's boobs, what happens when the natural fat comes back? You could wind up looking like a chipmunk!

My suggestion would be to review the information in The Body's Lipoatrophy Resource Center. Included at that site is an interview with yours truly, in which I discuss silicone and other potential therapies. At this point, I still tend to favor Sculptra, because it is immunologically inert and gets resorbed over time. Since it is FDA approved for treatment of facial lipoatrophy, it may be covered by your insurance carrier. Dermik Laboratories does have a patient-assistance program. I'm not trying to discourage you from considering the silicone product; I just want you to be able to make an informed decision.

Good luck!

Dr. Bob

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