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re: face wasting without meds
Oct 18, 2003

dr young

the facial wasting this man is talking about seems not much to do with lipodystrophy or lipoatrophy. the tissues at the temples and around the skull in general are blood rich muscle tissue. fat rests on top of these tissues, but the loss of the underneither layer of the former is what causes the caved in or tapered look.

also, even the most drastic changes in physical appearance (especially when the change is due to muscle loss - and especially when there is a significant amount of fat covering muscle definition) show up very subtly in photographs. fat softens the "holes" left from muscle wasting, and since two dimensional photos flatten images themselves, using photographs to determine whether or not someone has wasted is completely unreliable. example - the general rule that "the camera adds ten pounds" is one that only applies to persons without a lot of muscle definition. this general rule is laughable in the bodybuilding world - a world based on the photography of human bodies.

remember, lipoatrophy does contribute to wasting in some individuals who take antiretrovirals, but the drastic change in body composition boils down to muscle wasting and fat accumulation. there is no such thing as facial wasting without muscle loss in the face, but there certainly is such a thing as facial wasting without necessarily fat loss in the face.

Response from Dr. Young

I agree with your first point, but disagree with your proposal that fat atrophy cannot happen without simultaneous muscle atrophy-- studies show that the two are not necessarily linked. BY



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