Implants Limit HIV Wasting Facial Change

The loss of facial fat is characteristic of HIV infection, causing many otherwise healthy patients to lose their self-esteem -- even to the point of becoming shut-ins. But the appearance of facial lipoatrophy improved in 16 patients who underwent the surgical insertion of Gore-Tex multistrand implants, Dr. Alastair Carruthers of the Carruthers Dermatology Center in Vancouver told the recent annual meeting of the Canadian Dermatology Association.

In the procedure, Carruthers creates a tunnel beneath the area of facial hollowing and pulls one or more Gore-Tex implants under the skin to fill out the areas of fat loss. Some swelling is associated with the procedure and adds to the initial improvement in appearance. After approximately two months, however, the initial swelling has faded and some lumpiness typically is evident in the implanted areas. At this time, Carruthers reassesses the patient to see if more implants are needed. About three out of four patients have required a second implant procedure. For those with lumpiness remaining at three months, Carruthers has injected silicone oil. This substance can be difficult to inject but remains in place better than collagen and other filler materials.

Carruthers reported "zero complications" in the 16 patients on whom he has performed the procedure. "Even the scars healed better than I would have expected," he said. Most patients requesting the procedure have low or undetectable viral loads. They have been pleased with results, he said.

Lipoatrophy of the face and extremities and fat redistribution on the trunk have increasingly been recognized in HIV-positive patients. Initial reports suggested that this was a drug-related phenomenon, most likely associated with protease inhibitors. But subcutaneous fat loss is also seen in patients who have never received any HIV treatment, so HIV infection itself and other factors appear to contribute to the condition, Carruthers said.

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