HIV Patients Try to Remedy Gaunt Appearance

Like many people taking drugs to combat HIV, Steven Hodges, a former hairdresser in San Francisco, noticed a few years ago that he was becoming gaunt and hollow-cheeked even though he still felt healthy. So, Hodges, who has since retired to Palm Springs, did what thousands of other people with HIV have been doing lately: he began exploring cosmetic and reconstructive options for reversing the disfiguring loss of fat tissue in the face.

First, Hodges' dermatologist injected collagen, made from bovine tissue, into his cheeks. The procedure filled out his face, but his body metabolized the substance quickly and he had to repeat the treatment to sustain the effect. Then the doctor tried Fascian, a filler material synthesized from cadaver tissue and used in plastic surgery. Again, the improvement was temporary, leaving Hodges discouraged. "To be 50 and look in the mirror and see a 60-year-old is very disconcerting," he said.

Even as people with HIV are living longer than ever, a significant number look deathly ill because of lipodystrophy -- a disruption in the body's methods of processing and distributing fat. Many say their emaciated appearance frightens family members, friends and co-workers and severely undermines their self-confidence. "Cheek-wasting has become the modern day scarlet letter," said Dr. David Teplica, a Chicago plastic surgeon with many HIV patients.

Many plastic surgeons, like Dr. Jeffery Brande in New York, say the best strategy is to harvest a person's own fat from elsewhere in the body and transfer it to the cheeks. "If you're missing fat on your face, the logical therapy is to replace it with more body fat," he said. The problem, he added, is that many people with facial wasting have no extra body fat. Plastic surgeons and dermatologists who perform the procedures acknowledge that none of them is problem-free.

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