Injecting a Look of Good Health

Some dermatologists and plastic surgeons are reporting an increased interest in injectable silicone, especially among HIV-infected men seeking to erase the gaunt, hollow appearance that has come to be called "the face of AIDS."

It is not known whether the loss of facial fat, called lipoatrophy, results from HIV infection or the medications used to keep it at bay. Patients say that these distinct facial changes -- sunken cheeks and bony temples -- can subject them to painful stigma even as many are living longer, relatively healthy lives. The doctors who treat patients seeking a permanent filler for wrinkles, lines or scars, say that today's silicone is purer, the techniques safer and results better than in the past. Demand for cosmetic silicone treatment may grow if a new liquid silicone developed for the face is approved by federal regulators.

Critics of the procedure caution that although silicone injections often bring impressive results initially, some people develop unsightly bumps and lumps years later. Dr. Marvin Rapaport, a Beverly Hills dermatologist, calls liquid silicone a "time bomb" because problems can develop even 25 years after treatment. In 1996, Rapaport published a report about 54 problem cases in which silicone produced lumps, bumps, infection and inflammation. Attempts to remove silicone surgically often left patients looking worse. He has since seen 15 additional cases.

Despite the risks that may still exist, many HIV-infected people are seeking a way to improve an appearance that makes them look older and sicker than they are. Dr. Derek H. Jones, a Los Angeles dermatologist, estimates that he has treated more than 200 men and three women with HIV-related lipoatrophy in the last year and a half. Six to 10 treatments are typically required at about $700 each, which can bring the total bill to as much as $7,000. Most health insurance plans to do not cover the injections.

Liquid silicone has never been approved for any facial or cosmetic purpose. In the early 1990s, the FDA began going after doctors who injected silicone illegally. In 1996, a change in federal law allowed doctors to use any legally marketed drug or device for any purpose they deemed necessary. When the FDA approved Richard-James' Silikon 1000 to treat retinal detachments, doctors finally had access to an approved injectable silicone.

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