Studies on two treatments for repairing facial fat loss were
presented at this week’s Third International Workshop on Adverse Drug reactions
and Lipodystrophy in HIV Infection in Athens.
Polymethyl methylcrylate (PMMA) is a substance which has been used in cosmetic surgery for some
years as a facial implant. Brazilian cosmetic surgeon Mauro Serra reported on
the use of PMMA in 120 patients, followed for up to thirty months after their
first treatment.
Photographic evidence with before and after pictures was
presented for five patients. One individual, followed for 33 months, showed
clear evidence of repair of facial fat loss and a normal facial appearance for
an individual with relatively few signs of ageing. Dr Serra pointed out that
facial fat loss is a usual accompaniment of ageing – “that is why the product
was developed in the first place” – and the repairs carried out cannot prevent
further ageing or further fat loss. Some individuals required a further `top
up’ treatment twelve to 18 months after the first one as further lipoatrophy
occurred, but no individuals were reported to have experienced degradation of
the original implant, and Dr Serra believes that experience in normal cosmetic
surgery suggests a long lasting effect.
PMMA treatment is already being offered to people with
facial fat loss in Spain, where treatment costs between $1,000 and $2,500.
However, the product used is considerably cheaper.
A second study, by Vincento Del Pino, looked at the
injection of microspheres of polyvinyl gel and polyacramide (trade name Evolution) in individuals with facial fat wasting that had developed, on average, nine months prior to treatment. Individuals had been receiving HAART for an average of two and half years.
Thirty five individuals were treated, and the results were
compared with photos taken at baseline and with photographs taken prior to the
development of facial fact loss. Before and after pictures for half of the
group were presented, and showed convincing restoration of facial fat in each
case. Thirty three of 35 patients
described the results as excellent or very good one year after the first
treatment, and two thirds needed only two sets of injections to achieve this
effect. The treatment was also well
tolerated, with cases of mild facial swelling in two patients.
Researchers from Paris are due to report on an international
study of polylactic acid (New Fill) at the European Conference on
Clinical Aspects of HIV and AIDS next week in Athens which will provide long
term data on the durability of facial injections of polylactic acid in people
with HIV-related facial wasting. Polylactic acid has previously been reported
to produce restoration of normal facial distribution after up to five injection
sessions, by triggering the thickening of collagen. This effect generally lasts
up to eighteen months in normal cosmetic surgery. A number of clinics in the UK
are known to be seeking funding to provide this treatment for patients.
Treating buffalo hump
Dr Mauro Serra also reported on the use of
phophatidylcholine to reduce the size of fat pads, such as `buffalo humps’ in
two patients. Phosphatidylcholine is a subtance used to dissolve fat; in
medicine it is used to dissolve fat embolisms, and in cosmetic surgery it has been used to treat fat lumps described by the industry as “collagen”.
In each case the hump was divided up into 2cm squares in
each case, and an injection of 4cc of phosphatidylcholine and 1cc of mesocaine
was given every two to three weeks.
Improvements were noted after the first injection in each case, with
improvement in the ability to move the neck. After five injections, the size of
the hump was reduced substantially in each case, although it did not disappear.
Swelling and redness accompanied the injection, and tended to disappear within
three to four days, with no other local reactions.
References
Successful surgical therapy with polyvinyl
gel microspheres of severe facial lipoatrophy: results after one year of follow
up. Antiviral Therapy 6 (Supp 4):, 2001
Serra M. Facial implants with polymethyl-methylcrylate
for lipodystrophy correction: 30 months follow up. Antiviral Therapy 6
(Supp 4): 75, 2001
Serra M. Subcutaneous infiltration with
phosphatidylcholine solution for treatment of buffalo hump and fatty pads. Antiviral Therapy 6 (Supp 4): 75-76, 2001