Repairing facial fat loss

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.