People With HIV/AIDS Turning to Plastic Surgery to Reverse Facial Wasting Associated With Antiretroviral Therapy

Many people with HIV/AIDS are turning to plastic surgery to reverse the facial gauntness associated with antiretroviral therapy, a look some say singles HIV patients out like a "modern scarlet letter," the New York Times reports. The facial wasting is caused by lipodystrophy, a "widespread" condition among HIV-positive patients who are on antiretroviral therapy whereby fat deposits are redistributed throughout the body. Most people experience a substantial loss of fat in their cheeks, temples, buttocks, arms and legs, and fatty deposits tend to appear on the abdomen, neck and shoulders. The condition is also associated with high cholesterol levels, cardiovascular disease and diabetes, prompting many people to take lipid-lowering medications as part of their drug regimens. Most researchers have attributed lipodystrophy to antiretroviral drugs, but they do not understand how exactly the drugs alter patients' metabolic function. Although many people with HIV/AIDS and lipodystrophy remain relatively healthy, the disfigurement caused by the condition "severely undermines their self-confidence," prompting many to seek help from plastic surgeons. "To be 50 and look in the mirror and see a 60-year-old is very disconcerting," Steven Hodges, an HIV-positive Palm Springs resident who has undergone several treatments to fill in his cheeks, said.

Treatments Varied
Surgeons have several options for treating patients, but the preferred method is to take body fat from somewhere else on the patient's body and use that fat to fill in the cheeks. However, that approach can be problematic for some patients with facial wasting because they have no extra body fat. Collagen and Fascian, a filler made from cadaver tissue, can be injected into the face to fill in cheeks, but both materials give only short-term relief. Silicone or GORE-TEX, a synthetic polyurethane, can also be used, but both run the risk of slipping out of place or giving a "lumpy" look. Doctors have also experimented with New-Fill, a polyactic acid-based product, but it has not yet received FDA approval. Plastic surgery is expensive and most insurance plans will not cover the procedures, arguing that they are "cosmetic enhancements" and not medically necessary. In California, however, state officials have begun "pressuring" managed care plans to cover the costs after receiving numerous consumer complaints (Tuller, New York Times, 5/21).