Causes & Symptoms
Facial lipoatrophy (also known as lipodystrophy) is part of a redistribution of body fat, most commonly occurring in people living with HIV. This is due to both the HIV infection as well as its antiviral treatment. Lipoatrophy can also occur with hepatomegaly, hyperglycemia, insulin resistance, hyperlipidemia and hypermetabolism.
Lipoatrophy is part of the wide range of changes in body metabolism that can occur with HIV and its treatment. The main features of this skin condition are fat loss affecting the face, limbs and buttocks, accompanied by central fat accumulation in the abdomen and breasts and over the dorsocervical spine (the ‘buffalo hump’). However, facial lipoatrophy is the most visible element of this disorder.
The main areas affected on the face tend to be the cheek and temples. The cheeks can become sunken and the temples may also appear hollow. This loss of fat also increases facial lines and highlight changes seen with age. It also makes an individual look tired and older than their years. The loss of facial fat can be asymmetrical, made worse on one side by dental abscesses or other dental problems.
Treatment at The Skin Hospital
The visible changes and symptomatic impact of facial lipoatrophy improves by a healthy lifestyle, the adjustment of anti-retroviral medications and use of suitable injectable fillers. This treatment is studied and subsidized on the Medicare PBS for those with severe lipoatrophy due to the treatment of HIV.
An injectable facial re-contouring product is available that stimulates the body’s natural collagen production, gradually restoring lost facial volume. It is a non-toxic product that has been used in products such as resorbable sutures and tissue regeneration, for more than 30 years.
The number of treatment sessions required to restore normal facial appearance varies from person to person, as well as the degree of severity of lipoatrophy. Generally, two or three treatments, four to six weeks apart, will produce the desired results. Visible results may take full effect approximately 12 weeks after initial treatment, increasing dermal (collagen layer) thickness by 4 to 6 mm. For more severe lipoatrophy six or more treatment sessions over six or more months may be required.
The frequency of required top up treatments varies greatly between individuals and may need to be repeated 6 to 24 monthly to maintain restoration of facial volume.
If you are going to have these treatments it is important to inform your doctor if you have:
- Bleeding tendency and / or are on medications such as aspirin, Plavix (clopidogrel), warfarin, clexane, anti-inflammatory or anti-arthritis treatments and herbal supplements such as high dose vitamin E and ginkgo which can increase bleeding.
- Any recent skin infections or skin problems such as folliculitis, boils or nail infections (you may be given prophylactic antibiotics to reduce infection risk).
Overall these treatments are very safe, however there is some discomfort or pain during injection that can be reduced or minimized by the use of a topical anaesthetic cream, paracetamol, and by using a local anaesthetic agent.
Some swelling and redness can occur in the days after injection along with bruising. With proper technique and preparation of product for injection, nodules at sites of injection are rarely an issue and can usually be managed by massage in the days after treatment. Avoiding vigorous exercise or activitiesand alcohol on the day and evening of your treatment is recommended.
The Skin Hospital runs a speciality clinic dedicated to the treatment of HIV skin conditions at Darlinghurst, run by Dr Margot Whitfeld. If you would like to find out more about this speciality clinic please contact us.
If you would like further information on lipoatrophy the sites below provide more in-depth descriptions of lipoatrophy: