- 1 Description
- 2 Options
- 3 Indications
- 4 Evaluation
- 5 Option Details
- 6 Recovery
- 7 Frequently Asked Questions (FAQs)
- 7.1 Why do HIV drugs cause facial wasting?
- 7.2 What is facial wasting?
- 7.3 What causes facial wasting?
- 7.4 What are the benefits of having facial wasting corrected?
- 7.5 What areas of the face are affected by facial wasting?
- 7.6 What treatments are available for facial wasting?
- 7.7 What is Sculptra®?
- 7.8 What is Radiesse®?
- 7.9 What is fat grafting or Lipo Sculpting?
- 7.10 Why are facial implants so popular to treat facial wasting?
- 7.11 Why are injectables sometimes used with facial implants?
- 7.12 What are the risks of facial wasting treatments?
- 7.13 What should I expect from my consultation with Dr. Gabbay?
- 7.14 Are there any special precautions for HIV patients?
- 7.15 Will I have to have more than one procedure with an injectable treatment for my facial wasting?
- 7.16 What is recovery like from facial wasting treatments?
- 7.17 Will I have a lot of pain after my facial wasting treatment?
- 7.18 Will facial implant surgery change the way I look completely?
- 7.19 How will I feel after my facial wasting procedure?
- 7.20 Who is a good candidate for facial wasting treatments?
Lipoatrophy, the medical term for facial wasting, refers to subcutaneous fat loss in the cheeks and temples, resulting in a bony, emaciated, or “sunken” facial appearance. This condition occurs when fat wastes away from the fat pads in the cheeks, the temples, below the cheekbone, and alongside the nose. Lipoatrophy can be part of an overall condition known as Lipodystrophy Syndrome (LDS), which ranges from mild to severe, and can occur synonymously with other symptoms, such as fat loss in the limbs and buttocks, and fat accumulation in the abdomen. Facial wasting is a debilitating condition that can have a negative psychological impact on patients who suffer from it. Facial wasting many causes, including aging and weight loss and medication effects.
Loss of fat deposits in the face is a natural part of aging. A study published in “Aesthetic Plastic Surgery” documented the natural loss of volume that occurs throughout the aging process, and how this volume loss causes one’s face to appear gaunt and sunken in. Diseases such as cancer and HIV, and the treatments utilized to fight these diseases, can also result in facial wasting. In the past, lipoatrophy was linked to the use of various anti-HIV prescription drugs, including: Zerit® (stavudine, d4T), Retrovir® (zidovudine, AZT) and Videx® (didanosine, ddI).
According to the Program for Wellness Restoration, (a 501(c)3 non-profit organization that disseminates information about lipodystrophy) there are four grades of lipoatrophy. Patients with Grade 1 lipoatrophy show minimal signs of facial wasting symptoms and have a relatively normal facial appearance. Grade 2 lipoatrophy involves deeper fat loss in the face, and the early appearance of visible facial muscle, especially around the check and mouth area. Patients with Grade 3 lipoatrophy exhibit deeper and wider facial wasting symptoms, and the facial musculature is clearly visible. Grade 4 lipoatrophy symptoms are noticeable on the entire surface of the face, and facial muscles protrude prominently from the skin.
Dermal fillers are generally the best course of treatment for patients suffering from facial wasting symptoms. Sculptra, Juvederm, and Radiesse are three of the most frequently utilized dermal fillers that can be used to replace the fat lost during the course of facial wasting, and to restore volume to the face. Sculptra causes scar tissue and fat to collect where it has been injected, and Radiesse stimulates the body to produce new collagen, while delivering an immediate, natural-looking facial restoration. Every patient’s facial wasting symptoms are unique, and during your consultation, Dr. Gabbay will assess your facial wasting symptoms, and provide a customized course of treatment to resolve the effects of your lipoatrophy.
Your facial wasting correction procedure will be performed on an outpatient basis, and is generally a very quick procedure with no down-time required for post-procedure recovery. Some bruising or swelling may occur, but can usually be concealed with the use of cosmetics. If you would like more information about surgery to remedy the effects of facial wasting symptoms, please contact Gabbay Plastic Surgery and we will be happy to answer any and all of your questions, and to schedule an initial, complimentary consultation with Dr. Gabbay. You may also click the link below to read a more in-depth description of facial wasting symptoms and treatments.
Facial wasting (facial lipoatrophy) is a condition of the face wherein areas of fat are reabsorbed, causing sunken-in cheeks, very prominent cheekbones, loose facial skin, and hollow temples.
Facial wasting has a number of causes, including, but not limited to:
- Long-term use of nucleoside analog anti-HIV drugs (particularly Stavudine and Zidovudine).
- The natural aging process
- Very low BMI or body fat percentage
- Eating disorders such as anorexia nervosa and bulimia nervosa
- Elevated triglycerides.
- HIV/AIDS, cancer, and other diseases resulting in extreme weight loss
If you are interested in learning more about facial wasting correction options, please contact Gabbay Plastic Surgery and let us schedule your personal consultation with Dr. Gabbay. During your meeting, Dr. Gabbay will discuss your overall expectations and aesthetic goals, in order to determine whether you are a good candidate for facial wasting correction procedures.
You should come to your consultation prepared to discuss your medical history (including any past surgeries), present medical conditions, allergies, and medications. It is imperative that you are honest and provide complete information, as numerous medical conditions can potentially increase the risks and complications associated with treatment. If Dr. Gabbay feels that you are a good candidate for a facial wasting corrective procedure, he will explain the different techniques, costs and potential side effects before scheduling your procedure. When choosing Dr. Gabbay, you can be assured that you are in the hands of a surgeon who has undergone extensive training and is highly esteemed by his colleagues and patients alike.
Hyaluronic Acid (HA) Based Fillers: hyaluronic acid-based dermal fillers are a popular choice to correct facial wasting, because they are minimally invasive and have very few potential complications. Restylane®, Perlane®, and Juvéderm® are among the most frequently utilized HA-based fillers, and their volumizing results can last up to one year. Because it is a naturally occurring substance, hyaluronic acid is gradually broken down by the body over a period of several months. After your dermal filler injection, you may immediately resume your daily activities; however, the treated area may remain slightly red and swollen for 24 hours.
Sculptra®: in August 2004, the FDA approved Sculptra® (a poly-L lactic acid, formerly known as New-Fill®) for the restoration and/or correction of the signs of facial fat loss due to HIV-related lipoatrophy. Sculptra® injections work by stimulating the body to produce collagen, and can be used to increase facial volume in the eye and cheek areas. Sculptra® can cause tenderness, swelling, and bruising at the injection site, which typically subsides within a few days. These injections are generally given over a series of time, allowing for a more gradual shaping of the face. Moderate facial wasting may require 3-5 Sculptra® treatment sessions for optimal results, and patients with a severe level of lipoatrophy may need as many as six Sculptra® treatment sessions, which are typically spaced two weeks apart.
Radiesse®: Radiesse® is a dermal filler comprised of synthetic calcium hydroxylapatite that has been suspended in a gel carrier, and is FDA approved for use as a treatment for lipoatrophy. Radiesse® will be administered through a series of injections, and it causes the body to produce collagen, which fills in areas of the face that have been impacted by facial wasting.
Fat Grafting or Lipo Sculpting: fat grafting involves harvesting fat from donor sites (i.e. abdomen, buttocks) and then purifying and injecting this fat into the concave areas of the face to augment facial volume.
Cheek Augmentation: cheek augmentation with implants can effectively reverse many of the visible effects of facial wasting. Cheek implants come in a variety of materials, shapes and sizes, and can be uniquely customized for each patient. During the cheek implant procedure, Dr. Gabbay will typically make the first incision inside the mouth and cheek, push the muscle and fat away from the bone, and create a pocket to place the new implant into. He will then position the implant on the masseter muscle for support, and will secure the implant to the cheekbone. Once the implant is properly placed, an injectable filler may be used to further fill in the area.
Depending on the procedure you have for your facial wasting syndrome, recovery can range from a short amount of time with minimal pain (injectables) to a longer recovery after cheek implant surgery. When necessary, Dr. Gabbay will prescribe pain management medications and a prophylactic antibiotic to prevent infection. The recovery time after an injectable procedure ranges from one day to one week, with patients experiencing minimal pain and swelling.
After cheek implant surgery, it is normal to experience some swelling, redness or mild discomfort, and patients will be advised to refrain from any activity that could jar the implants for 2-3 weeks. Although rare, potential complications from facial wasting corrective procedures include: infection, bleeding, swelling, and adverse reaction to anesthesia.
Frequently Asked Questions (FAQs)
Why do HIV drugs cause facial wasting?
Over the last twenty years, the evolution of new categories of antiviral drugs has enabled patients infected with the human immunodeficiency virus (HIV) to live longer, healthier, and richer lives. For reasons unknown, among the unfortunate side effects of antiviral therapy for HIV is the decrease of facial fat deposits known as facial wasting.
What is facial wasting?
Facial wasting, also called lipoatrophy or lipodystrophy, normally impacts areas such as the cheeks and temples leading to a hollowed-out or skeletal appearance that can be disturbing to both the patient and their observers.
What causes facial wasting?
Although the causes are not completely clear, they may include:
- Long-term HIV infection
- Elevated lipid profiles
- Damage to cell mitochondria
- Long-term use of some antiretroviral medications
What are the benefits of having facial wasting corrected?
The primary benefits of treatments to correct lipoatrophy are to improve the appearance of the face, specifically around the eyes and cheekbones. The hollow, gaunt expressions of patients suffering from lipoatrophy make them appear to be less vibrant than they are, even if they are healthy after taking their anti-viral drugs. The procedures that allow for the restructuring of the face can restore the patient’s appearance to a degree that they resemble what they looked like before starting their antiviral regimen. Another benefit is that the patient will often be encouraged to continue on the antiviral routine, because in some cases, after seeing their gaunt and skeletal expressions, some patients become discouraged and cut back or stop their medication regimen in favor of improving their appearance. Successful facial wasting treatments can give the patient the confidence they need to stick with their therapy and keep the disease manageable.
What areas of the face are affected by facial wasting?
One of the areas affected by facial lipoatrophy is the buccal fat pad, located on either side of the face above the cheekbones. The buccal fat pad serves many purposes, including the protection of facial muscles and the lubrication for the upper jaw muscles when chewing.
What treatments are available for facial wasting?
Some of the most common treatments for facial wasting include injectable fillers, fat transfer, and facial implant surgery.
What is Sculptra®?
The Sculptra® treatment for facial wasting is an injectable treatment that uses a synthetic material called poly-L-lactic acid. The acid is injected into the skin to help restore facial fat loss, and treatments may span 3-6 visits over a 6-12 week period.
What is Radiesse®?
Radiesse® can be injected into the skin to help correct facial wasting. Radiesse® consists of synthetic calcium hydroxylapatite that has been suspended in a gel carrier. In December 2006, the FDA approved Radiesse® to be used as a treatment for lipoatrophy.
What is fat grafting or Lipo Sculpting?
Doctors sometimes choose to use fat from other areas of the body to treat facial lipoatrophy and during this procedure, fat is suctioned from the abdomen or buttocks, and injected into the concave areas of the face.
Why are facial implants so popular to treat facial wasting?
Many top surgeons advocate solid cheek implants for the treatment of lipoatrophy because they are stable, dependable, and they provide enough volume to fill the face. The implants are also highly effective at filling in the lost volume from the depleted buccal fat pad, and once the custom molded implant is inserted into the cheek area, it will fill out the hollow areas in the face.
Why are injectables sometimes used with facial implants?
The use of injectable compounds to fill in the depleted fat areas is also a highly successful technique, and in some cases they are used in conjunction with the implants, to give the face a well-rounded appearance.
What are the risks of facial wasting treatments?
One of the mitigating factors of the injectable method is that the chemicals may not be as cohesive as solid implants, meaning that they may move around and not adhere to the surrounding bone and muscle tissue. While the use of solid implants is one of the preferred methods for reconstruction for facial lipoatrophy, the implant can show through thin skin giving an abnormal appearance. For that reason, it is critical to choose a trained Facial Plastic and Reconstructive Surgeon such as Dr. Gabbay to carry out facial wasting procedures to ensure an excellent result, while reducing any risks or complications.
What should I expect from my consultation with Dr. Gabbay?
Dr. Gabbay will meet with you to examine your face and after a complete assessment of your condition, as well as your medical history and current health status, he will recommend the most effective treatment for your concerns.
Are there any special precautions for HIV patients?
Since HIV patients are often prescribed a variety of drugs to combat the disease, Dr. Gabbay understands how these drugs might interact with anesthesia, antibiotics, and any pain medications you may need during and after your surgery. This will help you avoid any unforeseen drug reactions that may compromise the current treatment regimen or recovery from surgery.
Will I have to have more than one procedure with an injectable treatment for my facial wasting?
Most injectables are temporary and the procedure may require several visits to achieve an optimal outcome. For more severe cases of facial wasting, the patient may require monthly treatment sessions for six months or more.
What is recovery like from facial wasting treatments?
Depending on the procedure, recovery from lipoatrophy treatments can be relatively short with minimal pain, to a longer recovery time after implant surgery.
Will I have a lot of pain after my facial wasting treatment?
If you experience pain from your facial wasting treatment, Dr. Gabbay will prescribe pain management medications when necessary, and a prophylactic antibiotic to prevent infection.
Will facial implant surgery change the way I look completely?
Plastic surgery is not designed to create an entirely new appearance, but instead, the goal is to bring the patient’s appearance as close to its ideal look as possible.
How will I feel after my facial wasting procedure?
When the facial wasting procedures are successful, they can restore a more vibrant and energetic look to the patient’s face, and this new appearance can restore a patient’s self-confidence, while boosting their self-esteem. Patients who have a healthier outlook on life typically live longer and have a higher quality of life, than those who have a negative attitude- and facial reconstruction can help create a positive attitude.
Who is a good candidate for facial wasting treatments?
If you are concerned about facial lipoatrophy and have a desire to correct or improve your condition, plus you have realistic expectations and goals: you could be an ideal candidate for facial wasting treatments.