Surgical Management of Moderate to Severe Facial Atrophy Using NewFill Saturday

ASHM, Dr Brett Archer of the Alfred Hospital, Melbourne

The causes of preventive lipoatrophy (LPD) are from the use of combinations of ARV's. LPA occurs in 60 percent of patients taking ARV's. The exact etiology of the path physiology is not known. There is a synergy between the PI's and

NRTi's. Risk factors include advanced age, male sex (although there are some female Africans in Paris), and duration of HIV disease and ARV use. The syndrome results in fat deposition in the abdomen, posterior neck (buffalo hump) and breast (gynecomastia) as well as fat loss/atrophy in the face, temporal area, and extremities. The fat deposition can be treated with liposuction while the fat loss is more difficult to treat. Dr Archer has been addressing the most serious problems of fat atrophy in the face such as in the infra-orbital region and the temporal area. This is a psychologically devastating syndrome. Patients "look" sick. Other treatments to date have not been satisfactory: fat injection harvested from other areas (not easy in HIV infected patients) is not useful as this fat is of "low" quality because it is fibrous in nature and wastes away in a few weeks. The use of synthetic compounds such as Bioplastique (a form of silicone) lead to granulomas, while collagen injections are too expensive. NewFill is poly-lactic acid, which is found in a powder form that forms a gel when mixed with water. It is natural in that it is biodegradable and immunologically inert. This solution is injected intradermally and into the cutaneous tissues and turns into a gel over hours to weeks and also promotes the growth of new collagen tissue and scar. The experience of 33 patients shows impressive results up to 3 months in pre/post photos. Three injections cost $1,400 and the injection technique is not complicated. Longer term follow up is needed. Increased training is needed and access to the product at lower cost is needed. The treatment is somewhat painful but tolerable. It is only useful for small areas such as the face but not the gluteal.