Fat transfer

Another surgical approach to facial wasting is to have ones own fat removed from one body area and injected into the hollows of the face. This is referred to as autologous fat transfer and is available through private surgeons in the United Kingdom .

An American plastic surgeon, Dr Jeffery Brande, has treated 300 people with HAART-associated facial wasting using this method. Short-term results show this to be effective, once the initial swelling has resolved. Although fat transfer may be challenging in extremely wasted HIV patients, Dr Brande asserts that fat harvesting is possible in most individuals.

An Italian group has presented results on fat transfer operations in 41 patients.¹ Patients with severe lipoatrophy but high CD4 cell counts (mean 582 cells/mm³, nadir 191 cells/mm³) were treated. Fat was harvested from a buffalo hump (14), the abdomen (27), breast (2) or pubic region (2), and injected into the cheeks. Ultrasound showed a median increase in subcutaneous cheek fat of 5.5mm at week 24 and 3.4mm at week 52. Outcomes were described as “safe, effective, and durable aesthetic results.” However, four patients who received fat transfer from the buffalo hump region or abdomen suffered disfiguring facial fat expansion at the same time as expansion of the fat depot from which the fat had been harvested. The authors did not indicate whether fat was being reabsorbed, which is a major potential drawback of fat transfer techniques.

The authors also noted that 40% of patients with lipoatrophy evaluated in the clinic did not have sufficient fat to allow fat transfer to be attempted.