Treating facial wasting

Current estimates suggest that approximately 30 to 40% of people taking antiretroviral therapy will develop some form of facial wasting, and that facial fat loss tends to occur quite rapidly, often within three months. How to prevent or reverse facial wasting is not known at present. Consequently, research has focused on reconstructive or surgical procedures to fill out sunken cheeks. Several approved and experimental procedures are being used, including: polylactic acid (New Fill) ; polymethyl methylcrylate (PMMA); polyvinyl / polyacramide gel (Evolution) and fat transfer injections.

Treatment advocates have urged that these interventions should not be described as cosmetic, but as reconstructive surgery, because they are needed to repair the effects of HIV treatment and the disease process. Arguments for the funding of reconstructive surgery are likely to be taken more seriously when the procedures stop being described as cosmetic.

It should also be noted that all the studies mentioned here drew upon the expertise and work of highly experienced cosmetic surgeons.

Access to cosmetic procedures for HAART-related facial wasting through the National Health Service is currently limited, although some UK HIV treatment centres are negotiating with health purchasers to provide some procedures (see below for details). Self-funded cosmetic surgery may also be an option.