Facial Wasting Causes and Treatment
Oleh Slupchynskyj, MD, Board Certified Facial Plastic Surgeon
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. Among the unfortunate side effects of antiviral therapy for HIV is the decrease of facial fat deposits. This side effect, called "Facial Wasting", leads to a hollowed-out or skeletal appearance, which can be rather disturbing to both the patient and any observers.
What is Facial Wasting? What are the available Treatments?
Facial Wasting, also called lipoatrophy or lipodystrophy, normally impacts areas such as the cheeks and temples. Dr. Slupchynksyj selects either solid, custom sculpted implants or injectable fillers to give the patient back an excellent semblance of his previous facial structure. Solid implants can be made from polymers such as Teflon, Polyethylene or Silicone. Dr. Slupchynskyj has had great success using Gore-Tex Silicone implants which can be custom carved to each individual patient offering natural results. Injectable fillers such as Silikon®™ 1000 is a favorable option as it is treated to insure that the body's immune system does not reject it, and it offers permanency which other fillers can not.
Benefits of Facial Wasting Treatment
The primary benefit of treatments to correct lipoatrophy is 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 healthy and vibrant than they are, even after taking the 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 on the anti-viral regimen.
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 as protection of facial muscles and as lubrication for the upper jaw muscles when chewing. The implants Dr. Slupchynskyj uses in facial reconstruction from lipoatrophy can restore many of these functions and bring the facial muscles the support they need.
Another benefit of this improved attitude is that the patient will often be encouraged to continue on the anti-viral routine. After seeing their gaunt and skeletal expressions, some patients have and may become discouraged and consider cutting back or stopping their medication regiment in favor of improving their appearance. Successful operations can give the patient the confidence they need to stick with the therapy and keep the disease at a manageable state.
Anatomy of Facial Wasting Surgical Treatment
Since facial lipoatrophy affects the buccal fat pad and the surrounding tissue, Dr. Slupchynskyj will typically make the first incision inside the mouth and cheek to prevent external scarring. The incision is usually no more than 1.5 centimeters wide, which allows him to insert a small tool that will push the muscle and fat away from the bone, allowing for the creation of a pocket for the placement of the implant.
If the midface (masseter) muscle is healthy and strong, Dr. S. may place the implant on the muscle for support. At that point, Dr. S. can place the backside of the implant along the cheekbone. If the muscle has also undergone some atrophy, he will place the more of the implant on the cheekbone, since the muscle is not strong enough to support the weight of the implant.
Once the implant is in the proper area, the angle will be adjusted to insure that it fills in the space as intended. At this time, Dr. Slupchynskyj may plan to use injectable materials to "fill in the edges" that the shaped implant did not cover, or he may wait until after the surgery to consult with the patient on spaces that the implant may have missed.
Techniques of Facial Wasting Surgery
Many top cosmetic surgeons advocate solid cheek implants for treatment of lipoatrophy. The firm, solid Silicone implants have become very popular and have been applied extensively in many Facial Wasting procedures. The most effective factor in favor of the implants is that they are stable, dependable, and provide enough volume to fill the face.
For patients infected with HIV, a substantial issue is that the decrease in fat is so noticeable that the thinned skin could allow the edges of the implant to show through. However, Dr. Slupchynskyj custom carves the implants so they are properly shaped to fit the contours of the face for each and every patient. The implants are also highly effective at filling in the lost volume from the depleted buccal fat pad. Once the custom molded implant is inserted it into the cheek area, it will fill out the hollow areas in the face.
The use of injectable compounds to fill in the depleted fat areas is also a highly successful technique of Dr. Slupchynskyj's. In some cases, the injectables are used in conjunction with the implants to give the face a well-rounded appearance. In other instances, Dr. S. will use only the injectables, as they allow more flexibility than solid implants.
Risks of Facial Wasting Surgery
One of the mitigating factors of the injectable method is that the chemicals may not be as cohesive as solid implants. The injectable compounds may move around and not adhere to the surrounding bone and muscle tissue. If the substance moves from its intended location, it can give the face an awkward appearance, as that of a "lump" or tumor on the face. For this reason, Dr. Slupchynskyj uses injectable materials for edge work, rather than as the primary fillers in the hollow areas.
While the use of solid implants is one of the preferred methods for reconstruction for facial lipoatrophy, they are also not without hazards. As discussed earlier, the details of the implant can show through thin skin or skin that does not have adequate support. If the surgeon inserts an implant, which is the wrong shape or a preformed shape versus customized, then it will not give the correct appearance after the surgical procedure. For men undergoing the process, the implants can also take out the sharper, more masculine aspects of the cheekbones, leaving a more "feminine" appearance. It is critical to select a formerly trained Facial Plastic and Reconstructive Surgeon like Dr. Slupchynksyj to carry out these procedures to ensure an excellent result while reducing any attendant risks or complications.
As with any surgery, the procedure to correct Facial Wasting carries some risks of infection. For patients with compromised immune systems, Dr. Slupchynskyj takes special precautions to prevent incidental infections. The surgeon will often irrigate the incision with antibacterial solution during the operation. Dr. Slupchynskyj, who practices this procedure regularly, is aware of the special precautions to take with HIV-infected patients and insists on specific safety measures.
Preparations for Facial Wasting Surgery
Before the surgery, Dr. Slupchynskyj will consult with the patient about the specifics of the procedure. He then will examine the patient's face and begin either designing the molds for the solid implants or planning for where and how to insert the injectable solutions into the hollowed-out areas. He also advises that patients who are smoking or using other tobacco products quit the habit as soon as possible to avoid complications from the surgery.
Since HIV patients are often prescribed a variety of drugs to combat the disease, Dr. Slupchynskyj understands how these drugs interact with anesthesia, antibiotics, and pain medications that the patient may need during and after the surgery. This step will help the patient avoid any unforeseen drug reactions that may compromise the current treatment regimen or recovery from surgery.
In the case of some injectables, the procedure may require several visits to complete. For collagen injections, the process may take an average of five procedures over the course of two years. For more severe instances, the patient may require monthly treatment sessions for six months or more.
Recovery from Facial Wasting Surgery
Depending on the procedure, recovery from Lipoatrophy surgery can be relatively short with minimal pain. The recovery time from implant surgery is typically longer than that from a procedure involving only injectables. The surgeon will often prescribe pain management medications, if needed, and a prophylactic antibiotic. After implant surgery, the patient may experience swelling and pain for a few days, which can be treated with cold compresses and Tylenol.
The recovery time after an injectable procedure ranges from two days to a week with patients experiencing minimal pain and swelling. However, these procedures are seldom permanent after the first round and patients frequently have to return for additional treatments.
Treatment Results for Facial Wasting
Despite some popular beliefs, plastic surgery is not about creating an entirely new appearance. Instead, Dr. Slupchynskyj's goal is to bring the patient's appearance as close to its ideal look as possible. He is an experienced facial plastic and reconstructive surgeon who has brought back the patient's natural look and has returned many faces to a normal, healthy appearance.
When the procedures are successful, they can restore a more vibrant and energetic look to the patient's face. This new appearance can also restore a patient's self-confidence. The boost in self-esteem that the process can bring, along with the changes in attitudes from friends, family, and co-workers, can also improve the healing process from the disease. Patients with a healthier outlook on life typically live longer and have a higher quality of life than those without such a positive attitude, and the facial reconstruction procedures can be an instrumental part of that process.
Facial Wasting is shown in the before photos, in the temporal and infra-zygomatic region from Lipoatrophy, secondary to HIV medication. This is a healthy male who had a temporal Gore-Tex Silastic implant in the temporal region placed through a small hairline temporal incision. The Gore-Tex Silicone implant was custom carved by Dr. Slupchynskyj and inserted to augment and fill out the temporal facial wasting region. The infra-temporal region (cheek area) was augmented with microdroplet Silikon®™ 1000. Treatments took place over a period of 4 months. Although there are many injectable fillers which can be used to augment the temporal and infra-temporal regions, which include Radiesse®™ Sculpra®™ and JUVEDERM®™, Dr. Slupchynskyj prefers to use permanent Gore-Tex Silicone implants for the temporal region due their permanency and very natural results. The infra-temporal region or cheek area can also be augmented with custom carved sub-malar implants and later improved with injectable fillers. Dr. Slupchynskyj uses Silicone or Silikon®™ 1000 in a meticulous microdroplet fashion, which achieves a great cosmetic result and is permanent. Again, other fillers can be employed but results are temporary.
Silikon®™ 1000 Microdroplet Treatment
46 yr old male complaining of aesthetic changes in his face due to Facial Wasting Syndrome. Dr. Slupchynskyj treated the patient with five sessions of medical grade Silikon®™ 1000 using the microdroplet technique. Each treatment session was 3 weeks apart. Patient is eight months post-treatment.
Facial Wasting Treatment
Facial Wasting Treatment
HIV Facial Wasting
Facial Wasting Causes
Dr. Oleh Slupchynskyj is a talented facial plastic surgeon who offers a full range of plastic and reconstructive procedures at his NY cosmetic surgery practice. In addition to treating facial wasting, he performs aesthetic procedures such as mini facelift, facelift, browlift, eyelid lift and more. He also offers non-surgical treatments such as Botox, Juvederm and chemical peels.