Long-term treatment for lipoatrophy associated or not with HIV infection using ePTFE implants and polyacrylamide gel

Abstract

HIV-related lipoatrophy (HIVLA) is notable for its increasing incidence, multiple etiologies, relatively low morbidity, apparently irreversible effects, and unequivocal clinical features. The underlying cause of HIVLA is still controversial, but there is an increasing demand for correction. We describe a treatment approach using soft malar implants and polyacrylamide gel injections, separately or in combination. Expanded polytetrafluoroethylene (GORE-SAM, W.L. Gore & Associates, Flagstaff, AZ) malar implants were used for augmentation of the most sunken areas below the eye. They were placed subperiosteally and more medially than conventional implants. After trying sheets and custom-made implants, preshaped GORE-Tex SAM implants are now used systematically. Polyacrylamide gel (Eutrophill, Lab Procytech, Martillac, France) injections were performed continuously and evenly from one side to the other in the deepest part of the sunken area at the subcutaneous level only. A total of 85 consecutive patients were treated using implants alone in 8 cases, injections alone in 65 cases, and both implants and injections in 12 cases. The few adverse effects included 3 cases of chronic inflammation (dental conflict) after placement of sheets and custom-made implants; no such cases occurred using preshaped implants. Some very light bulges developed after polyacrylamide injections, which usually disappeared after a few months. Mean follow-up was 16 months for injections and 29 months for implants. Combination treatment using implants in sunken areas near the bone and fillers in soft tissue areas offers a balanced trade-off between benefits and risks and provides excellent long-term and natural results, as well as notable psychological benefits.