Objective evidence for the use of polylactic acid implants in HIV-associated facial lipoatrophy using three-dimensional surface laser scanning and psychological assessment

Ong, J.; Clarke, A.; White, P.; Johnson, M.A.; Withey, S.; Butler, P.E.M.

doi:10.1016/j.bjps.2008.07.046

« Previous Next »Journal of Plastic, Reconstructive & Aesthetic Surgery
Volume 62, Issue 12 , Pages 1627-1635, December 2009

Objective evidence for the use of polylactic acid implants in HIV-associated facial lipoatrophy using three-dimensional surface laser scanning and psychological assessment

J. Ong
- Department of Plastic and Reconstructive Surgery, The Royal Free Hospital Hampstead NHS Trust, Pond Street, London, NW3 2QG, UK
- Corresponding author. Address: Department of Plastic and Reconstructive Surgery, The Royal Free Hospital Hampstead NHS Trust, Pond Street, London NW3 2QG, UK. Tel.: +44 7903 858 297.
A. Clarke
- Department of Plastic and Reconstructive Surgery, The Royal Free Hospital Hampstead NHS Trust, Pond Street, London, NW3 2QG, UK
P. White
- Department of Statistics, University of the West of England, Frenchay Campus, Coldharbour Lane, Bristol, BS16 1QY, UK
M.A. Johnson
- Department of Infectious Diseases and HIV Medicine, The Royal Free Hospital Hampstead NHS Trust, Pond Street, London, NW3 2QG, UK
S. Withey
- Department of Plastic and Reconstructive Surgery, The Royal Free Hospital Hampstead NHS Trust, Pond Street, London, NW3 2QG, UK
P.E.M. Butler
- Department of Plastic and Reconstructive Surgery, The Royal Free Hospital Hampstead NHS Trust, Pond Street, London, NW3 2QG, UK

Received 19 March 2008; accepted 17 July 2008. published online 26 November 2008.

Summary

The advent of highly active antiretroviral therapy (HAART) has dramatically improved the life expectancy of people infected with human immunodeficiency virus (HIV). Although patients often have excellent disease control with these combinations of antiretrovirals, they are at risk for the multiple toxicities associated with these drugs. Facial lipoatrophy is a particularly distressing complication of some HAART regimes. This disfigurement can lead to significant psychosocial stress, resulting in decreased treatment compliance. Polylactic acid (PLA) facial implants provide a potential method of restoring a normal appearance.

One hundred consecutive patients had a course of PLA facial implants. All patients were assessed clinically and had photographs, facial surface laser scans and completed psychological questionnaires throughout the course of treatment.

After a mean of 4.85 treatments per patient, there were improvements in all measures. The mean clinical scores improved from a moderate–severe grade to none–mild grade after treatment. Three-dimensional (3D) laser surface scans showed a volume increase of 2.81cc over the treated area of the cheek. There were significant improvements in all of the psychological measures.