Experience in the treatment of HIV-associated lipodystrophy.
OBJECTIVE
To evaluate the outcome of patients with HIV-associated lipodystrophy treated within the Edinburgh unit to date.


METHODS
Information was collected from the medical case notes on the clinical features, method of treatment, postoperative complications, and length of follow up for each patient. A questionnaire was devised to assess patient satisfaction and facial volume was evaluated using three-dimensional imaging.


RESULTS
Forty-six patients with HIV-associated lipodystrophy were treated over a 3-year period. Twenty-six patients received Coleman fat injections, 10 patients were treated with Newfill, eight patients were treated with Bio-alcamid, 21 patients received liposuction, and three patients had a minimal access cranial suspension facelift. Follow up ranged from 1 to 14 months. Patient and surgeon satisfaction was high with autologous fat injections although fat resorption occurred in nine patients. Aesthetic improvement with Newfill was moderate and required up to seven treatment sessions. The results of treatment with Bio-alcamid were good immediately postoperatively, although two patients required further corrective procedures. Two patients who had liposuction to the dorso-cervical fat pad reported recurrence at 5 and 9 months, respectively.


CONCLUSIONS
Based on our experience, a treatment algorithm has been devised to aid management decisions. We favour the use of autologous fat injections for facial lipoatrophy but have found fillers to be useful in patients with inadequate fat reserves.
Nelson
L
L
Plastic Surgery Department, St John's Hospital, Howden Road West, Livingston, West Lothian EH54 6PP, UK. drlisanelson@hotmail.com
Stewart
K J
KJ
D000180:Acrylic Resins / Q000627:therapeutic use; D000273:Adipose Tissue / Q000637:transplantation; D000465:Algorithms; D005145:Face / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D039682:HIV-Associated Lipodystrophy Syndrome / Q000473:pathology / Q000601:surgery*; D006801:Humans; D021621:Imaging, Three-Dimensional; D019344:Lactic Acid / Q000627:therapeutic use; D015187:Lipectomy / Q000379:methods; D008297:Male; D017060:Patient Satisfaction; D011091:Polyesters; D011108:Polymers / Q000627:therapeutic use; D019736:Prostheses and Implants; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome
D000180:Acrylic Resins; C470344:Bio-Alcamid; D011091:Polyesters; D011108:Polymers; D019344:Lactic Acid; C033616:poly(lactide)