title: High-density hyaluronic acid for the treatment of HIV-related facial lipoatrophy.
abstract: BACKGROUND
  Facial lipoatrophy is a stigmatizing hallmark of HIV. The injection of facial fillers has an essential role in the treatment of this condition. The objective of our study was to verify the safety and efficacy of a new formulation of high-density hyaluronic acid for the injectable treatment of HIV-related facial lipoatrophy.
  
  
  METHODS
  We treated with high-density hyaluronic acid injections HIV patients affected by moderate to severe facial lipoatrophy and evaluated them at last follow-up, at a minimum of 36 weeks. Physician-related outcomes included pre-and post-treatment ultrasound measurement of the soft-tissue thickness of the cheeks and qualitative assessment of aesthetic results by means of the Global Aesthetic Improvement Scale using pre- and post-treatment photos of the patients. Patient satisfaction outcomes were evaluated with the VAS-face scale and Freiburg test.
  
  
  RESULTS
  Fifty-four patients were studied. The median number of treatment sessions was 3 and the median length of treatment was 5.5 months. The thickness of the soft tissues of the cheek increased significantly from 9.45 to 13.12 mm (p<0.0001). On the basis of the Global Aesthetic Improvement Scale, 87.5% of the patients were judged as "much improved" or "improved." Patient satisfaction at 1 year from the end of treatment was proven (VAS-face: 77.9; Freiburg questionnaire: 93.6% of patients were satisfied or very satisfied). Complications were limited to mild redness and swelling in the early postoperative period.
  
  
  CONCLUSIONS
  Long-term improvement of facial contour and excellent patient satisfaction, in the absence of severe side effects, were obtained by the injection of high-density hyaluronic acid (STYLAGE® XL) in HIV patients with facial lipoatrophy.
authors: Department of Plastic and Reconstructive Surgery, Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy. mrpignatti@googlemail.com
authors: Marco
authors: M
authors: Pignatti
authors: Antonio
authors: A
authors: Pedone
authors: Alessio
authors: A
authors: Baccarani
authors: Giovanni
authors: G
authors: Guaraldi
authors: Gabriella
authors: G
authors: Orlando
authors: Matteo
authors: M
authors: Lombardi
authors: Giorgio
authors: G
authors: De Santis
mesh_terms: D000328:Adult; D001672:Biocompatible Materials; D005145:Face; D005260:Female; D039682:HIV-Associated Lipodystrophy Syndrome / Q000188:drug therapy*; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage*; D007267:Injections; D008297:Male; D008875:Middle Aged
chemical_list: D001672:Biocompatible Materials; D006820:Hyaluronic Acid