title: A facial marker in facial wasting rehabilitation.
abstract: BACKGROUND
  Facial lipoatrophy is one of the most distressing manifestation for HIV patients. It can be stigmatizing, severely affecting quality of life and self-esteem, and it may result in reduced antiretroviral adherence. Several filling techniques have been proposed in facial wasting restoration, with different outcomes. The aim of this study is to present a triangular area that is useful to fill in facial wasting rehabilitation.
  
  
  METHODS
  Twenty-eight HIV patients rehabilitated for facial wasting were enrolled in this study. Sixteen were rehabilitated with a non-resorbable filler and twelve with structural fat graft harvested from lipohypertrophied areas. A photographic pre-operative and post-operative evaluation was performed by the patients and by two plastic surgeons who were "blinded." The filled area, in both patients rehabilitated with structural fat grafts or non-resorbable filler, was a triangular area of depression identified between the nasolabial fold, the malar arch, and the line that connects these two anatomical landmarks.
  
  
  RESULTS
  The cosmetic result was evaluated after three months after the last filling procedure in the non-resorbable filler group and after three months post-surgery in the structural fat graft group. The mean patient satisfaction score was 8.7 as assessed with a visual analogue scale. The mean score for blinded evaluators was 7.6.
  
  
  CONCLUSIONS
  In this study the authors describe a triangular area of the face, between the nasolabial fold, the malar arch, and the line that connects these two anatomical landmarks, where a good aesthetic facial restoration in HIV patients with facial wasting may be achieved regardless of which filling technique is used.
authors.affiliation: Unit of Maxillo-Facial Surgery, Head & Neck Department, University of Naples, Naples, Italy. raffaelerauso@virgilio.it
authors.forename: Raffaele
authors.initials: R
authors.lastname: Rauso
authors.forename: Gianpaolo
authors.initials: G
authors.lastname: Tartaro
authors.forename: Nicola
authors.initials: N
authors.lastname: Freda
authors.forename: Antonio
authors.initials: A
authors.lastname: Rusciani
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Curinga
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects; D005145:Face / Q000473:pathology* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D039682:HIV-Associated Lipodystrophy Syndrome / Q000139:chemically induced / Q000175:diagnosis* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods*