title: Autologous fat grafting and injectable dermal fillers for human immunodeficiency virus-associated facial lipodystrophy: a comparison of safety, efficacy, and long-term treatment outcomes.
abstract: BACKGROUND
  Facial lipoatrophy is a common side effect of human immunodeficiency virus treatment with highly active antiretroviral therapy. To identify the most clinically durable and efficient way of addressing facial lipoatrophy, the authors reviewed all available evidence for the use of injectable dermal fillers and autologous fat transfers as treatment modalities, focusing on safety, outcomes, and long-term durability.
  
  
  METHODS
  A systematic review of the Cochrane and MEDLINE databases for autologous fat transfer and injectable dermal fillers for the treatment of human immunodeficiency virus-associated lipodystrophy was performed. Based on U.S. Food and Drug Administration approval in human immunodeficiency virus lipoatrophy, studies were limited to the use of hyaluronic acid and/or poly-L-lactic acid. Facial volume, subjective patient satisfaction, standardized outcome scales, reinjection rates, and complications were recorded.
  
  
  RESULTS
  Nineteen studies were included representing 724 patients, with 549 patients in the hyaluronic acid/poly-L-lactic acid cohort and 175 in the autologous fat transfer cohort. Improvements in facial volume and durability of treatment were similar between dermal fillers and fat transfer, as measured by both objective means and subjective patient outcomes. However, poly-L-lactic acid was reinjected at a rate three times that of autologous fat, and was associated with a relatively high rate of subcutaneous papule formation at 22 percent (range, 3 to 44 percent).
  
  
  CONCLUSIONS
  Dermal fillers and autologous fat transfer are effective treatment modalities for human immunodeficiency virus-associated facial lipoatrophy, with high rates of facial volume restoration and patient satisfaction. Autologous fat transfer may offer similar to superior long-term durability but with less of a financial burden compared with injectable fillers.
authors.affiliation: Washington, D.C. From the Department of Plastic Surgery, Georgetown University Hospital, and DAVinci Plastic Surgery.
authors.forename: John
authors.initials: J
authors.lastname: Shuck
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Iorio
authors.forename: Rex
authors.initials: R
authors.lastname: Hung
authors.forename: Steven P
authors.initials: SP
authors.lastname: Davison
mesh_terms: D000273:Adipose Tissue / Q000637:transplantation*; D003357:Cosmetic Techniques / Q000009:adverse effects; D005145:Face; D039682:HIV-Associated Lipodystrophy Syndrome / Q000601:surgery*; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage* / Q000009:adverse effects; D007267:Injections; D019344:Lactic Acid / Q000008:administration & dosage* / Q000009:adverse effects; D011091:Polyesters; D011108:Polymers / Q000008:administration & dosage* / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D011091:Polyesters; D011108:Polymers; D019344:Lactic Acid; C033616:poly(lactide); D006820:Hyaluronic Acid