Custom-built facial implants helpful for patients with HIV and facial wasting syndrome

CHICAGO – Patients taking highly active antiretroviral therapy (HAART) for the treatment of HIV/AIDS often lose fatty tissues in the face as a result of treatment, making them appear gaunt and emaciated. Silicone facial implants can help these patients achieve a healthier appearance and fuller face, according to an article in the November/December issue of The Archives of Facial Plastic Surgery, a special theme issue on facial rejuvenation and one of the JAMA/Archives journals.

As patients with HIV live longer, they are beginning to seek surgical procedures to help improve their appearance caused by the disease and treatment, the article states. Traditionally, facial wasting syndrome has been treated using the patient's own fat, but frequent adjustments and additional procedures were often required. Custom designed implants tend to remain stable in their position after implantation and retain their original size and structure.

William J. Binder, M.D., of the University of California, Los Angeles, and David C. Bloom, M.D., of the University of Washington, Seattle, investigated the use of custom-designed facial implants in the treatment of 22 patients with facial wasting syndrome.

High resolution computer tomography (CT)--a procedure that scans the patient's face and allows physicians to create a three-dimensional model of the skull bones--as performed on each patient. Custom-made implants were sized and fitted before implantation using models created using the CT images.

The researchers write that "Overall, 22 patients had excellent aesthetic postoperative outcomes as determined by the patient and the surgeon. Fourteen of the 22 patients received custom implants for more severe midfacial changes, and eight patients received "off-the-shelf" submalar implants for midfacial conditions of moderate severity," the authors write.

"The dramatically improved therapy provided by HAART has enabled patients with HIV to live longer and healthier lives. Human immunodeficiency virus is not the death sentence that it once was. As a result, many patients are seeking correction of the bony, emaciated appearance of facial wasting syndrome, which occurs in more than 50 percent of patients who receive HAART for longer than one year. Custom-designed submalar implants provide a safe, stable, definitive, aesthetically pleasing solution to this problem," the researchers conclude.

(Arch Facial Plast Surg. 2004;6:394-397. Available post-embargo at archfacial.com)

For more information, contact JAMA/Archives Media Relations at 312-464-JAMA (5262) or e-mail mediarelations@jama-archives.org .

To contact William J. Binder, M.D., call 310-858-6749.

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