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LIPOATROPHY/Facial Wasting

“Lipoatrophy” or “Facial Wasting Disease,” is a condition in which patients with HIV lose much of their facial tissue beneath the skin, most notably on the cheeks. The resulting gaunt appearance can be an obvious marker for patients of their HIV status. Lipoatrophy can be emotionally distressing, and although it is not reversible, it can be successfully treated. Our physician wrote the first paper in a medical journal using Radiesse in the treatment of HIV Lipoatrophy and has since written another paper on Radiesse and also is a trainer of other physicians in the use of Sculptra.

Treatments are available, mainly in the form of materials known as fillers, which help to fill the defect of lipoatrophy. Among the current fillers used for lipoatrophy include Sculptra, Radiesse and Restylane®, and silicone.

Our office has experience with the following three materials: Sculptra, Radiesse and Restylane®. Currently we treat most patients with either Sculptra or Radiesse but will sometimes use Restylane.

Depending upon the substance we choose to use, anesthesia will be used to minimize any discomfort.

With all of the following fillers, we can generally correct a patient's lipoatrophy within two or six visits spaced a few weeks apart. Retreatments will be performed when indicated.


Sculptra Treatment

Sculptra is the first filler medicine to be approved in the USA for the treatment of HIV associated lipoatrophy or facial wasting. It was approved in August 2004. Our dermatologist has used SculptraTM in many patients for the past few years. Because of his expertise, our dermatologist trains other doctors across the country in the use of SculptraTM .

SculptraTM is not made from human or animal sources. It can be injected on the same days as your consultation, time permitting.

SculptraTM works by stimulating your own collagen to grow. While patients can see immediate improvement, that is generally because of the water that is used to dissolve the SculptraTM before injection. This temporary swelling will go away after about a week after treatment. More long term correction requires several treatments of SculptraTM. Depending upon how extensive the facial wasting, it can take a number of treatments for SculptraTM to reach the desired effect.

Like any injection, there may be short term side effects including bruising, swelling and redness. These generally resolve within a week and often sooner, but you should not schedule a SculptraTM treatment before an important social or work event. On occasion, bumps beneath the skin can form. Often these are barely noticed by either the physician or the patient, but can occasionally persist as a cosmetic problem.

Once the necessary series of SculptraTM treatment have been performed, results can last for up to two years.

Overall our patients and dermatologist have been quite pleased with SculptraTM. For those of our patients with facial wasting who cannot afford the treatment, sometimes low cost or even free SculptraTM is available, although the patient will be responsible for the injection fee. Please check with our office for further information or to set up a consultation.


Radiesse Treatment

Radiesse is manufactured in a lab and is similar to the substance from which bone is made, but is soft when injected in the skin. Radiesse is FDA approved to safely correct moderate to severe facial folds and wrinkles, including Nasolabial folds. Radiesse for the treatment of lipoatrophy just like Botox is being used to treat wrinkles in a variety of areas. The FDA has approved Radiesse for the treatment of lipoatrophy as well as for wrinkles and folds. We generally inject local anesthesia before injecting the medication. The amount of time Radiesse lasts in patients varies; some practitioners believe Radiesse may last up to a year or more. Like most filler treatments, touch-ups are necessary. At this time, no skin allergy testing is necessary, so we can often inject the Radiesse on the same day of your consultation.


Restylane® is made in a test tube and is purified and sterilized. It has been used safely worldwide for years with a very low risk of allergy. Restylane® has been approved by the FDA for the treatment of wrinkle lines between the nose and outer edge of the lip; using Restylane® to treat lipoatrophy, as previously discussed, is considered an off-label use by the FDA. We generally inject Restylane® after using topical anesthetics. Restylane appears to last longer than does collagen. Restylane® is also helpful for other defects and wrinkles in the face such as for the lines between the nose and the lips. Like Radiesse no skin allergy testing is currently necessary for Restylane, so we can inject the Restylane®, time permitting, even on the same day of your consultation.

Restylane Treatment

The first consultation and treatment may require a few hours, while subsequent touch-ups take less time. Generally, improvement is noted on the same day as your treatment since some redness can occur for a few hours or more after the treatment, though with Sculptra improvement is delayed. We advise you not to schedule important personal or business appointments for a few days after your treatment. Occasionally, make-up cover-up for a few days can be helpful. The cost of the materials we use will be discussed in the office during your consultation. The amount of filler used depends on the extent of lipoatrophy.

If you are interested in a consultation for your facial wasting/lipoatrophy, please click the indicator below to set up an appointment or call us at (212) 557-2600. Be sure to call or contact us now if you are interested.