Changes to Your Face (Facial Lipoatrophy) en español

What are some of the temporary fillers?

Temporary Fillers	Advantages	Disadvantages	Cost	Availability in the U.S.
Autologous fat transplant: This procedure involves taking fat from one part of the body (such as the butt, hips, inner thighs, or abdomen), cleaning and filtering it, and injecting into another part of the body, such as the face.	Most natural of all the facial fillers. Good results and very natural in appearance if performed by an experienced specialist. Harvested fat can be frozen and stored if touch-ups are needed in the future. Has been shown to last anywhere from six months to two years in some studies involving HIV-positive patients.  Might be possible to increase the length of benefits through a method that involves injecting fat into the muscles of the face.	Fat can be difficult to harvest from other parts of the body, especially in HIV-positive people with advanced lipoatrophy lacking in subcutaneous fat. Post-surgical recovery can be uncomfortable and take several days. Injected fat can sometimes become abnormally enlarged (hypertrophy); this is more often seen in patients who have fat taken from existing "buffalo humps" to fill hollows in the face.	$4,000 to $6,000 per office visit, with approximately three visits over a two-year period.	Yes. Offered by many plastic surgeons who regularly perform liposuction.
Collagen (Bovine: Zyderm and Zyblast; Human: CosmoDerm and CosmoPlast): Collagen has been used for more than 25 years for cosmetic purposes in the United States, most notably as a filler for facial wrinkles. Because it has long been approved by the FDA for this purpose, it was one of the first products evaluated and used in HIV-positive people with facial lipoatrophy. Bovine collagen is derived from calf skins; human collagen is grown in test tubes using human tissues. If bovine collagen is used, an allergy test is required before the product is injected into the face.	Both bovine collagen and human collagen are widely available, and many plastic surgeons and dermatologists have experience using it (although not necessarily in HIV-positive individuals with lipoatrophy). Post-injection recovery is mild and limited.	Possibility of allergic reaction or severe scarring (necrosis). Can be expensive, given that a single course of injections only lasts three to five months. Repeated maintenance injections can increase the annual cost of therapy. Large volumes of collagen may be needed to restore facial features in HIV-positive people with lipoatrophy. Probably best for people with mild-to-moderate facial lipoatrophy.	Approximately $600 per visit, with an average of five visits over a two-year period ($2,500 in total for two years of therapy).	Widely available, although not specifically approved by the FDA for the treatment of facial lipoatrophy.
Human cadaveric dermis (Cymetra, Dermalogen) and fascia (Fascian): These products are derived from cadavers at the time of death.  The dermis or muscle fascia (the gray/white covering over the muscles) is harvested and brought to a lab for sterilizing, testing, and processing. Allergy testing is not necessary.	FDA approved and are readily available. Impressive filling of hollows in the face, at least initially.	Very temporary, with injections lasting approximately one to three months. Requires a large-gauge needle for injection. Can be very expensive, given the need for frequent touch-ups.	Can cost more than $2,000 per year.	Widely available, although not specifically approved by the FDA for the treatment of facial lipoatrophy.
Hyaluronic Acid (Restylane, Perlane, Hylaform): Hyaluronic acid is naturally found in human connective tissues. These three brands are synthetic versions of hyaluronic acid and have been designed to prevent rapid breakdown by the body.	Injections of hyaluronic acid have been shown to last six to 12 months in HIV-positive individuals with lipoatrophy. Cheaper than many other products, given that fewer touch-ups are needed. Can easily be removed in the event of side effects or dissatisfaction with the end results.	Post-injection recovery can be slightly uncomfortable. Large volumes are needed for patients with moderate-to-severe facial lipoatrophy.	Approximately $1,500 per visit, depending on the brand and volume of hyaluronic acid needed and the treatment fee charged by the specialist.	Only Restylane is approved for use in the United States. Perlane and Hylaform are available in Europe and South America.
Calcium hydroxylapatite (Radiance, Radiesse): These products contain synthetic calcium hydroxylapatite, a natural substance found in bones and teeth. It is primarily used in the reconstruction of bony structures. When it is injected into the dermis layer of skin, natural collagen forms around the calcium hydroxylapatite, providing long-term, natural-looking fullness.	Calcium hydroxylapatite is approved by the FDA for various uses in the United States, including orthopedic and reconstructive surgery and in dentistry, and has a good safety record. Even though it is considered to be a temporary filler, it appears to have a longer lasting effect than most other temporary fillers.	Can be very expensive. Can also cause nodules—hard lumps—at the injection site (they can be felt but not usually seen) in some patients.	As much as $3,000 per office visit.	Currently being explored in clinical studies for HIV-associated facial lipoatrophy—at cost to the patient.
Poly-l-lactic acid (Sculptra, New-Fill): Poly-l-lactic acid is a synthetic product that has a long history of use in reconstructive surgery. Even though it is synthetic, it is eventually broken down and removed by the body, meaning that its effects are temporary. It is the only facial filler to be approved by the FDA for the reconstructive management of HIV-associated facial lipoatrophy. Usually requires between two and six treatment sessions every four to six weeks.	Safety and effectiveness have been evaluated by the FDA. Even though it is considered to be a temporary filler, it appears to have a longer lasting effect than most other temporary fillers. Repeat injections, within a year or two after an initial treatment, are likely necessary.	The cost of poly-L-lactic acid can be high, although the manufacturer of Sculptra (Dermik Laboratories) has implemented a sliding-scale fee for the product based on an individual's income. Multiple sessions can be cumbersome and increase the cost of treatment. Can also cause nodules—hard lumps—at the injection site (they can be felt but not usually seen) in some patients.	Approximately $1,500 per visit, depending on the amount of poly-L-lactic acid needed and the treatment fee charged by the specialist.	FDA approved for HIV-associated facial lipoatrophy with many specialists throughout the country now providing access to treatment. Dermik Laboratories has developed a searchable database to help HIV-positive individuals locate a nearby specialist offering this service: click here.

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