| Semi-Permanent and Permanent Fillers |
Advantages |
Disadvantages |
Cost |
Availability in the U.S. |
| Silicone Oil (Silikon® 1000, VitreSil® 1000): Silicone comes in solid formulations and liquid formulations. Solid silicone is rarely used for facial lipoatrophy. Silicone oil is more commonly used, but its safety and effectiveness for cosmetic purposes are still controversial. At present, silicone oil is approved for eye repair only; it is still being investigated for facial augmentation. |
Safe and highly effective when injected in very small volumes (microdroplets). Very long lasting, limiting the cost and the need for follow-up procedures. |
Cannot be removed. Can be toxic and damaging to the face if too much is injected. In some cases, silicone can migrate – usually down toward the jaw line – causing new cheeks to become jowls. |
Highly variable, depending on amount of silicone used and costs associated with the procedure. |
Although it is not approved for cosmetic purposes, silicone is widely available. Be sure that silicone injections are performed by a reputable, knowledgeable, and experienced healthcare provider. |
| Polymethylmethacrylate (PMMA; Artecoll®, Artefill®, Precise™, Metacrill®): PMMA is best known for its use in manufacturing hard contact lenses and Plexiglas. These products contain small particles (microspheres) of PMMA. Artecoll and Artefill also contain bovine collagen; Precise and Metacrill do not. After it is injected, the body produces collagen that surrounds the PMMA microspheres. The PMMA molecules and the surrounding collagen persist indefinitely. The FDA has indicated that PMMA with bovine collagen is safe and effective for the correction of facial wrinkles, lines, and furrows, but has not yet officially approved the product. Precise- and Metacrill-brand PMMA have not been evaluated by the FDA. |
Very long lasting, limiting the cost and the need for follow-up procedures. |
Cannot be removed. Can cause side effects if large amounts of PMMA are used. Can sometimes be felt, but rarely seen, under the skin in some people. |
$800 to $2,500 for product and insertion. |
Artefill was recommended for approval in February 2006 and will likely be available sometime in April. Bovine collagen-free PMMA injections are currently available in Mexico (Precise) and Brazil (Metacrill). |
| Expanded Polytetrafluoroethylene (ePTFE) Implants (Gore-Tex®, Gore S.A.M., SoftForm®): These solid implants require minor surgery, via a small incision, under local anesthesia. They have been used for many years to help restore deep facial defects and may be useful for HIV-associated lipoatrophy in terms of filling large, sunken areas. Some experts believe that ePTFE should be used in combination with other fillers, particularly those that spark collagen production in the dermis. |
An option for HIV-positive people with severe lipoatrophy. Semi-permanent; can be removed in the event of side effects or dissatisfaction with the end result. |
Post-operative complications, including infection and swelling. Can cause fibrosis/scarring around the implant. Can be visible and felt if not inserted correctly. |
Expensive; approximately $2,000 per cheek. |
Widely available, although none of the ePTFE implants are specifically approved by the FDA for the treatment of facial lipoatrophy. |
| Polyalkylimide (Bio-Alcamid™): Polyalkylimide is a synthetic product that can be injected using a high volume, making it a possible option for HIV-positive individuals with severe lipoatrophy. There is very little experience testing or using Bio-Alcamid in the United States. However, it has been used in Europe for cosmetic and reconstructive purposes, with good results, and is the product of choice at a clinic in Tijuana that has yielded a lot of encouraging before-and-after photographs. An American division of the Italian company that makes Bio-Alcamid is planning clinical trials in the United States. |
A long-lasting semi-permanent filler that can easily be removed in the event of over filling, side effects, or dissatisfaction with the end results. Thus far, side effects have been minimal. |
Was approved for use in Canada in April 2006. Not yet available in the United States. FDA has not yet reviewed scientific data supporting its safety and effectiveness. Expensive, especially when international travel to and from clinics offering polyalkylimide injections are necessary. |
Total costs of approximately $4,500 – including travel, the necessary amount of product, and injections – have been cited. |
Not yet available in the United States. Many HIV-positive people in the United States have visited the Clinic'estetica in Tijuana, Mexico for the procedure. Its availability in Canada may also mean increased access to residents of the United States. |
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