Top

Aesthetic Plastic Surgery

Published in:

01-02-2012 | Original Article

Polyacrylamide Gel for Facial Wasting Rehabilitation: How Many Milliliters per Session?

Authors: R. Rauso, G. Gherardini, V. Parlato, R. Amore, G. Tartaro

Published in: Aesthetic Plastic Surgery | Issue 1/2012

Abstract

Background

Facial lipoatrophy is most distressing for HIV patients in pharmacologic treatment. Nonabsorbable fillers are widely used to restore facial features in these patients. We evaluated the safety and aesthetic outcomes of two samples of HIV+ patients affected by facial wasting who received different filling protocols of the nonabsorbable filler Aquamid^® to restore facial wasting.

Methods

Thirty-one HIV+ patients affected by facial wasting received injections of the nonabsorbable filler Aquamid for facial wasting rehabilitation. Patients were randomly divided into two groups: A and B. In group A, the facial defect was corrected by injecting up to 8 ml of product in the first session; patients were retreated after every 8th week with touch-up procedures until full correction was observed. In group B, facial defects were corrected by injecting 2 ml of product per session; patients were retreated after every 8th week until full correction was observed.

Results

Patients of group A noted a great improvement after the first filling procedure. Patients in group B noted improvement of their face after four filling procedures on average. Local infection, foreign-body reaction, and migration of the product were not observed in either group during follow-up.

Conclusion

The rehabilitation obtained with a megafilling session and further touch-up procedures and that with a gradual build-up of the localized soft-tissue loss seem not to have differences in terms of safety for the patients. However, with a megafilling session satisfaction is achieved earlier and it is possible to reduce hospital costs in terms of gauze, gloves, and other items.

Danner SA, Carr A, Leonard JM, Lehman LM, Gudiol F, Gonzales J, Raventos A, Rubio R, Bouza E, Pintado V et al (1995) A short-term study of the safety, pharmacokinetics, and efficacy of ritonavir, an inhibitor of HIV-1 protease. European-Australian Collaborative Ritonavir Study Group. N Engl J Med 333(23):1528–1533PubMedCrossRef

Hammer SM, Squires KE, Hughes MD, Grimes JM, Demeter LM, Currier JS, Eron JJ Jr, Feinberg JE, Balfour HH Jr, Deyton LR, Chodakewitz JA, Fischl MA (1997) A controlled trial of two nucleoside analogues plus indinavir in persons with human immunodeficiency virus infection and CD4 cell counts of 200 per cubic millimeter or less. AIDS Clinical Trials Group 320 Study Team. N Engl J Med 337(11):725–733PubMedCrossRef

Carpenter CCJ, Fischl MA, Hammer SM et al (1998) Antiretroviral therapy for HIV infection in 1997: updated recommendations of the International AIDS Society-USA panel. JAMA 280:78–86PubMedCrossRef

Waters L, Nelson M (2007) Long-term complications of antiretroviral therapy: lipoatrophy. Int J Clin Pract 61:999–1014PubMedCrossRef

Lichtenstein KA (2005) Redefining lipodystrophy syndrome: risks and impact on clinical decision making. J Acquir Immune Defic Syndr 39:395–400PubMedCrossRef

Carr A, Samaras K, Burton S, Law M, Freund J, Chisholm DJ, Cooper DA (1998) A syndrome of peripheral lipodystrophy, hyperlipidaemia and insulin resistance in patients receiving HIV protease inhibitors. AIDS 12(7):F51–F58PubMedCrossRef

Lichtenstein KA, Ward DJ, Moorman AC, Delaney KM, Young B, Palella FJ et al (2001) Clinical assessment of HIV-associated lipodystrophy in an ambulatory population. AIDS 15:1389–1398PubMedCrossRef

Bernasconi E, Boubaker K, Junghans C, Flepp M, Furrer HJ, Haensel A et al (2002) Abnormalities of body fat distribution in HIV-infected persons treated with antiretroviral drugs: the Swiss HIV Cohort study. J Acquir Immune Defic Syndr 31:50–55PubMedCrossRef

Miller J, Carr A, Emery S, Law M, Mallal S, Baker D et al (2003) HIV lipodystrophy: prevalence, severity and correlates of risk in Australia. HIV Med 4:293–301PubMedCrossRef

10.

Carr A, Samaras K, Thorisdottir A, Kaufmann GR, Chisholm DJ, Cooper DA (1999) Diagnosis, prediction, and natural course of HIV-1 protease-inhibitor-associated lipodystrophy, hyperlipidaemia, and diabetes mellitus: a cohort study. Lancet 353:2093–2099PubMedCrossRef

11.

Gervasoni C, Ridolfo AL, Trifiro G, Santambrogio S, Norbiato G, Musicco M et al (1999) Redistribution of body fat in HIV-infected women undergoing combined antiretroviral therapy. AIDS 13:465–471PubMedCrossRef

12.

Strand A, Wolters M (2006) HIV-related lipodystrophy and facial lipoatrophy: the role of Restylane SubQ in reversing facial wasting. Aesthet Surg J 26(Suppl):S35–S40PubMedCrossRef

13.

Duran S, Savès M, Spire B, Cailleton V, Sobel A, Carrieri P, Salmon D, Moatti JP, Leport C (2001) Failure to maintain long-term adherence to highly active antiretroviral therapy: the role of lipodystrophy. AIDS 15(18):2441–2444PubMedCrossRef

14.

Serra-Renom JM, Fontdevila J (2004) Treatment of facial atrophy related to treatment with protease inhibitors by autologous fat injection in patients with human immunodeficiency virus infection. Plast Reconstr Surg 114:551–555PubMedCrossRef

15.

Nelson L, Stewart KJ (2008) Experience in the treatment of HIV-associated lipodystrophy. J Plast Reconstr Aesthet Surg 61:366–371PubMedCrossRef

16.

Sturm LP, Cooter RD, Mutimer KL, Graham JC, Maddern GJ (2009) A systematic review of permanent and semipermanent dermal fillers for HIV-associated facial lipoatrophy. AIDS Patient Care STDS 23:699–714PubMedCrossRef

17.

Carey D, Baker D, Petoumenos K, Chuah J, Rogers GD, Watson J, Cooper DA, Emery S, Carr A (2009) Poly-L-lactic acid for HIV-1 facial lipoatrophy: 48-week follow-up. HIV Med 10:163–172PubMedCrossRef

18.

Karim RB, de Lint CA, van Galen SR, van Rozelaar L, Nieuwkerk PT, Askarizadeh E, Hage JJ (2008) Long-term effect of polyalkylimide gel injections on severity of facial lipoatrophy and quality of life of HIV-positive patients. Aesthetic Plast Surg 32(6):873–878PubMedCrossRef

19.

Dinman S (2008) Sculptra use in HIV-associated lipodystrophy. Plast Surg Nurs 28(1):53–54PubMed

20.

Hönig J (2008) Cheek augmentation with Bio-Alcamid in facial lipoatrophy in HIV seropositive patients. J Craniofac Surg 19(4):1085–1088PubMedCrossRef

21.

Reytan N, Rzany B (2008) Porcine filler for facial lipoatrophy associated with human immunodeficiency virus treatment. J Drugs Dermatol 7(9):884–886PubMed

22.

Karon JM, Fleming PL, Steketee RW, DeCock KM (2001) HIV in the United States at the turn of the century. Am J Public Health 91:1060PubMedCrossRef

23.

De Santis G, Jacob V, Baccarani A, Pedone A, Pinelli M, Spaggiari A, Guaraldi G (2008) Polyacrylamide hydrogel injection in the management of human immunodeficiency virus-related facial lipoatrophy: a 2 year clinical experience. Plast Reconstr Surg 121:644–653PubMedCrossRef

24.

Negredo E, Higueras C, Adell X, Martinez JC, Martinez E, Puig J et al (2006) Reconstructive treatment for antiretroviral-associated facial lipoatrophy: a prospective study comparing autologous fat and synthetic substances. AIDS Patient Care STDS 20(12):829–837PubMedCrossRef

25.

Negredo E, Puig J, Aldea D, Medina M, Estany C et al (2009) Four-year safety with polyacrylamide hydrogel to correct antiretroviral-related facial lipoatrophy. AIDS Res Hum Retrovir 25:451–455PubMedCrossRef

26.

Kates LC, Fitzgerald R (2008) Poly-l-lactic acid injection for HIV-associated facial lipoatrophy: treatment principles, case studies, and literature review. Aesthet Surg J 28(4):397–403PubMedCrossRef

27.

Zarini E, Supino R, Pratesi G, Laccabue D, Tortoreto M, Scanziani E et al (2004) Biocompatibility and tissue interactions of a new filler material for medical use. Plast Reconstr Surg 114:934–942PubMedCrossRef

28.

Bello G, Jackson IT, Keskin M, Kelly C, Dajani K, Studinger R, Kim EM et al (2007) The use of polyacrylamide gel in soft tissue augmentation: an experimental assessment. Plast Reconstr Surg 119(4):1326–1336PubMedCrossRef

29.

Christensen LC, Breiting VB, Aasted A, Jorgensen A, Kebuladze I (2003) Long term effects of polyacrylamide hydrogel (PAAG, Interfall/Contura SA) in human breast tissue. Plast Reconstr Surg 111:1883PubMedCrossRef

30.

Christensen LC, Breiting V, Janssen M et al (2005) Adverse reaction to injectable soft tissue permanent fillers. Aesthetic Plast Surg 29:34PubMedCrossRef

31.

Orlando G, Guaraldi G, De Fazio D et al (2007) Long-term psychometric outcomes of facial lipoatrophy therapy: forty-eight-week observational, nonrandomised study. AIDS Patient Care STDS 21:833–841PubMedCrossRef

32.

Hornberger J, Rajagopalan R, Shewade A, Loutfy MR (2009) Cost consequences of HIV-associated lipoatrophy. AIDS Care 21(5):664–671PubMedCrossRef

Title: Polyacrylamide Gel for Facial Wasting Rehabilitation: How Many Milliliters per Session?
Authors: R. Rauso
G. Gherardini
V. Parlato
R. Amore
G. Tartaro
Publication date: 01-02-2012
Publisher: Springer-Verlag
Published in: Aesthetic Plastic Surgery / Issue 1/2012
Print ISSN: 0364-216X
Electronic ISSN: 1432-5241
DOI: https://doi.org/10.1007/s00266-011-9757-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Polyacrylamide Gel for Facial Wasting Rehabilitation: How Many Milliliters per Session?

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2012

Patients Have a Right to Safe Surgery

Five-Year Experience with Modified Fogli (Loré’s Fascia Fixation) Platysmaplasty

Implant Infection After Augmentation Mammaplasty: A Review of the Literature and Report of a Multidrug-Resistant Candida albicans Infection

Treatment of Overweight Patients by Radiofrequency-Assisted Liposuction (RFAL) for Aesthetic Reshaping and Skin Tightening

Rhinoplasty Sizers

Tissue Degeneration 7 Years After Breast Augmentation With Injected Polyacrylamide Hydrogel (PAAG)