People on HIV medications sometimes experience a loss of fat from the face caused by the condition lipoatrophy. It can result in a sunken or hollow-cheeked appearance and have a debilitating affect on a person’s self-confidence.

New combinations of therapies are providing lower rates of lipoatrophy and there is research currently under way in Sydney into how to prevent the condition. But for those already living with it a number of cosmetic procedures are available.

One is the injection of a synthetic substance called Sculptra (or New Fill) into the affected areas, where it encourages the growth of collagen to plump the face back out.

Sculptra has been used in Australia for around five years and, according to the National Association of People Living With HIV/AIDS Australia (NAPWA) website, is safe, has limited side effects and has become popular with positive people.

It’s made up of polylactic acid which is gradually broken down by the body over time. Sculptra treatments last around two years.

Dr Joseph Ajaka, director of Cosmos Cosmetic Medicine in the CBD, has been treating positive people with Sculptra for a number of years.

The good thing about the product is it gives a natural look and a natural feel, he said. It vastly improves their confidence and their day-to-day interaction with people.

Results are not immediate as it takes the body time to remodel collagen, Ajaka said. By around three months the results should be about complete.

The injections are usually completed over a course of three treatments, one month apart, though people with extreme cases of lipoatrophy may need more.

Possible side effects include bruising for a few days after the procedure, and in some cases small nodules or lumps may form where the product accumulates. Ajaka said this is unlikely if the patient massages their face twice a day for five days after the procedure.

While the results last for two years, Ajaka encourages his patients to top up every year to maintain the improvements.

The procedure isn’t cheap. Ajaka charges $770 per vial, with one vial usually used per treatment (he offers a discount to people who sign up for the full course of three treatments).

Another product becoming popular overseas with people experiencing lipoatrophy is Aquamid. It’s a biocompatible gel implant made up of 97.5 percent water and 2.5 percent cross-linked polyacrylamide.

Like Sculptra, it’s injected into the affected areas. The big difference is that Aquamid is considered a permanent filler, lasting around 10 years, and the effects are immediate.

The NAPWA website advises caution with permanent or semi-permanent fillers, warning that they may cause distortion if, in the future, fat returns to the face due to improved HIV treatments. They also suggest Aquamid is too new to know how it will affect people over time.

However, Aquamid seems to be growing in popularity in European countries, where a number of nations are reported to be looking at subsidising Aquamid for positive people.

Dr William Pouw, who uses Aquamid on clients with lipoatrophy at his Cosmedical Clinic in Woollahra, said it’s safe and has been used on thousands of people in Europe with no incidents.

The possible side effects that can occur include bruising and, rarely, infection.

Pouw is a fan of the product because it feels natural, soft, is undetectable and doesn’t harden.

Aquamid is injected over a course of two or three treatments, two weeks apart. Most patients need injections of between four and 10 millilitres of the product, which costs between $800 and $1,000 per ml. As with Sculptra, most practitioners offer discounts depending on the amount needed.

NAPWA suggests people with lipoatrophy speak to their GP for a referral and seek out a reputable cosmetic practitioner before embarking on any cosmetic procedures.

For more information on lipoatrophy, see the NAPWA website or the Australian Federation of AIDS Organisations website.

For more on Sculptra see its website or call 1800 640 791. For Aquamid see its website or call 1800 633 830.

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