Sculptra, a procedure for facial lipoatrophy, is it for you?
"Best face forward, despite HIV"
at the end of this article is a link to recently published study showing 2-year followup after sculptra procedures.
By Yomi S. Wronge
Sunday, April 2, 2006
Dan Bueling, shown with his dog, Rudy, has received a cosmetic treatment for the loss of fat beneath the skin that creates a gaunt look common to people infected with HIV.
SAN JOSE, Calif. - Looking at him now, one would never guess that Dan Bueling has HIV, that he takes more than 30 pills a day to manage the infection or that he once packed little wads of tissue inside his jowls to fill in areas left hollow by the resulting facial wasting.
For Bueling, the subtle changes in his face began appearing just when he was happy, healthy and looking forward to a long life thanks to advances in HIV treatment.
"Here we'd come so far," said Bueling, a 45-year-old landscape architect from San Jose, "and now we're going to live, but the irony is you look like a monster."
Lipoatrophy - a wasting of facial fat common to people with human immunodeficiency virus that causes the most seriously afflicted to look like walking death - probably is caused by the ravages of the HIV infection and the medications patients must take to stay alive. The trade-off is one Bueling couldn't take - and now he doesn't have to.
He's started using a product called Sculptra, an injectable form of poly-L-lactic acid, a synthetic polymer widely used in dissolvable stitches, bone screws and facial implants.
It comes as a powder that gets reconstituted in sterile water and injected under the deepest layer of skin. The product gets broken down in the body, but in the process, the skin thickens and the face appears fuller.
The improvement to folds and sunken areas of the face means that Bueling can move through life without the visual stigma of an illness.
"It's wonderful that people are living longer, healthier lives," said Dr. Mark DuLong, a plastic surgeon. "But lipoatrophy can limit you in what you feel comfortable doing. So it's not at all just a cosmetic issue."
The U.S. Food and Drug Administration in August 2004 approved the injectable filler to correct facial fat loss in people with HIV infection.
Sculptra was the first such treatment approved for lipoatrophy. It doesn't fix the underlying cause of facial fat loss but creates a healthier look.
"The nice thing about Sculptra is it removes that telltale sign," said Ed Lortz, 62, of San Francisco. He learned about Sculptra after joining a Yahoo message group for people dealing with HIV-related problems.
But it's expensive. One Sculptra treatment costs well over $1,000, and patients need three to six courses to achieve lasting results. Touch-up work is necessary about every two years.
"On a technical level, facial wasting is a byproduct of the HIV disease process as well as the treatment, so it ought to be dealt with as reconstructive surgery," said Dana Van Gorder, a lobbyist with the San Francisco AIDS Foundation.
Van Gorder's concern is that patients will delay or suspend taking life-saving anti-retroviral drugs for fear of this crippling side effect.
Bueling went off his medications for a full year while he researched options for lipoatrophy, but he doesn't recommend that, and neither do physicians.
He joined a clinical trial for Sculptra, which meant he received his first several treatments at a discount and now sees DuLong regularly.
Lortz, a retiree, applied for a patient subsidy with the manufacturer, Dermik Laboratories of Berwyn, Pa. He is more or less pleased with the results.
"I feel a very small bump under the skin," Lortz said of a side effect of the Sculptra treatment. Patients are advised to massage their face for five minutes, five times a day, for five days to smooth away lumps that might form.
"I'm 62 years old. I'm not supposed to look like a movie star, anyway," he said. "But the holes are gone, my cheeks are somewhat evened out, as are my temples, and I feel better about myself."
The procedure is simple, causes little pain and takes about 90 minutes.
On a recent Friday, DuLong programmed the XM Satellite Radio in the exam room to the "Awesome '80s" station. As Stevie Nicks set the mood, DuLong snapped on a pair of rubber gloves, grabbed a sterile marking pen and began mapping out problem areas on a patient's face.
"Do you agree with the treatment area?" DuLong asked, handing the patient a mirror so he could see what would be accomplished on this fourth visit. The man nodded.
Little specks of blood appeared on his face as DuLong first numbed each side with a local anesthetic and then injected Sculptra into multiple areas.
The doctor followed each needle pass with a gentle massage to keep the thick solution from clumping up under the skin.
The results were immediate and dramatic. Where the man's face was depressed, there was an appreciable plumpness.
Much of this fast effect is due to swelling and the presence of the liquid under the skin.
But when the Sculptra resorbs, the natural collagen that formed around it will remain, providing a gradual and significant increase in skin thickness.
"It's been life-changing for some of these patients," DuLong said as he reviewed his work.
Sculptra was approved by the U.S. Food and Drug Administration in 2004 for the restoration and/or correction of the signs of facial fat loss (lipoatrophy) in people with human immunodeficiency virus. It is manufactured by Dermik Laboratories of Berwyn, Pa.
What it does: Sculptra gradually restores the fullness of the face, creating a more natural appearance, but it will not correct the underlying cause of facial fat loss.
How it's used: It is injected under the skin, and patients are given a local anesthetic prior to treatment.
Common adverse effects: Bleeding at the injection site, small bumps under the skin and minor swelling or discomfort.
Where to learn more: Visit the Web site about the product, www.sculptra.com/US, for a searchable database of health-care providers who offer Sculptra treatments.
Source: Dermik Laboratories
Poly-L-Lactic Acid for Facial Lipoatrophy - 2 years Followup - (03/30/06)