Multi-Layered e-PTFE Facial Reconstruction for HIV Lipoatrophy

Homere Al  Moutran; Eric W.  Cerrati; Thomas  Romo III

doi:10.4236/ijohns.2014.35041

Homere Al Moutran¹, Eric W. Cerrati², Thomas Romo III³^*

Abstract: Importance: Facial lipoatrophy is a common problem among the Human Immunodeficiency Virus (HIV) population. With highly active antiretroviral therapy, these patients are able to delay the evolution of the disease and live many more years; however, more than half of them are faced with difficulties in their social and professional lives secondary to the physical changes of their faces. Observations: The majority of HIV-positive patients exhibit significant facial soft tissue loss, especially in the buccal fat pad resulting in accentuation of the malar eminence and the inferior orbital rim. Reconstruction has been performed with many temporary and permanent methods, but no single satisfactory procedure has been universally adopted. Conclusions and Relevance: We present a new method of addressing the resulting facial hollowing by tailoring a multi-layered e-PTFE sheet in a customized fashion to camouflage the specific atrophic areas in the face. Our patient demonstrated a significant improvement in both cosmesis and social re-integration. A detailed surgical description along with a review of the literature is reported.

Keywords: HIV Lipoatrophy, Gore-Tex, e-PTFE, Facial Augmentation

Cite this paper: Moutran, H. , Cerrati, E. and Romo III, T. (2014) Multi-Layered e-PTFE Facial Reconstruction for HIV Lipoatrophy. International Journal of Otolaryngology and Head & Neck Surgery, 3, 223-227. doi: 10.4236/ijohns.2014.35041.

References

[1] Domingo, P., Estrada, V., Lopez-Aldeguer, J., et al. (2012) Fat Redistribution Syndromes Associated with HIV-1 Infection and Combination Antiretroviral Therapy. AIDS Reviews, 14, 112-123.

[2] James, J., Carruthers, A. and Carruthers, J. (2002) HIV-Associated Facial Lipoatrophy. Dermatologic Surgery, 28, 979-986.

[3] Collins, E., Wagner, C. and Walmsley, S. (2000) Psychosocial Impact of the Lipodystrophy Syndrome in HIV Infection. AIDS Reader, 10, 546-551.

[4] Bergeret-Galley, C. (2004) Comparison of Resorbable Soft Tissue Fillers. Aesthetic Surgery Journal, 24, 33-43.
http://dx.doi.org/10.1016/j.asj.2004.01.006

[5] Larsen, N.E., Pollak, C.T., Reiner, K., et al. (1993) Hylan Gel Biomaterial: Dermal and Immunologic Compatibility. Journal of Biomedical Material Research, 27, 1129-1134.
http://dx.doi.org/10.1002/jbm.820270903

[6] Bes, G. (2003) Efficacite du Juvederm 30: un an de suivi. Réalités thérapeutiques en Dermato-Vénérologie, 127, 45-49.

[7] Tzikas, T. (2004) Evaluation of the Radiance FN Soft Tissue Filler for Facial Soft Tissue Augmentation. Archive of Facial Plastic Surgery, 6, 234-239.
http://dx.doi.org/10.1001/archfaci.6.4.234

[8] Pettit, D.K., Lawter, J.R., Huang, W.J., et al. (1997) Characteri-zation of Poly(glycoide-co-D, L-lactide)/Poly(D, L-lactide) Microspheres for Controlled Release of GM-CSF. Pharmaceutical Research, 14, 1422-1430.
http://dx.doi.org/10.1023/A:1012176823155

[9] Mole, B. (1992) The Use of Gore-Tex Implants in Aesthetic Surgery of the Face. Plastic Reconstructive Surgery, 90, 200-206.
http://dx.doi.org/10.1097/00006534-199290020-00007