Bio-Alcamid complications: A 10 year review.

This article is a follow up to "Early and late complications of polyalkimide gel (Bio-Alcamid)".1 It is a summary of late complications that have developed in patients treated with Bio-Alcamid for HIV lipoatrophy following extended follow up of 10 years.

Gluteal Augmentation With Intramuscular Implants in Patients With Human Immunodeficiency Virus With Lipoatrophy Related to the Use of Antiretroviral Therapy.

INTRODUCTION: Lipodystrophy syndrome associated with highly active antiretroviral therapy (HAART) may lead to low self-esteem and poor compliance with the drug treatment on patients infected with human immunodeficiency virus (HIV), which is a matter of concern for the health system. The aim of this study was to evaluate patients with HIV submitted to gluteal augmentation with intramuscular silicone implants to correct gluteal lipoatrophy related to the use of HAART. METHODS: This is a retrospective evaluation of 10 patients submitted to gluteal augmentation with intramuscular silicone implant for correction of gluteal lipoatrophy related to the use of HAART, operated between 2012 and 2015. Postoperative complications and the degree of patient's satisfaction were analyzed. RESULTS: There were 3 postoperative complications including 1 case of surgical wound dehiscence and 2 cases of seroma. Six months after surgery, 8 patients had an excellent degree of satisfaction, and 2 patients had a good degree of satisfaction related to the procedure. Although this intervention does not offer functional advantages, it improves the body contour, increases patients' self-esteem, and helps them to accept their body image. These advantages can lead to higher compliance with prolonged HAART. CONCLUSIONS: Gluteal augmentation with intramuscular silicone implant can be a viable option to treat patients with HIV with gluteal lipoatrophy related to the use of HAART. The patients were satisfied with the outcomes of the procedure, and there were only minor self-limited postoperative complications.

Embodiment and biographical disruption in people living with HIV/AIDS (PLWHA).

This study attempts to provide a concrete understanding to the embodied experience of HIV/AIDS. PLWHA have to cope with physical changes, especially lipodystrophy, caused by HIV and its treatment. These clinical manifestations make the disease socially visible and form a potential source of stigmatization. Visibility seems to transform the personal experience of this particular illness into a collective one. The changing body image and the stigma, which is often internalized by individuals, along with other consequences of chronic illness, such as alteration of life plans and social relationships, constitute new elements that appear in their life after diagnosis. These new experiences can break one's biographical continuity, especially in cases like HIV/AIDS. Semi-structured and in-depth interviews were conducted with 18 HIV-positive individuals (13 men, 5 women) with lipodystrophy. Their ages ranged from 36 to 65 years. The analysis of data revealed three main themes: loss of control over the body, ambivalence about visibility of HIV/AIDS, attributing positive meaning to HIV/AIDS. Physical changes caused by lipodystrophy are a source of dysphoria for PLWHA. This dissatisfaction was closely associated with the absence of control over their own body, due to the virus and the side effects of medication. Furthermore, it became evident that there was ambivalence among participants about the visibility of HIV, as it was in parallel a source of stigmatization, but also a part of their identity and biography. Results indicate that individuals were in search of meaning and constitute strategies in order to "answer" to the disruptive aspects of HIV. These were the normalization of illness, the integration into personal identity and the recognition of positive effects of HIV in their lives (e.g., stopping drug and alcohol abuse). Further research is required to identify the factors that determine the selection of each "answer" by these particular individuals who belong to broader social groups.

Ten-Year Safety with Polyacrylamide Gel Used to Correct Facial Lipoatrophy in HIV-Infected Patients.

Long-term results (>5 years) for synthetic substances used to repair facial lipoatrophy have not been published. We performed a cross-sectional study to evaluate the 10-year safety of polyacrylamide hydrogel (Aquamid) among the 751 patients from our unit who received facial infiltrations at least 10 years ago. Epidemiological and clinical data such as complications and patient satisfaction were collected. We also identified those patients who presented a facial infection at any time after infiltration. A total of 104 patients had received Aquamid at least 10 years ago. Before infiltrations, 24.0%, 41.3%, and 34.7% presented very severe, severe, and moderate facial lipoatrophy, respectively. After a mean (SD) of 10.3 (0.5) years since the infiltrations, 19.2%, 47.7%, and 31.7% of patients reported moderate, mild, and no signs of facial lipoatrophy. The values reported by physicians for the same categories were 1.9%, 10.6%, and 87.5%. Indurations were detected in 6.7% of patients and nodules in 3.8%. Five patients (4.8%) had a local infection. A further 15 patients with a shorter follow-up (less than 10 years) presented local infections (overall incidence considering the 751 patients who received infiltrations of Aquamid, 2.7%); the product had to be withdrawn in three cases. The majority of patients were highly satisfied (74.8%) or satisfied (23.4%) with the cosmetic results; among patients with severe or very severe lipoatrophy at baseline, 31.4% were satisfied and 65.7% were highly satisfied. Infiltrations with polyacrylamide hydrogel (Aquamid) are a safe strategy for the treatment of facial lipoatrophy in the long term. The rate of severe complications was low, and patient satisfaction with the cosmetic results was high. However, facial infections may appear in the long term. Therefore, HIV-infected patients who received synthetic substances should be carefully monitored over time.

Correção cirúrgica da lipodistrofia relacionada ao uso da terapia antirretroviral: uma análise sobre os procedimentos realizados e o impacto sobre os pacientes / Surgical lipodystrophy correction associated with the use of antiretroviral therapy: an analysis of procedures performed and impact on the patients

Introdução: O tratamento de pacientes portadores da síndrome da imunodeficiência adquirida deve ser integral e se basear no controle da doença e das complicações relacionadas ao uso de medicações antirretrovirais, como a lipodistrofia. Esse estudo tem como objetivo avaliar as principais queixas, os aspectos epidemiológicos e os procedimentos cirúrgicos realizados para corrigir a lipodistrofia em pacientes em uso crônico de antirretrovirais. Método: Estudo retrospectivo, no qual foram coletados dados dos prontuários de 27 pacientes submetidos a 36 procedimentos cirúrgicos relacionados à correção de lipodistrofia no período de março de 2010 a junho de 2014 no serviço de Cirurgia Plástica do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto. Resultados: A idade média dos pacientes foi 47,2 anos, 22,2% homens e 77,8% mulheres. O tempo médio de uso da terapia antirretroviral (TARV) foi de 12,1 anos. As queixas mais encontradas foram: giba dorsal (44,4%), lipodistrofia abdominal (44,4%) e lipoatrofia glútea (37,04%). Na maioria dos pacientes (70,4%), foi realizada uma cirurgia. Quanto às cirurgias, a lipoaspiração de giba foi realizada em 48,1% dos pacientes, seguida da lipoaspiração de abdome, dorso ou flancos (44,4%) e gluteoplastia (22,2%). Entre todos os 36 procedimentos realizados, apenas dois apresentaram complicações. O tempo médio de seguimento pós-operatório foi de 11,2 meses. Do total, 70,4% dos pacientes mostraram-se satisfeitos após os procedimentos. Conclusões: O sucesso do tratamento cirúrgico da lipodistrofia causada pelo uso da TARV baseia-se na seleção pré-operatória adequada e em seguimento constante e prolongado. A melhoria da autoestima facilita a adesão ao tratamento com antirretrovirais.

Introduction: Treatment of patients with acquired immunodeficiency syndrome should be complete and based on controlling the disease and the complications related to the use of antiretroviral medications, such as lipodystrophy. This study aimed to evaluate the main complaints, epidemiological aspects, and surgical procedures performed for lipodystrophy correction among patients receiving long-term antiretroviral therapy. Method: In this retrospective study, data were collected from the medical records of 27 patients who underwent 36 surgical procedures associated with lipodystrophy correction, from March 2010 to June 2014, at the Plastic Surgery Service of the Hospital das Clínicas, Faculty of Medicine of Ribeirão Preto. Results: The average age of the patients was 47.2 years; 22.2% were men and 77.8% were women. The average duration of antiretroviral therapy (HAAR ) was 12.1 years. The most frequent complaints were dorsal hump (44.4%), abdominal lipodystrophy (44.4%), and gluteal lipoatrophy (37.04%). The majority of patients (70.4%) had undergone surgery . The most common type of surgery performed was hump liposuction (carried out in 48.1% of the patients), followed by abdominal, back, or flank liposuction (44.4%) and gluteoplasty (22.2%). Among all 36 procedures performed, only 2 resulted in complications. The average postoperative follow-up period was 11.2 months. In total, 70.4% of patients were satisfied with the results of their procedure. Conclusions: The success of surgical treatment of HAARinduced lipodystrophy is based on proper preoperative selection as well as constant and prolonged follow-up. Improved selfesteem facilitates the adherence to antiretroviral drug treatment.

Double-blind clinical trial to compare autologous fat grafts versus autologous fat grafts with PDGF: no effect of PDGF.

BACKGROUND: This work evaluates the effect of adding platelet-derived growth factor to autologous adipose tissue grafts in the treatment of human immunodeficiency virus facial lipoatrophy by means of objective measurements. METHODS: This is a randomized clinical trial conducted at the Hospital Clinic of Barcelona. Patients with facial human immunodeficiency virus atrophy were randomized into two groups, one treated with autologous fat injection (group A), and another treated with autologous fat injection with plasma rich in growth factors (group B). Before the treatment, structural changes were identified in facial soft tissue by means of computed tomography, and clinical changes were also assessed by means of photographic records. Posttreatment assessments were repeated after 2 and 12 months to compare the results. Posttreatment complications were recorded. RESULTS: Forty-nine patients (33 men and 16 women), with a mean age of 46 years, participated in the study. In both groups, there was a statistically significant average increase of volume in the facial area measured by computed tomography between the baseline and the 2- and 12-month posttreatment assessments. All cases showed an improvement of the clinical facial atrophy grade after treatment, which was statistically significant. This improvement was related to a statistically significant fat volume increase measured by means of computed tomography. There was no difference in the volume gain between both groups. No major complications were observed. CONCLUSIONS: Fat grafting is a safe, effective, and durable treatment for human immunodeficiency virus facial atrophy. The results of this study show that it is not necessary to add plasma rich in growth factors to the adipose tissue graft to get a better result. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.

Facelift in a patient with benign symmetric lipomatosis and HIV facial lipoatrophy: a case report.

Benign symmetric lipomatosis (BSL) is a rare condition characterized by deposition of unencapsulated adipose tissue at typical sites on the body. Although the pathogenesis is not clearly defined, the disease has been associated with male gender, alcoholism, Mediterranean descent, and highly active antiretroviral therapy. A case study is presented of a facelift performed on a human immunodeficiency virus-positive patient on a highly active antiretroviral therapy with facial lipoatrophy in the anterior cheek region in combination with BSL characterized by excess fat deposits in multiple areas including the posterior cheeks and neck. The resultant peculiar deformity was managed in this case with a modified facelift and fat excision without recurrence. There are few reports in the English literature describing surgical excision using the facelift pattern for treating BSL.

Labia majora labioplasty in HIV-related vaginal lipodystrophy: technique description and literature review.

BACKGROUND: We present a rare case involving severe hypertrophy of the labia majora. This 39-year-old married woman developed a clinically noticeable bilateral lipodystrophy of her labia majora following the administration of chronic antiretroviral therapy. Different combination drug regimens that included drugs like Crixivan(®), Epivir(®), and Zerit(®) were administered to the patient from 1998 to 2005. The patient is currently on a single drug regimen of Atripla(®) with the disease under control and no other comorbidities. The severity of the pubic protuberance created an appearance resembling male genitalia, even when covered by underwear. This anatomical abnormality obviously impaired her social life and forced her to avoid wearing tight pants, swimming garments, and tight clothes in general. She also avoided any sexual activity. METHODS: Her pubic hair was shaved. Crural creases and vulvar mucosa were marked in order not to be violated. The estimated amount of skin and fat to be removed was marked. Intraoperative tailor-tacking suturing was used to mark the extent of the resection of the labia majora. Sutures were left in place to verify the accurate tension of the remaining skin. The procedure was performed with the patient under general anesthesia. Labial skin resection was performed by sharp dissection. Electrocautery was then used to excise the lobulated fat accumulation. Two layers of 3/0 Vicryl(®) sutures were used in the lax subcutaneous tissue. 4/0 Vicryl(®) rapide was used on the skin to approximate wound edges. Suction drains were left in place for 48 h to reduce the dead space and to manage postoperative bleeding. The patient was instructed to keep ice and compression pads on the area for the first 24 h and to keep the area clean. This was followed by the application of antibiotic ointment two times a day on the wounds to avoid blood crust formation and to keep the skin soft. RESULTS: Stitches were removed on POD 14 after an overall uneventful postoperative course. The sensitivity of the labia majora's interior aspect was preserved, even initially. With the legs slightly open, the labia majora just covered the entrance to the vagina. The clitoris and labia minora became visible again, restoring a normal anatomical appearance. Moderate edema was observed for 4 weeks after surgery. CONCLUSION: The surgical technique used provided an excellent result according to the patient, who regained her self-confidence and started having a normal sexual life again. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

HIV-associated lipodystrophy in South Africa: the impact on the patient and the impact on the plastic surgeon.

BACKGROUND: With 67% of the world's human immunodeficiency virus (HIV)-infected population existing in sub-Saharan Africa and recent access to highly active antiretroviral therapy (HAART), the demand for plastic surgical intervention in addressing lipodystrophy has expanded dramatically. We assessed the rate of lipodystrophy in a random clinic cohort, the demand for surgical correction and risk of treatment non-compliance. METHOD: Questionnaire and database cross-sectional review of 554 patients over a 3-month period at the Themba Lethu Clinic, Johannesburg, South Africa. RESULTS: A total of 479 patients completed the questionnaire, 83% were female. Nearly 90% of patients were on, or had been on, stavudine (d4T). The prevalence of lipodystrophy was 11.7%. Nearly 5.9% of patients had considered stopping treatment due to the development of lipodystrophy; 47% would consider surgery to correct unwanted physical changes. Male patients were satisfied by the changes they noted in their physical features following treatment (pre-treatment satisfaction 38% vs. post-treatment satisfaction of 94%). Female patients had 6.5 times more breast hypertrophy-related symptoms than in their pre-treatment state. CONCLUSION: We identify a prevalence of 11.7% of patients with HIV-associated lipodystrophy, of whom 5.9% would consider non-compliance on the basis of this side effect alone. The demand for surgical correction is significant and needs to be addressed.

Autologous fat grafting and injectable dermal fillers for human immunodeficiency virus-associated facial lipodystrophy: a comparison of safety, efficacy, and long-term treatment outcomes.

BACKGROUND: Facial lipoatrophy is a common side effect of human immunodeficiency virus treatment with highly active antiretroviral therapy. To identify the most clinically durable and efficient way of addressing facial lipoatrophy, the authors reviewed all available evidence for the use of injectable dermal fillers and autologous fat transfers as treatment modalities, focusing on safety, outcomes, and long-term durability. METHODS: A systematic review of the Cochrane and MEDLINE databases for autologous fat transfer and injectable dermal fillers for the treatment of human immunodeficiency virus-associated lipodystrophy was performed. Based on U.S. Food and Drug Administration approval in human immunodeficiency virus lipoatrophy, studies were limited to the use of hyaluronic acid and/or poly-L-lactic acid. Facial volume, subjective patient satisfaction, standardized outcome scales, reinjection rates, and complications were recorded. RESULTS: Nineteen studies were included representing 724 patients, with 549 patients in the hyaluronic acid/poly-L-lactic acid cohort and 175 in the autologous fat transfer cohort. Improvements in facial volume and durability of treatment were similar between dermal fillers and fat transfer, as measured by both objective means and subjective patient outcomes. However, poly-L-lactic acid was reinjected at a rate three times that of autologous fat, and was associated with a relatively high rate of subcutaneous papule formation at 22 percent (range, 3 to 44 percent). CONCLUSIONS: Dermal fillers and autologous fat transfer are effective treatment modalities for human immunodeficiency virus-associated facial lipoatrophy, with high rates of facial volume restoration and patient satisfaction. Autologous fat transfer may offer similar to superior long-term durability but with less of a financial burden compared with injectable fillers.

Bioplastia na lipodistrofia de pacientes com HIV/AIDS / Bioplasty for lipodystrophy in patients with HIV/AIDS

INTRODUÇÃO: O início do tratamento da síndrome da imunodeficiência adquirida (AIDS) com a terapia antirretroviral de alta atividade (HAART), na década de 1990, aumentou, consideravelmente, a longevidade e a qualidade de vida dos portadores da doença. A redução da morbidade e da mortalidade associadas a doenças infecciosas e neoplásicas oportunistas, porém, tem sido acompanhada pelo aumento da prevalência de outras doenças, entre elas a lipodistrofia associada ao vírus da imunodeficiência humana (HIV). A lipodistrofia decorre da toxicidade de drogas utilizadas na terapia antirretroviral, sendo atribuída aos inibidores de protease e aos inibidores da transcriptase reversa análogos do nucleosídeo. Este trabalho aborda a lipoatrofia facial, que confere um aspecto de envelhecimento precoce e traz de volta o velho estigma da "facies da AIDS", podendo impactar negativamente na qualidade de vida dos portadores de HIV. MÉTODO: Neste estudo foram incluídos 41 pacientes apresentando lipoatrofia facial, que foram submetidos a preenchimento com polimetilmetacrilato (PMMA) no Hospital Universitário da Universidade Federal de Juiz de Fora (HU-UFJF) e na clínica Plastic Center, Clínica de Cirurgia Plástica em Juiz de Fora, no período entre janeiro de 2010 e fevereiro de 2012. RESULTADOS: O número de procedimentos realizados em cada paciente variou de 1 a 4, sendo respeitado um intervalo mínimo de 90 dias entre eles. A quantidade de PMMA utilizado variou de acordo com o grau e a região a serem corrigidos, ficando entre 3 ml e 18 ml por procedimento. Em todos os pacientes, o resultado obtido foi favorável esteticamente. CONCLUSÕES: Os resultados obtidos pela bioplastia com PMMA foram considerados satisfatórios pelos pacientes. O material utilizado possui alta adaptabilidade às áreas receptoras, necessitando apenas da modelagem e da quantidade adequada para que apresente bom padrão estético.

BACKGROUND: When the treatment of acquired immunodeficiency syndrome (AIDS) with highly active antiretroviral therapy (HAART) began in the 1990s, it considerably increased the life expectancy and quality of life of AIDS patients. However, the decrease in morbidity and mortality associated with opportunistic infectious and neoplastic diseases was accompanied by an increase in the prevalence of other diseases, including HIV-associated lipodystrophy. Lipodystrophy is due to the toxicity of drugs used in antiretroviral therapy, including protease inhibitors and nucleoside analog reverse transcriptase inhibitors. This article discusses the treatment of facial lipodystrophy, which confers an appearance of premature aging and brings back the old stigma of the "AIDS face," which negatively impacts the quality of life of HIV carriers. METHODS: Forty-one patients with facial lipoatrophy received filling with polymethylmethacrylate (PMMA) at the Hospital Universitário da Universidade Federal de Juiz de Fora (HU-UFJF) and at the Plastic Center Clinic, Plastic Surgery Clinic in Juiz de Fora between January 2010 and February 2012. RESULTS: Patients received 1 to 4 procedures with a minimum interval of 90 days between procedures. The amount of PMMA used ranged from 3 to 18 mL per procedure according to the degree and region to be corrected. The results were aesthetically favorable in all patients. CONCLUSIONS: The results obtained through bioplasty with PMMA are considered satisfactory by patients. The material used is highly adaptable to the receiving areas, requiring only modeling and an adequate amount in order to obtain good aesthetic results.

[3-dimensional imaging systems: first experience in planning and documentation of plastic surgery procedures]. / 3-dimensionale Bilderfassung: Erste Erfahrungen in der Planung und Dokumentation plastisch-chirurgischer Operationen.

A reproducible 3-dimensional photographic system enables plastic surgeons to perform preoperative planning and helps them to understand the patient's expectations. There are a few systems available that allow a reproducible 3-dimensional scans of the patient with direct simulation of the planned procedure. The Vectra Volumetric 3D Surface Imaging® by Canfield® provides such an option and helps the surgeons to document and compare postoperative changes at different time points. Since January 2011 we are digitally documenting all patients receiving form-modulating procedures in our plastic surgery unit. We present the spectrum of clinical implications and discuss advantages and disadvantages of the system. Furthermore, we have studied the accuracy of the system in comparison to direct measurement in 15 volunteers. The system is especially suited for planning and evaluation of breast augmentation, facial aesthetic and reconstructive surgery as well as volumetric measurements before and after liposuction and lipofilling. Computer-assisted measurements correlate with a median deviation of 2.3% with manually measured distances in the face. We found the user-friendly Vectra® system to be a reliable and reproducible device for planning plastic surgery therapies and for documenting postoperative results.

Fat redistribution syndromes associated with HIV-1 infection and combination antiretroviral therapy.

More than 15 years after the introduction of highly active antiretroviral therapy, HIV/HAART-associated lipodystrophy syndrome still shadows the indisputable efficacy of antiretroviral therapy. Several issues related to this complication (prevalence, diagnosis, pathogenesis, prevention, or clinical management) have not been completely clarified. However, in the last years, substantial progress has been made in elucidating some of these basic aspects. This includes a better knowledge of the pathogenic mechanisms underlying HIV/HAART-associated lipodystrophy syndrome such as genetic host determinants, the impact of HIV infection per se, as well as the contribution of antiretroviral therapy. In regard to treatment, we have learned that certain drugs are especially prone to cause HIV/HAART-associated lipodystrophy syndrome (i.e. thymidine analogues). Pharmacological interventions to treat this condition have yielded mostly disappointing results, and the only intervention which offers an immediate aesthetical improvement for patients with HIV/HAART-associated lipodystrophy syndrome is plastic surgery. Even under the most favorable conditions (ideal host genetic make-up, and the timely initiation of HIV therapy with less toxic drugs), current data show that HIV/HAART-associated lipodystrophy syndrome is a complication of HIV infection and/or antiretroviral treatment that we are unable to avoid. In the context of HIV-1-infected patients under long-term antiretroviral therapy, fat toxicity is still the dark side of the rainbow.

A facial marker in facial wasting rehabilitation.

BACKGROUND: Facial lipoatrophy is one of the most distressing manifestation for HIV patients. It can be stigmatizing, severely affecting quality of life and self-esteem, and it may result in reduced antiretroviral adherence. Several filling techniques have been proposed in facial wasting restoration, with different outcomes. The aim of this study is to present a triangular area that is useful to fill in facial wasting rehabilitation. METHODS: Twenty-eight HIV patients rehabilitated for facial wasting were enrolled in this study. Sixteen were rehabilitated with a non-resorbable filler and twelve with structural fat graft harvested from lipohypertrophied areas. A photographic pre-operative and post-operative evaluation was performed by the patients and by two plastic surgeons who were "blinded." The filled area, in both patients rehabilitated with structural fat grafts or non-resorbable filler, was a triangular area of depression identified between the nasolabial fold, the malar arch, and the line that connects these two anatomical landmarks. RESULTS: The cosmetic result was evaluated after three months after the last filling procedure in the non-resorbable filler group and after three months post-surgery in the structural fat graft group. The mean patient satisfaction score was 8.7 as assessed with a visual analogue scale. The mean score for blinded evaluators was 7.6. CONCLUSION: In this study the authors describe a triangular area of the face, between the nasolabial fold, the malar arch, and the line that connects these two anatomical landmarks, where a good aesthetic facial restoration in HIV patients with facial wasting may be achieved regardless of which filling technique is used.

[Treatment of facial lipoatrophy by lipofilling in HIV infected patients: retrospective study on 317 patients on 9 years]. / Traitement de la lipoatrophie faciale par lipofilling chez les patients infectés par le VIH: étude rétrospective de 317 patients sur neuf ans.

INTRODUCTION: HIV infection and antiretroviral therapy are responsible in 20 to 40% of cases of facial lipoatrophy. This one has an impact in an important way on the quality of life with a major social impact. Several treatments are available to correct facial lipoatrophy. We evaluate the efficiency of autologous fat transfer described by Coleman (Lipostructure®). PATIENTS AND METHODS: We recorded HIV-infected patients who had facial lipofilling between May 1999 and April 2008.Then, we estimated the severity of their lipoatrophy and the result of lipofilling after 1 month to 4 years follow-up. RESULTS: We have treated 317 patients by lipofilling. We have injected a mean of 8mL of fat on each side. There were no adverse events. Sixty-three percent had a good result on 1-year evaluation. CONCLUSION: Lipofilling is a safe and stable surgical procedure that makes the reference technique to correct facial lipoatrophy in HIV-infected patients. The use of facial fillers must be limited in case of impossibility to take fat tissue, which was exceptional in our study.