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Long-Term Efficacy and Safety of Polyacrylamide Hydrogel Injection in the Treatment of Human Immunodeficiency Virus–Related Facial Lipoatrophy: A 5-Year Follow-Up

De Santis, Giorgio M.D.; Pignatti, Marco M.D.; Baccarani, Alessio M.D.; Pedone, Antonio M.D.; Spaggiari, Antonio M.D.; Orlando, Gabriella M.D.; Guaraldi, Giovanni M.D.

Plastic & Reconstructive Surgery: January 2012 - Volume 129 - Issue 1 - p 101–109
doi: 10.1097/PRS.0b013e3182362142
Reconstructive: Head and Neck: Original Articles

Background: Facial lipoatrophy, a human immunodeficiency virus–related wasting of the facial soft tissues, can compromise patients' quality of life. Injection of different materials in the cheeks can improve this condition. Concern regarding potential long-term complications of nonbiodegradable fillers remains. The authors investigated the long-term efficacy and safety of polyacrylamide gel injections.

Methods: Human immunodeficiency virus–infected patients treated with polyacrylamide gel for moderate to severe facial lipoatrophy with a minimum of 5 years' follow-up were included. Aquamid (1 ml) was injected monthly into each cheek until adequate correction was obtained. Outcome measures were ultrasound measurement of cheek soft-tissues thickness, evaluation of aesthetic improvement, and self-evaluation of satisfaction and psychological consequences of treatment (visual analogue scale for the face, Assessment of Body Change and Distress questionnaire, and Beck Depression Inventory score). Adverse events were classified as acute (<1 week), early (1 week to 1 month), midterm (1 month to 1 year), or late (>1 year).

Results: One hundred forty-one patients completed the treatment as of June of 2005; 38 (32 men; mean age, 42 years) were available for follow-up of more than 5 years (mean, 62 months). The mean number of treatment sessions was seven over a mean period of 8 months. Significant improvement of cheek thickness and aesthetic result and highly significant satisfaction and psychological improvement were obtained. No serious adverse events occurred during the follow-up period.

Conclusion: The long-term efficacy and safety of polyacrylamide gel injection for the treatment of human immunodeficiency virus–related facial lipoatrophy were shown over a period of 5 years.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Modena, Italy

From the Department of Plastic and Reconstructive Surgery and the HIV Metabolic Clinic, Department of Infectious and Tropical Diseases, Azienda Ospedaliero-Universitaria di Modena, University of Modena and Reggio Emilia.

Received for publication April 8, 2011; accepted June 23, 2011.

Disclosure: The authors do not have any commercial associations to disclose.

Marco Pignatti, M.D.; Department of Plastic and Reconstructive Surgery, Azienda Ospedaliero-Universitaria di Modena, Policlinico di Modena, Via del Pozzo 71, Modena, I-41124, Modena, Italy, mrpignatti@googlemail.com

©2012American Society of Plastic Surgeons