We read the article entitled “Comparing Efficacy and Costs of Four Facial Fillers in Human Immunodeficiency Virus-Associated Lipodystrophy: A Clinical Trial” with great interest.1 It is true that a variety of new fillers have been introduced to the cosmetic market. Some of them are being used among other treatments2—off label—for human immunodeficiency–related “facial wasting treatment.” In the United States, the two products that are—to our knowledge—U.S. Food and Drug Administration approved are Radiesse (Merz Aesthetics, Frankfurt am Main, Germany) and Sculptra (Sanofi-Aventis, Paris, France).3,4
Fat has become a globally widespread tool for lipodystrophy treatment, and some believe that it is today the gold standard or the best value cost-wise. However, one should keep in mind that lipofilling carries certain limitations. At first, it is difficult to obtain enough fat donor sites from some of the patents, because of generalized lipodystrophy. Although the quantity fat that needs to be transplanted is not large, in some patients we find it difficult to harvest enough fat of sufficient quality. Second, in our hands, acceptable symmetry is not always achieved easily in a single-stage operation. One or two revisions are usually found necessary, in more than one-third of our patients, because a part of the transplanted fat is finally absorbed 6 to 8 weeks postoperatively, and not always following the rules of symmetry in its absorption.
The use of fat, for various indications, has been a trend during the past few years, because of its unique characteristics.5 Most of all, the use of “like with like” tissue replacement meets certain standards that cannot be easily found by use of other biological or synthetic materials.
As a conclusion, it is a common belief that a tissue that until recently was considered “useless” has found an important role on the reconstructive ladder. In our hands, it has become an important tool in the replacement of soft-tissue loss, especially on the face. Indications and limitations need to be observed regarding efficacy and safety factors.
The authors have no financial interest to declare in relation to the content of this communication.
Leonidas Pavlidis, M.D., Ph.D.Georgia Alexandra Spyropoulou, M.D., Ph.D.Efterpi Demiri, M.D., Ph.D.Aristotle University of ThessalonikiThessaloniki, Greece
1. Vallejo A, Garcia-Ruano A, Pinilla C, Castellano M, Deleyto E, Perez-Cano R. Comparing efficacy and costs of four facial fillers in human immunodeficiency virus-associated lipodystrophy: A clinical trial. Plast Reconstr Surg. 2018;141:613623.
2. Maguina P, Chaar M, Nadimi S, Szczerba SM. Subcision with a wire dissector as an approach to human immunodeficiency virus lipoatrophy. Plast Reconstr Surg. 2010;125:206e208e.
3. Eviatar J, Lo C, Kirszrot J. Radiesse: Advanced techniques and applications for a unique and versatile implant. Plast Reconstr Surg. 2015;136(Suppl):164170.
4. Kaplan E. Cosmetic injection techniques: A text and video guide to neurotoxins and fillers. Plast Reconstr Surg. 2014;133:462.
5. Pavlidis L, Sapountzis S, Spyropoulou GA, Demiri E. Fat grafting to the hand in patients with Raynaud phenomenon: A novel therapeutic modality. Plast Reconstr Surg. 2015;135:229e230e.