Meds, Mind, Body & Benefits > Lipodystrophy & Metabolic Problems

Lipoatrophy Treatment (Reposted from the old forums)

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Nick and GSOgymrat,
Thanks for your feedback. I contemplated Sculptra but it had just been approved, and in addition I was told that it did not work that good for severe facial wasting. That you could get a hardened look to the skin if the wasting was severe. Also, that it was not permanent. The doctor I went to said he had done it on dozens of guys with HIV related facial wasting. He just never used dorsal fat for the donor site. I do look better than the previous wasted look that made me feel like an Aids poster boy everywhere I went. But now I have a abnormally large look that I feel self conscious about, especially in comparison to my body. I am lean and muscular so it looks even more odd in contrast. I know much of what we go through with our treatments for HIV as well as our treatments for the after affects of the drugs we take are experimental and there are no long term studies. But I feel like the surgeon should have had some sort of foresight that there was the possibility that the fat from the back would take on the same traits when transferred to the face. He does do facial lypo. But so far only to patients having their own original fat lypoed out. Since my face has already been worked on once, I worry about scar tissue causing lumps, distortions and asymmetry. Plus, if the fat takes on the same traits as when it was in the back, even when lypoed out, the fat cells though fewer, might still expand. (I have had lypo twice on the back, and it keeps coming back. At this point he cannot do another lypo. Too much scar tissue to get the candala through. He would have to cut it out. And it could come back yet again.) I feel like the only option might be to find a plastic surgeon who specializes in serious facial surgery, possibly lift the skin, remove as much fat as possible from the face and start from scratch again. Either that or I may have the original surgeon try lypo on the face. And if I get more scar tissue, lumpiness or unevenness, go with either Sculptra to even out the lumps, bumps and divits. Or possible the filler in Tijuana, MX at Cliniqúe Estetica.

  Earlier in this post, someone indicated that fat cells don't come back once they die.  In addition, the patient who posted this statement said it was his doctor who told him that.  And let me guess, his doctor is either a plastic surgeon who specializes in cosmetology or he is friends of someone who makes his living in this area.

  Your doctor is wrong and there is substantial data that indicates that face fat can be regenerated, but it takes a long time and it is not without risk.  The
following article was reposted in Rita Reports and supports the notion that fat cells can be regenerated:

    6. CROI: Disappointment for Glitazones, Metformin and Testosterone for 
        Body Fat Changes (2/11/06) Bernard E

   Also, I would like to point out that the Australian hiv lypodystrophy study confirmed this data as well and that Actos (Pioglitazone) has been approved or is near approval in Taiwan for peripheral artery disease.

  I think it is a complete abomination that the medical community only offers patients the option of filling up their face with plastic as opposed to regenerating the face.

  My question to you is whether or not your doctor and his friends would make the same recommendation if they weren't getting paid for it.  I have a sunken face and I am not persuing no plastic fillers.   Instead I want things that regrow the face, raise HDL Cholesterol, and reduce C-Reactive protein.

   It is a short sighted clinician who doesn't warn his patient of the broader problems caused by lypodystrophy besides the cosmetic component.  You might get your face pulled out and looking nice and puffy, but it won't solve the problems of what is going on in your arteries.  What is your running pulse when you have run a mile on a treadmill?  Is it slowing down after several weeks of exercise?  If so, you are probably ok, but the rest of us long term survivors who have been doing years of drugs have narrowing of the arteries and there are treatments for this that also regrow facial fat.


I definitely would love to see a cure for the metabolic problems associated with lipoatrophy. I have had cholesterol problems which are directly related to HIV medications. When I was taking Kaletra/Epivir/Viread my cholestrol labs were a mess and when went I went off meds completely for two months the labs went to normal. I've since changed to Reyataz, Norvir,Truvada and with a statin my cholesterol labs are almost normal. I think certain HIV meds greatly contribute to lipoatrophy and metabolic changes.

The doctor who told me that once fat cells in the face are gone they don't come back was a plastic surgeon. Was he just saying this to promote his business? I have no idea. However I have not heard of anyone who has had severe lipo getting their face back without fillers, even for people I have known who have stopped taking HIV meds altogether.

If there is a treatment out there that is proven to stop lipoatrophy and is safe we all need to know about it. I think medical researchers have been more concerned with keeping PWA alive and are only now looking at complications experienced by long-term survivors.

Miss Philicia:
I just started having high blood pressure (forget the numbers) ever since Thanksgiving and I've been on lots of meds now for 13 years.  Also have had lypo now for 6 years.  So ZCorker, you think this is all connected?  We initially thought it was connected with my going on (at Thanksgiving) Cymbalta so now I'm tapering off on that.  I'm taking hydrochlorothiazide and diovan until my numbers improve.

ZCorker, could you link me to some information on the Actos studies that I could take to my doctor?


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