Q: Dr. Eppley, I’m a 48 year old HIV positive male who is healthy, have undetectable viral loads, and have been on Atripla for many years. I have always had a full round face and cheeks and was thinking of getting buccal fat pad removal. (buccal lipectomies) I workout with weights and cardio. I will be getting cheek implants. Do all people on HIV meds get facial waiting? Is buccal fat pad removal totally contraindicated for me?
A: Historically HIV medications did cause a lipodystrophic spectrum of facial lipoatrophy and body lipohypertrophy. Newer medications, like Atripla, have a much lower incidence of causing these fat altering side effects. If your face is round and always has been then I would say that buccal lipectomies are not contraindicated and can be performed without concerns about adverse aesthetic long-term effects..
The key question now is not whether buccal lipectomies should be sone but whether they would produce a noticeable external facial thinning effect. That would depend on how round your facial shape is and where most of the fullness is. I have performed buccal lipectomies in a select few HIV positive patients whose face merited a facial defatting procedure.
Dr. Barry Eppley