Q: I am interested in getting Smartlipo for my love handles. I am a 42 year old healthy HIV positive male since 2005. My CD4 count is 435 and my viral load is undetectable. I am 5′ 9 and weigh 170lbs. I am on HIV medications with no signs and symptoms. I have been recently diagnosed with Hepatitis C but am not on any medications for it. My liver enzymes are close to being normal and my liver ultrasound is normal. Would I be a candidate for Smartlipo?
A: Having these two viral infectious diseases does not preclude you from having any form of liposuction surgery. The key is that your medical conditions are stable with good counts that would not make your risk of infection significantly increased and that you could safely go through a short surgical procedure without any adverse effects on your health. You would need medical clearance from your physicians as they are most familiar with the details of your current condition and laboratory values.
Smartlipo of the flanks is a fairly small liposuction procedure that can have a dramatic effect on the waistline and the flanks. It is a common treatment for men that reduces a fat problem that is otherwise impossible to exercise and diet off. Done as an outpatient procedure, it is completed in under an hour with minimal recovery and restriction of activities.
Dr. Barry Eppley
Q: I have been infected with HIV for nearly 15 years. While he medications have been invaluable and have saved my life I suffer from some of their cosmetic side effects including a very gaunt face and a non-existant butt. For my face which is better, fillers or iimplants. Can anything be done to my butt bigger?
A: One of the well known side effects of the medications to treat HIV is lipoatrophy or fat loss. The fat loss is quite specific, however, and has a predilection for facial and buttock fat. Loss of the buccal fat pads and, in severe cases, much of the subcutaneous fat results in a sunken in or very gaunt look to the face. It is such a classic presentation that it can be socially stigmatizing has having the underlying medical problem. In the buttocks, fat is lost so they become very flat appearing. Other parts of the body, for unknown reasons, undergo fat hypertrophy (excessive growth) most commonly in the back of the neck (buffalo hump) and in the abdominal area.
Facial lipoatrophy can be successfully improved with a variety of approaches including synthetic cheek implants, fat injections, or synthetic fillers. (e.g., Sculptra) Which one is best must be determined on an individual basis considering the extent of the fat loss and whether one prefers to avoid actual surgery or not. Fat grafting is probably best avoided as its persistence in the face of the medications is unlikely.
Treatment of buttock lipoatrophy is a different matter with no good options. Fat injections are not adviseable due to likely complete resorption and a result which will be underwhelming. This leaves buttock implants as the only option which carries with it a significant recovery and risks of infection and seroma complications.
No type of plastic surgery should be performed in an HIV patient unless their cell counts have been normalized and medical clearance is obtained from their treating physician. According to recent studies, the infection rate for plastic surgery procedures is not different in HIV vs non-HIV patient populations if good cell counts exist.
Dr. Barry Eppley