Q: Dr. Eppley, I am an HIV positive 56 year old male. My CD4 count is near 500 and my viral load has been undetectable for over 15 years. I have severe facial lipoatrophy as a result of the adverse effects of antiretroviral therapies. I wish to explore the possibility of cheek implants.
A: By your pictures, I can see that you have a type 5 Facial Lipoatrophy with severe submalar tissue atrophy. I have found submalar cheek implants to be very helpful in all types of cheek lipoatrophy although in type 5 they alone may not be sufficient. While the implant will help build out the cheek prominence, and particularly the submalar area, the lowest portion of the buccal atrophy (where the tissues are pinched in under the cheek bone) may be not be changed adequately. In these type cases I have added a dermal-fat graft under the implant in the lower buccal space to get a more complete correction. Dermal-fat grafts can be harvested from any scar area on the body if you happen to have one. In addition, You might also consider temporal implants to improve the deep temporal hollowing from the lipoatrophy as well. In many type 3 to 5 facial lipoartophy, augmentation of the tenmporal and submalar cheek area can together help make for a better improvement of the gaunt facial look.
Dr. Barry Eppley