What Is The Best Option To Restore Facial Volume?
Q: Dr. Eppley, I have what I would consider a significant amount of lipoatrophy in my face (and I’m HIV positive for almost 4 years). I also unfortunately had a small amount of buccal fat removed when I was younger. That, combined with the lipoatrophy, has left my cheeks, buccal, and temporal areas looking quite thin (and in my view, gaunt). What do you feel is the best way of treating this fat loss? I’m not really interested in an implant due to cost and I really am interested in restoring volume. I have had Sculptra treatments previously, but the results were not long lasting and did not restore an adequate amount of volume in my view. I have considered facial fat grafting, but am concerned about the reliability of whether that fat would survive (especially in someone with HIV). I am interested in your thoughts as to what the best course of treatment may be for something that is not short lasting and not outrageously expensive.
A: The only reliable permanent method of restoring volume in the malar, submalar and temporal regions are with implants. Malr shell and temporal implants will do well in those areas. Injectable fat grafting is another alternative, and the least costly one, but its reliability on someone on antiviral medication is very suspect. Even in a patient not on such medication, fat grafting is not always reliable anyway. Unfortunately, there are no treatment options that combine the concepts of ‘not short lasting and not expensive’ when it comes to facial volume restoration. Your best choice under these circumstances is fat grafting and one has to accept that it is unknown what will happen with volume persistence. Another option is to combine temporal implants with malar/submalar fat grafting. Temporal implants are the easiest and least costly of all facial implants to put in and can easily be done under IV sedation as can fat grafting.
Dr. Barry Eppley