Update on Current Options in the US for HIV-related Facial WastingNelson Vergel
Some of you have emailed me to ask me about my opinions lately on the most popular options for facial reconstruction. I have been following this field for almost 7 years now and my opinions have evolved with time.
I have realized that there is place for each of the facial reconstruction products in the HIV facial wasting field. Initially, I was not impressed after seeing how slowly NewFill (Sculptra in the US) works and how some people with grade 3-4 facial wasting never attained complete reconstruction even after 6 sessions. I also used to believe that permanent solutions were the way to go for cost effectiveness and durability.
The first poster presentations on facial reconstruction products for HIV were the one on PMMA (Dr Serra – Brazil) and NewFill (Dr Armard from France). Not one , but two.
Most of the world focused on the French product a lot more. I have no idea why PMMA did not get any attention.
I have met people around the country, received emails, and followed this field closely as part of my work in facialwasting.org. Their feedback gives me a sense of where we are right now in this field:
1- Sculptra’s perceived weakness is its strength. Yes, it is not completely permanent for some (it may need a touch up every 1-2 years), but that may be its main attractiveness. Since some studies show that fat under the skin can return (although very slowly) in patients after they switch from Zerit or AZT to Ziagen or Viread, we may not want something permanent. For instance, I decided to get BioAlcamid in my face 4 years ago and my lipoatrophy has gotten better since that. I consider that I now have too much product in my face and may get some extracted in the future (more of that later). Sculptra is the only option that has FDA approval and patient assistance program. But an at average $400 fee for doctor’s time per session, it would cost someone on patient assistance around $1200 to $2400 of out-of-pocket cost for 3-6 sessions, depending on the severity of facial wasting. No reimbursement for this fee is available through insurance or Medicare/Medicaid, although a few HMOs and VA systems pay for it. Activism is needed to convince third party payers that the facial reconstruction needed to repair a drug-induced side effect is actually not a cosmetic procedure but a clinical one. Women with breast cancer that needed reimbursement for breast implants fought this battle after a few years successfully. Will we do the same in HIV? Not until we start writing letters and having our doctors appeal rejections to reimbursement requests. It will take work.
Also, make sure that the doctor who applies the product in your face has experience and training. For a list of doctors in your zip code and for patient assistance information go to Sculptra.com. Most doctors that inject it also take care of your patient assistance application. I am hearing good things about this process (simple form, one week processing time, and product for 6 sessions is paid for). I have been following this product since 1999.
2- BioAlcamid is permanent but removable in many cases. But it is not approved in the US and you need at least $4500 to pay for it and travel to Mexico, Europe or Canada once or twice. I have hardly seen any decent studies presented in HIV conferences. I like the product since I have my own biases but having selected it 4 years ago. My face feels natural but I have a little more than I think I need (due to my lipoatrophy reversal after being 6 years off Zerit.) The doctor in ClinicEstetica and a doctor in Los Angeles have successfully extracted product from people with “overcompensated” faces. No other product so far has been shown to be extractable. I will inform the group when and if I get some of mine pulled out (I have not had the time for a trip to LA for that purpose). I have been following this product since 2001.
3- PMMA in Brazil has as much history as NewFill (Sculptra) in HIV and has gained a lot of acceptance. It is also the cheapest option but you need to go to Rio at least once. I think the going rate is $700 total for the entire face (someone correct me if I am wrong), plus travel. DR Serra has been injecting HIV faces for longer time than anyone else in the field. Like all other products that I mention here, I have heard about isolated cases of granulomas that have been successfully treated with corticoid steroids. Dr Serra also treats the buttock area for $1000 (I think). This product cannot be removed later. I have been following this product since 1999.
I am hearing that ClinicEstetica has a product similar to this one also and that they are using it more than BioAlcamid now. May be someone can correct if that is a wrong statement.
4- The Silikon 1000 microdroplet procedure has also gained a lot of acceptance in the US even though this product is not used for its approved indication (go to facialwasting.org for more). Last time I checked , its cots was $700-900 a session. Most people need 3-6 sessions and it is a permanent, non-removable option. Many doctors are using it successfully. No patient assistance is available.
There are also products (Radiance®, Radiesse®) that contain synthetic calcium hydroxylapatite, a natural substance found in bones and teeth. It seems that the company selling Radiesse is going for a HIV lipoatrophy indication in the US. More on this later. Cost will be an issue and the fact that it will require 1-2 year touch ups. I hope this company sets a good patient assistance program (I am yet to communicate with them)
This is the best article I have found to give a review on all facial reconstruction options, besides my facialwasting.org