Multi-Layered e-PTFE Facial Reconstruction for HIV Lipoatrophy

Abstract

Importance: Facial lipoatrophy is a common problem among the Human Immunodeficiency Virus (HIV) population. With highly active antiretroviral therapy, these patients are able to delay the evolution of the disease and live many more years; however, more than half of them are faced with difficulties in their social and professional lives secondary to the physical changes of their faces. Observations: The majority of HIV-positive patients exhibit significant facial soft tissue loss, especially in the buccal fat pad resulting in accentuation of the malar eminence and the inferior orbital rim. Reconstruction has been performed with many temporary and permanent methods, but no single satisfactory procedure has been universally adopted. Conclusions and Relevance: We present a new method of addressing the resulting facial hollowing by tailoring a multi-layered e-PTFE sheet in a customized fashion to camouflage the specific atrophic areas in the face. Our patient demonstrated a significant improvement in both cosmesis and social reintegration. A detailed surgical description along with a review of the literature is reported.