HIV-associated lipodystrophy is a syndrome that occurs in individuals infected with the HIV virus who are being treated with antiretroviral medications (typically protease inhibitors). This treatment results in lipohypertrophy (increased fat deposition) and lipoatrophy (loss of fat) in various body locations. It is the loss of fat in the face that typically produces the most concern.

The precise mechanism is unknown, but researchers hypothesize that decreased production of a protein that prevents triglyceride uptake leads to decreased fat absorption into the cells. Apparently protease inhibitors have a high affinity for the catalytic site of the HIV virus. Retinoic acid protein and HIV virus catalytic sites have similar structures to two proteins involved in lipid metabolism. Fat is unable to be stored or produced leading to high levels of fat accumulation in the blood. Facial lipoatrophy is disfiguring, with the loss of fat from the face leading to an ill, malnourished look. HIV positive people may feel great, but their faces say otherwise.

Many techniques have been used to improve the cachetic appearance of lipoatrophy. Temporary fillers such as Zyplast, Cosmoplast, Dermologen, Restylane, and Perlane, and New Fill have been used, but are costly and need to be repeated at regular intervals. Fat transfer has had some success, but is limited in duration, perhaps because HIV causes structural changes in the fat cells which affect their ability to survive transfer.

Liquid injectable silicone and the Micro Droplet have been used successfully to permanently rebuild tissue in desired sites by stimulating the body's own collagen production. Used for decades in the skin, liquid silicone oil can be used to fill wrinkles, scars and facial contours that have been altered by time or trauma.

Silicone is an inert, or non-reactive, substance. It is found in numerous household products, and is used as a lubricant for medical equipment including needles and syringes. Medical-grade silicone oil is sterile and highly purified, requiring no skin testing prior to treatment. Liquid injectable silicone oil is currently "labeled" for ophthalmologic use. Although the FDA has not specifically approved the cosmetic use of the agent, the FDA allows licensed physicians to use these agents "off label" for other purposes, similar to the numerous uses for BOTOX®. With its long history of safety and a sterile, medical-grade composition, silicone oil is an excellent filler for most areas of the face. It is currently under investigation for potential FDA approval in the treatment of HIV-associated lipoatrophy of the face.

The Micro Droplet technique involves the injection of tiny drops into the affected areas in multiple sessions. In much the same way that an oyster reacts to a grain of sand, the body makes a pearl of collagen around each droplet of silicone. It does not migrate and rarely if ever produces any kind of inflammatory reaction. Treatments are conducted at monthly intervals to allow for collagen rebuilding and a resulting natural appearance.

The number of treatments varies depending on the number of sites and the extent of augmentation needed. The cosmetic use of silicone oil is compatible with other procedures including lasers and surgery. The Micro Droplet technique provides a safe, slowly progressive, and very natural appearing result in all areas of potential treatment. It is often less painful that other fillers and patients can resume their daily activity immediately.

All cosmetic procedures do carry some degree of risk. Possible side effects include bruising and swelling, overcorrection, discoloration, firm texture, and an idiosyncratic inflammatory reaction that produces redness and swelling. Fortunately these reactions are extremely rare; in most instances, time alone resolves the problems. In other cases, they can be managed with a variety of procedures including local cortisone injections, removal of tissue, electrodessication and antibiotics.

Today, the catch phrase in cosmetic surgery and rejuvenation is "have your cake and eat it, too." This means that the best rejuvenating therapies offer significant change with minimal down time. Liquid injectable silicone and the Microdroplet Technique fit this bill perfectly.