Liquid Injectable Silicone and Facial Lipoatrophy
Lipoatrophy is the loss of fat from body parts and facial lipoatrophy is the loss of fat in the face with no similar loss of fat in arms and upper part of trunk. One of the most common causes for facial lipoatrophy is anti-HIV treatment. HIV-treatment associated facial lipoatrophy is a fat redistribution syndrome which results as a consequence of treatment of HIV patients with highly active anti retroviral therapy (HAART). In this condition, fat from the cheeks, temple area (side of the head behind eyes) and around the eyes is lost leading to an ill, malnourished look. Other causes for facial lipoatrophy include aging, cachexia, diabetes, hereditary syndromes and autoimmune disorders such as lupus panniculitis.
Facial lipoatrophy is not a life threatening condition however it is a cause for cosmetic concern. It is disconcerting to patients and at times may cause social isolation. Self confidence, emotional well being and commitment to staying on HIV treatment can all be negatively affected by this complication of HIV treatment.
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.
Injection of permanent fillers is one of the most common treatment approaches for HIV-treatment associated facial lipoatrophy. Liquid injectable silicone is widely used filler in this approach. Liquid silicone is approved by the U.S Food and Drug Administration (FDA) for treatment of facial lipoatrophy in the United States. Silikon™ 1000 (liquid injectable silicone) is considered a safe and effective method for the treatment of HIV facial lipoatrophy.
Silicone is a generic term for polymers of dimethylsiloxane and is composed of elemental silicon, oxygen and methane subgroups. Silicone can be in a solid or a liquid form. Silicone is heat stable and chemically and biologically not reactive. If used as injectable filler, it is permanent and not biodegradable.
Liquid injectable silicone is used for soft tissue augmentation procedures in conditions of skin atrophies including acne scars and HIV associated facial lipoatrophy.
- Liquid silicone should not be injected into active sites of infection.
- It should not be injected into breasts orgenitals.
- It should not be used for “ice-pick” acne scars.
- Injection of liquid silicone into upper layers of the skin should be avoided because of formation of lumps.
Pure injectable grade silicone which is approved by the US FDA for injection into the human body is used. The serial puncture microdroplet technique is used in which injections are given to the skin layer just below the dermis and about 0.01 cc is injected each time at intervals of 2-5 mm. The treatment protocol requires no more than 2 cc be injected at monthly intervals. The injection session should be carried out once a month. Treatments are conducted at monthly intervals to allow for collagen rebuilding and a resulting natural appearance. It is often less painful than other fillers and patients can resume their daily activity immediately.
Some of the rare complications that can occur with liquid injectable silicone include:
- Granuloma formation – formation of firm and hard inflamed nodules
- Lymphatic obstruction – cutaneous necrosis and pigmentary abnormalities
Your dermatologist uses proper injection methods as mentioned above to prevent these complications from occurring.