Lipoatrophy: Definition and Care

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It is the loss of subcutaneous fat, ie lying just below the skin. Lipoatrophy can affect the entire body, but is usually more visible in the legs, arms, buttocks and especially in the face.

Can it be prevented?

Official recommendations for the treatment and control of metabolic disorders specialists, Spanish and international, advise avoiding antiretroviral d4T and AZT.

If you started the intake of drugs against HIV, or even if they are already being eaten in place of these drugs is recommended to use tenofovir (Viread®And co-formulated in Truvada®) And abacavir (Ziagen®And co-formulated in Kivexa®).

One study noted some cases of mild lipoatrophy in people who started treatment with efavirenz (Sustiva®), Although, for now, there is no recommendation to be used.

It can be reversed?

Several studies observed a certain recovery of subcutaneous fat in the extremities when it replaced it d4T or AZT by abacavir or tenofovir. It is possible that this strategy also work with other antiretrovirals.

Similarly, the benefit is being researched which could cause certain drugs used to treat insulin resistance such as pioglitazone or rosiglitazone.

The sooner it is detected, easy bad could be reversed, it is very unlikely that you can recover all the lost fat when lipoatrophy are on a longer significant stage.

Ways to know if you may be developing lipoatrophy:

  • Visually control the symptoms.
  • Use more precise measurement techniques.

Visual control. Look in the mirror carefully or take pictures frequently. If any change is noticed, it is important to tell the doctor. At periodic visits, ask him if he is seeing any changes.

The first symptom is usually on the face the cheeks sag slightly. The arms and legs, the veins become more visible.

Testing of fat measurement. Health posts have measuring devices used for other purposes, but can also provide a fat distribution image in the body.

One is the absorptiometry dual energy X-ray absorptiometry (DEXA, in English). It is used to control the bone density in the elderly or those with bone problems, but also can measure subcutaneous fat.

It is useful in the early detection of lipoatrophy, especially in the legs and arms, as it may indicate small changes before you the note.

Make a DEXA scanner before starting antiretroviral treatment will see if there are changes. In the opinion of many experts, all people with HIV should have access to this procedure, but many health centers would be unwilling to implement it, mainly for economic reasons.

Classification of facial lipoatrophy

A group of researchers (which include doctors and cirurgiãos) specialize in lipodystrophy, developed a classification that allows visually identify the changes in the face. It might be useful to you.

Rating Fontdevila

Degree 1


Light. The affected person in this grade shows a flattening of cheekbones - malar region - as a result of loss of subcutaneous fat -gordura malar -. The effect would be similar to that observed in a lean person or with slightly protruding cheekbones.

Degree 2


East. The loss of fat it produces a pronounced flattening of the cheekbones; skin adapts to the prominence of the bone, which causes a dip or depression on the cheek.

Degree 3


Grave. They notice the same characteristics of 1 and 2 degrees but, due to the almost total absence of subcutaneous fat, the skin is further adapted to bone and muscle structures, causing the cheeks to sink more than the face of the anatomical structures are visible -aspecto skeletal -.

Repair of lipoatrophy

The facial lipoatrophy can be repaired by surgery and use of filler substances.

Today, in Spain, facial reconstruction treatments can be done in private clinics reconstructive plastic surgery and aesthetics, and free in an increasing number of public hospitals. At the end of this document is a list of autonomous communities.

In some Autonomous Community is not possible to access the patient and decide to do the procedure in a private clinic, it is very important to choose one that is qualified and has experience in reconstructive facial surgery and the use of fillers.

Synthetic fill

The filler material may be of autologous origin (patient's own), heterologous (animal) or synthetic (made in the laboratory).

For a product to be suitable must meet the following requirements: it must not be carcinogenic (causing cancer), teratogen (produce fetal malformations), immunogenic (cause hypersensitivity reactions or allergies) or annoying (should cause minimal inflammation possible). It should be sterilizable, with durable chemical stability and in any location, and physical characteristics similar to the original tissue in which it is deployed. It should be durable and not move to other distinct regions.
Finally, it should be economical, since the treatment of facial lipoatrophy in people with HIV a larger volume is required to that normally used in ordinary cosmetic surgery indications.

One of the characteristics that best defines a filler material is your period of stay in the tissue. In this sense, materials may be classified into: quickly resorbable (or temporary) slowly resorbable (or semi-) and nonresorbable (or permanent).

There is a fairly widespread consensus that slowly resorbable material (or semi-permanent) are best suited for, if you experience side effects are transient, and the results are not definitive, which means that can be corrected and managed in future interventions. The main drawback is the high price, which sometimes equals the Permanent treatments, but with the additional of having to repeat on a regular basis.

The side effects of synthetic materials may be immediate - usually associated with the implant technique - or late - related to the implanted substance. Immediates include erythema, edema, and possible allergic reactions depending on the nature of the product. Among the late ones, they are inflammatory reaction, granulomatous fibrosis, Reactions due to the presence of a foreign body and movement of the product to other areas.

The polyacrylamide gel (Aquamid® Reconstruction) is permanent and useful for 2 and 3 lipoatrophy. Although granulomatous reactions may occur in the injection site, studies in people with HIV have shown the absence of complications over time.

Among the semi-permanent fillers, there is the calcium hydroxylapatite (Radiesse®), Biocompatible substance and useful for 2 degree of lipoatrophy. Its application is recent, but increasingly used in people with HIV. It is reabsorbed very slowly.

Known as New-Fill, polylactic acid is called in Spain, Sculptra®. It is a resorbable material, useful for 2 degree of lipoatrophy and widely used in countries like France and the United States. In some cases not developed nodules were visible, but palpable in the injection zone. Its drawback the need for multiple sessions with time intervals.

In some clinics it was used hyaluronic acid. This gel, used frequently by the general population to reduce wrinkles or increase the cheekbones, can present a granular finished when used in the repair of lipoatrophy in people with HIV. On the other hand, it is very safe to be highly biocompatible.

In general, experts believe that to this day has not found a material, synthetic or natural, guaranteeing the absence of complications with long lasting aesthetic results, but not permanent.

Filling with own fat

Another facial reconstruction technique is to use the patient's own fat, called autologous fat as filling material. This would be possible in cases where it has a sufficient amount of fat in other areas of the body, especially in the regions (abdomen, buffalo hump, breast) in which there is greater accumulation.

One of the advantages of this restorative technique is that the adipose tissue is a natural and therefore biocompatible material, versatile, stable, long lasting and natural looking. This intervention, whose cost is not excessively high, requires an initial investment in machinery and, as in other cases, in training. In recent years, it has been held successfully in a center of Barcelona.

Who affects lipodystrophy? Index Hypertrophy: definition and Care

Original Issue:

Working Group on Treatment of HIV (TWG)
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Translation into Portuguese in Brazil by:

Raquel Cirne
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Publishing and Editing:

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