Licking Lipo : Lipo Fix-Its - by Liz Highleyman

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Back to home » HIV 101 » POZ Focus » Licking Lipo

Table of Contents

 
Licking Lipo

Body Language

The Med Connection

Ready, Set, Switch?

Lipo Fix-Its


What You're Talking About
Why I Still (Kinda, Sorta) Go to the Gym (blog) (27 comments)

Sanctuary for Survivors (14 comments)

The Treatment Divide: When’s the Best Time to Start HIV Meds? (11 comments)

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It’s Time for Tenofovir 2.0 (8 comments)

CDC Analyzes Impediments to Viral Suppression in People With HIV (6 comments)
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Lipo Fix-Its

by Liz Highleyman

Switching meds is not the only way to remedy—or hide—lipo’s hills and valleys. As Liz Highleyman reveals, the nondrug solutions are improving with time

Problem: Sunken cheeks

FIX   
Sculptra injections (poly-L-lactic acid, also known as New-Fill) encourage production of collagen, your body’s natural filler. Serious complications are rare when it’s done right, but some people develop bumps under the skin, in addition to post-op bruising and pain. Since the body breaks down Sculptra, it’s a temporary fix, and you may need a refill a year or two down the road. There are other options, such as Bio-Alcamid (polyalkylimide gel, easy to remove if necessary), Gore-Tex (polytetrafluoroethylene), ArteFill (polymethylmethacrylate or PMMA, a long-lasting mix of bovine collagen and synthetics), liquid silicone and solid silicone implants.

At the moment, only Sculptra is FDA-approved in the U.S. for HIV’s facial wasting, but it’s just a matter of time before some of the others get their approval. And Bio-Alcamid is available in Canada on a case-by-case basis. Studies have shown that dumping Zerit (d4T) can also help halt facial fat loss

BUZZ   
White men in clinical trials have been raving for a while now about Sculptra’s natural-looking results, but women and people of color haven’t had as much of a go at it.   

Sculptra costs about $1,000 per session, and the procedure is especially hard to convince insurers to cover, because they consider it “cosmetic.” But it’s more widely available since its August 2004 approval, with more and more doctors learning how to sculpt with Sculptra (see www.sculptra.com /US/Locator.do).

Problem: Flat butt, toothpick arms and legs

FIX   
Fillers don’t work as well for large areas like arms, legs and buttocks as they do for faces. There are a few procedures for butt enhancement—fat transfer, silicone implants, Bio-Alcamid—but none is FDA-approved for HIV positive people with lipo.

Exercise can help your body look fuller and healthier by building up muscle, but it won’t replenish lost fat. Serostim (human growth hormone, or HGH) has helped many people with HIV and fat loss in limbs or butts—especially if they also have fat accumulation elsewhere—but the hormone can also cause  fat loss (and other problems).

BUZZ   
If a bony butt makes sitting painful, try a portable gel or foam seat cushion (see www.backbenimble.com; 713.521.0003). The right clothes—with a loose fit and bright colors—can shape up your profile. And, although it’s not the real thing, padded undergarments can sure look good  (try www.buttforyou.com; 1-800-409-1563).

Problem: Buffalo hump

FIX   
Liposuction (sucking out fat from underneath the skin) may rid you of your buffalo hump; surgical removal of the fat pad is also possible. Liposuction is generally safe and rarely causes serious complications. You can, however,  expect some post-op bruising and pain. And fair warning: The fat can come back. Some people find that Serostim (or a PI-sparing combo) helps reduce a hump, but this isn’t true for everyone.

BUZZ   
We’re talking big bucks. Liposuction can run $2,500 and up, depending on how much fat there is to remove (surgery is even more expensive). If the hump is painful or interferes with your daily activities, insurance may pick up the tab. Your best bet could be getting hold of some tools to help you cope, such as specially shaped pillows (www.backbenimble.com) and oversize rear- and side-view mirrors for driving when it’s hard to turn your head (visit www.rearlens. com or www.adamobility. com). Dressing a little differently can help, too; try chunky scarves and bulky collars to camouflage a hump.

Problem: Big belly     

FIX   
Since lipo belly is deep internal fat, liposuction won’t work. Some folks get good results with Serostim; others don’t see much benefit, and the hormone can cause other problems like carpal tunnel syndrome, blood-sugar abnormalities and fat loss in face and limbs. The diabetes drug Glucophage (metformin)—plus exercise and a healthy diet—helped melt fat in one study, but another diabetes drug, Avandia (rosiglitazone), failed to do so. Most exercise doesn’t get rid of visceral fat, but consistent weight lifting may stimulate hormones that can help reduce it—and keep your metabolism in balance.

BUZZ   
It’ll cost you an arm and a leg—about $250 a day!—to reduce your spare tire with Serostim, and benefits fade quickly after you stop taking it. Some insurers won’t cover Serostim, because it’s not FDA-approved for treating HIV-related lipo.

Problem: Ballooning breasts

FIX   
There have been few studies on treating breast enlargement in HIVers—which is not limited to women. Breast reduction is a complicated procedure (removing fat, reshaping the breast and moving the nipple) and may be too permanent a solution for a usually temporary problem. Liposuction is an option for smaller amounts of fat (so it may be useful for men).

BUZZ   
Like all surgical procedures, breast reduction and liposuction are expensive, and your insurance probably won’t cover such a procedure unless you can convince your insurer that it’s medically necessary. Certain HIV meds seem to promote breast growth in some people—ask your doctor whether your combo could be contributing to the situation.

Problem: Chipmunk cheeks

FIX   
There’s no simple answer for this one (officially known as benign bilateral parotid hypertrophy), which may be caused by fat buildup in the saliva glands. Some doctors use low-level radiation with good results, but the improvement may be only temporary. Just in case your cheek is puffy for some other reason, get a CAT scan to find out what you’re facing. Then again, this is another one of those areas that may benefit from a switch in your combo.

BUZZ  
Radiation looks promising, but it needs more study. Because parotid swelling can be painful as well as unsightly, insurance companies usually cover treatments for the condition. Another option: Try a hairstyle that disguises the lumps.



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