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.
