The news of success using polylactic acid (PLA) injections to treat facial wasting -- complete with impressive before-and-after shots -- did not cause a buzz at Toronto's 2nd International Workshop on Adverse Drug Reactions and Lipodystrophy in HIV last September. Maybe that's because most of the conferees were researchers with full fleshy faces. But when POZ readers got wind of the great results -- 22 of 26 guys with HIV who had their cheeks injected with the stuff got their faces back (see "Kiss Lipo Buh-Bye," POZ, January 2001) -- our e-mail server all but crashed from the breathless requests for more info. You asked, we answer.
The author of the study is Patrick Amard, MD, a Parisian facial surgeon who came up with the idea of using PLA, a simple sugar, to reverse facial wasting. (Biotech Industry markets PLA in Europe under the brand name New-Fill.) Amard's study results were confirmed by 54-week followup data presented at a leading French lipo conference in April.
Chairman of France's nonprofit Association for Medical and Aesthetic Research, Amard's search to solve the facial wasting problem led him to PLA. He had already discarded other injectable compounds because they wouldn't last long or result in a natural appearance, weren't safe or were likely to trigger allergic reactions. But -- eureka! -- PLA has none of these problems. With a track record of success in other cosmetic surgeries (it's approved in Europe for wrinkle elimination) and many other medical uses, it is safe and non-allergenic. It doesn't last forever -- usually 18 months -- but its gradual disappearance could actually be a plus if for any reason the results disappoint.
Amard says that PLA works because its powdered particles, once injected, trigger your body's own production of collagen, a skin protein. Because the particles are miniscule, the new collagen looks all-natural -- like a new layer of your own skin. The result, he says, is a return to your original looks. A single treatment consists of multiple injections into each cheek, and several repeats, spaced at least three weeks apart, are needed.
"The sooner patients begin, the easier and faster they will obtain a good result," Amard says, although the exact number of sessions varies. Factors he cites include the degree of fat wasting, the areas that must be treated (sunken cheeks and temples), skin quality (thicker is harder to treat), age (older is more challenging) and gender (men may need more sessions). For mild wasting, Amard says, three sessions is usually sufficient. Moderate wasting may require four; severe, five to seven. After that, a booster is recommended every 12 to 18 months to maintain optimum cheekiness.
Amard says that he has never seen an HIVer whose face couldn't be improved using this procedure, although some will need more patience, and all will need a well-trained surgeon.
"Even for a good surgeon experienced in doing other types of facial injections, the product is still very difficult to use," Amard says. "Its thickness makes it tricky to inject -- resulting in the product sometimes being wasted -- and there are multiple sites that must be filled [the Bichat fat pad of the cheeks, the temples, the perizygomatic and preauricular areas]. The results depend on a trained, controlled technique."
In addition to sufficient repeats and physician expertise, another crucial factor is proper dosage (3 cc on each side of the face). Amard insists that the appropriate training about how to inject the smallest quantity for the best results in each area is imperative. He says, "We have seen bad results when docs without training have used PLA, including nodules" -- lumps in the skin that will eventually disappear after a few months. "Also, if injected incorrectly, missing the intradermal layer, there will be no collagen development and no facial return."
It takes several weeks for the PLA-triggered collagen to become visible, but when it does, the HIVers who have been treated by experienced surgeons sure seem pleased. Allen Robinson (not his real name) flew from Fort Lauderdale, Florida, to Paris to be treated by Amard.
"After the first treatment, people said I looked rested," Robinson says. "After the second, a waitress at my local hangout kept telling me how much better I looked. After the third, now I can absolutely see the difference." And that was just halfway through Robinson's six-cycle plan of action for reversing his semisevere facial-fat loss.
Sounds great, but don't those needles hurt? "The first session was the worst," Robinson says. "That's when the surgeon goes the deepest -- he's building the base layer that the collagen will develop around. He uses tiny needles, but they are poked into your face." Amard says that icing the face first and using a topical lidocaine (anesthetic) ointment can reduce the pain. The New-Fill brand is also mixed with lidocaine (150 mg of powder, 2 ml of sterile water, and 1 ml of lidocaine).
It takes about 45 minutes to do the injections in both sides of the face. "It's maybe 15 or 20 needle jabs," Robinson says, "but it felt like a thousand." However, according to Amard, there's no bruising, pain or swelling afterwards. Ice is applied to the face for 15 minutes after the injections are completed, and then, Robinson says, "You walk out on the street looking the same. Once it's over -- it's over. I went out to dinner afterwards, and no one noted a difference."
Although currently approved only in Europe and Mexico, New York City's Direct Access Alternative Information Resources (DAAIR) buyers club will have PLA kits available this summer for $235 per treatment. Obtaining it will require a prescription as well as a standard personal-use importation form. Because it's not FDA-approved, it may be difficult to find a well-trained doctor who is willing and able to poke you. However, there are plans for Amard to conduct three-day trainings in Mexico this summer for interested physicians. DAAIR will provide info on the sessions, as well as a surgical instruction sheet developed by Amard.
The bottom line for Amard is simple. "Wearing AIDS on your face does not make you feel good about yourself. My patients' lives return to normal. It even makes it easier to accept drug treatment." Robinson seconds that, saying, "Before I did this, I felt miserable and disfigured. Now my normal face is coming back."
For info, contact DAAIR at 888.951.5433.