February 22, 2012

February 22, 2012
Soft Tissue Fillers

Welcome to another day in my life. Today is Wednesday and we have almost made it through the middle of another work week. I hope you are having a safe and great week so far. It has been another busy week for Dab the AIDS Bear and me.

Some men and women have a problem with facial (and bodily) wasting when they are taking some of the HIV medications. This is more common with protease inhibitors but can occur with many different HIV medications. So what can you do? One of the solutions, although temporary, is using fillers.

Soft tissue fillers can be divided in three main groups, depending on the longevity of both the product and its effect:

• Absorbable, like collagen and hyaluronic acid

• Slowly absorbable, like polylactic acid (PLA) and calcium hydroxiapatite (CaHA)

• Non-absorbable, like polymetylmethacrila te (PMMA), silicone oil, and polialkylimide (BioAlcamid™, BA)

Only slowly absorbable and non absorbable fillers have proven efficacy for the correction of soft tissue deficits associated with facial lipoatrophy, but combining them is restricted by their physical characteristics.

Ideally, combinations of soft tissue fillers should be avoided, and only one type of filler should be used in a given area; however, patients face different situations which can influence their decision to seek more than one type of product for the same given area.

BA is the least combinable product, because it forms gel filled cavities with impermeable walls; it is common that bacteria organize around the implant, creating a clinically dormant biofilm. Manipulation, perforation, addition of other products,etc., can trigger a clinical infection. Furthermore, it is impossible to avoid migration of any soft tissue filler that is added next to or into existing BA.

I do not recommend the use of any filler in areas of BA; and do not recommend the use of BA at all.

Silicone oil is also a non-compatible product because the chronic inflammatory response or granuloma that it creates in the implanted areas can be worsened with the presence of other substances. Patients that have had silicone oil injected, should stick to it for future sessions. No combinations are recommended.

The other three common soft tissue fillers (PMMA, PLA and CaHA) can be safely implanted in the same area, provided that they are not mixed during one single session.

Ideally, patients that used either PLA or CaHa, should wait until they are absorbed to get PMMA.

So now you know some about the possible filler solutions. Hope you have a great Wednesday.

Until we meet again; here's wishing you health, hope, happiness and just enough.

big bear hug,

Daddy Dab