Facial Wasting

A personal Story - By JB in Florida

It's a strange thing to wake up, look in the mirror, and not recognize the person looking back at you, but this began to happen to me sometime during 1998.  It's hard to say when it happened, but it wasn't long after starting HAART.  The changes in my body came first. It seemed I was really getting cut and losing body fat, and my trainer was beginning to ask me for diet tips. "Uh.....eat more quarter-pounders, and don't leave off the shakes, I would reply, helpfully."  Soon after, strange things began in my face.  My cheeks sank in, my cheekbones became hard, my temples receded, and my parotid glands got really big.  When I picked up the phone, I had to be careful not to clunk my skull with the receiver.

Looking around South Beach, I knew that I was not alone. And it was noticeable like the "Scarlet Letter." A whole army of men was around me - men with the same gaunt face. For the first time in my life, I felt I looked older than my age. It really hit me when my auto mechanic commented that I looked tired. That was the day I knew I had to do something.    

First, I went to a plastic surgeon here in Miami Beach. This surgeon has seen many men with HIV-related facial changes, and went over a few options with me. The first procedure he used was "fat transfer." In this procedure, fat is sucked from a "donor site," often just below the navel, and transferred to the face.  

A second procedure is to remove a solid block of fat and fibrous tissue from the bathing suit area. This wedge of tissue is then placed in the cheek via a tiny incision hidden in the nasal fold. It is hoped that the solid tissue graft will grow better and survive longer than the shredded fat from liposuction. I have seen a few cases of this, and the results are quite impressive. The jury is out on how long the results will last though.

Longer lasting are synthetic grafts. A variety of materials are used. Gortex is one, and I suppose you can wear it out in the rain and stay dry. Just kidding. The solid prosthetics look good, but can be hard to the touch, and they can be a bit visible in the "fat free" face.

Look, plastic surgery has always interested me; now I found myself taking it on as a hobby. Living in South Florida, I have seen lots of older women who have had "work" done.  The Greater Miami Opera is a festival for the nip and tuck crowd, and I did not want to have that face anymore than I wanted a protease face. Plus, I don't like the idea of surgery on me!  That is when I began to look into other options available for facial reconstruction.   Almost as soon as "the face" began to appear, some people were making it "disappear" -using injectable products.  These products are like “Bondo” from car body shops.  Collagen is the best known of these. It is legal, safe, and available everywhere. What's the hitch? It doesn't last.  After three months, it is pretty much gone. The most famous, and infamous injectable treatment for wrinkles is silicone.  Silicone has a long and chequered history. Once unregulated, it was used for everything from smoothing wrinkles to giving breasts to transsexuals. Unfortunately, this supposed wonder material can have problems. Still, the idea of an injectable product (and avoiding the knife!!!) appealed to me.

What other injectables are there in the US? None, at least, not yet. Well, Canada is not far, and I located a doctor in Toronto who was willing to inject me with "Artecoll," a mix of collagen and polymethylmethacrylate, a plastic, used for years in orthopedic surgery. The synthetic material is formed into tiny spheres, which are suspended in the collagen. The material is injected into the skin, giving the desired contour. Over the next few weeks, the collagen goes away. Then, the plastic spheres cause fibrous tissue to form, thickening the skin. I decided to do this (anything to avoid a surgeon's healing knife).    

The injections were uneventful - though you feel like a pincushion during the procedure, and I looked great. My cheeks could support a pair of glasses, and I didn't look like a survivor of the Bataan Death march. It was great!  It was amazing to look at myself in the mirror, and see me.   For a few short weeks, I was happy with the results. As predicted, the collagen was absorbed, and my face again looked thin. I kept waiting for the fibrous reaction to form, but it never did. Within two months, friends were asking sheepishly, "I thought you were going to do something about your face. What happened?" Time for another option.    

On the Internet, I learned of another material, "hyaluronic acid."  HA is a component of your skin, just like collagen. If your skin is like fibreglass, collagen is the glassy fibres and HA is the  resin. This product is available in Europe, so, at least, you can get frequent flyer miles. Once again, it is given in a series of injections. Monsieur le dermatologist divided the treatment into three sessions. So far, I have had two. The improvement, so far, is impressive, and it better be.  Each treatment cost $850.00. If it holds up, it will have been worth it. Like so many things, though, we'll have to see how it lasts.