Facelift surgery is performed on a wide variety of patients, regardless of age, gender, race or medical condition. There are nuances in facelift surgery for all of these differing patient considerations that can alter the technique and the tissues manipulated to optimize outcomes. The greatest nuances amongst facelift techniques is in what tissues below the skin are lifted, resuspended or excised.
HIV patients can very safely undergo facelift surgery and are not usually at any increased risk of infection if their cell counts are adequate. What is unique about the HIV patient, whether they are young or old, is the change in the fat compartments of the face. For many HIV-positive patients, facial fat wasting (lipoatrophy) is well known and is believed to be the result of antiretroviral therapies. While facial wasting is the most recognized facial fat change in HIV, some patients will develop a more generalized lipodystrophy syndrome which can include unencapsulated fatty deposits, often seen around the parotid glands and into the neck.
In the September 2013 issue of the Annals of Plastic Surgery, an article appeared entitled ‘Facelift in a Patient With Benign Symmetric Lipomatosis and HIV Facial Lipoatrophy’ In this case report, this peculiar combination of fat deformities was managed with a modified facelift and fat excision. Recurrence of the abnormal fat collections did not recur. This report is unique in that it is one of the few in the medical literature that uses a facelift approach for treating the abnormal fat collections in the face.
The most common treatment of the HIV face is that of soft tissue volume augmentation. The mild to severe wasting in the cheeks and temples creates a classic appearance that can only be corrected by fat injection, synthetic fillers, implants or combinations of any of these three augmentation methods. In my Indianapolis plastic surgery practice, the combination of malar-submalar shell and temporal shell implants with dermal-fat grafts added to the lower midface region has been a very successful approach to sustained correction of these volume-deficient facial areas.
But as the HIV patients ages, loose skin develops on the face, jawline and neck as it would in any other person. The development of loose skin may be exaggerated by the fat volume loss that is present. Thus some older HIV patients will benefit by a combined facelift (usually without any SMAS manipulation) with the placement of a dermal-fat graft into the shrunken buccal fat pad space. This can be combined with malar (cheek) implants) for an even more complete facial rejuvenation/voluminization effect.
Dr. Barry Eppley
Indianapolis, Indiana