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Modified facelift procedure may provide safer results for facial lipodystrophy

Article-Modified facelift procedure may provide safer results for facial lipodystrophy

Key iconKey Points

  • Polytetrafluoroethylene sheets has established safety record with history of use in a number of surgical specialties
  • Modified facelift technique with ePTFE sheets involves inserting sheets into facial region in areas of soft-tissue deficiency

TORONTO — For treatment of facial lipodystrophy, a modified facelift procedure with placement of polytetrafluoroethylene sheets (ePTFE; Gore-Tex, Gore) to replace lost volume is a better alternative than augmentation with permanent injectable fillers, according to Nancy Van Laeken, M.D., who spoke at Plastic Surgery 2010, the joint annual meeting of the American Society of Plastic Surgeons and the Canadian Society for Aesthetic Plastic Surgery.

Dr. Van Laeken based her remarks on experiences she has had throughout the past seven years using different methods for treating facial lipodystrophy. She told attendees that while she was initially satisfied with the results achieved using polyalkylimide gel (Bio-Alcamid, Polymekon) and reported her positive impressions at a scientific meeting based on early follow-up, some patients who received that product subsequently presented with difficult-to-treat complications. In contrast, Dr. Van Laeken said that both she and her patients remain pleased with the efficacy and safety outcomes associated with the more aggressive surgical approach during follow-up that extends now to seven years.

"When polyalkylimide gel was originally described and presented to us as a biocompatible permanent filler, it seemed to be the perfect solution for treating the problem of facial lipodystrophy, and findings from early follow-up were consistent with that impression. However, beginning at about one year after the procedure, some patients returned with complaints relating to the product shifting and malpositioning, and we have seen infections as well," says Dr. Van Laeken, associate professor, division of plastic surgery, University of British Columbia, Vancouver.

"Based on this new evidence, I felt obligated to publicly recant my previous positive report. We know that ePTFE has an established safety record from a long-standing history of use in a number of surgical specialties, and using it for augmentation with facelifting has resulted in outcomes that are safe, durable and associated with high patient satisfaction," she says.

INVESTIGATING COMPLICATIONS Dr. Van Laeken says she had treated about a dozen patients — mostly HIV-positive patients but also a few who had lipodystrophy secondary to tumor treatments — with polyalkylimide gel for facial lipodystrophy, and the patients who developed complications associated with the filler were not limited to the HIV-positive population.

To better define the prevalence and features of the complications, she is currently conducting a multipractice chart review that includes all of her patients as well as those treated by several plastic surgery and dermatology colleagues in Vancouver.

"In addition to reports of product migration and infection associated with polyalkylimide gel injection for facial lipodystrophy and other facial defects, information is also now emerging about similar events in Asia, where the product is being used for breast augmentation," Dr. Van Laeken says.

In her patient series, management of the complications proved to be challenging. Some patients had to undergo surgical removal of the migrated or contaminated product using a facelift technique to expose the cheek plane and gain access to the material. In several patients, the product had migrated into the oral mucosa and had to be removed by direct excision through an intraoral approach, she says.

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