Surg Cosmet Dermatol. 2026;18(3):1-7
INTRODUCTION: HIV-associated facial lipoatrophy can impair social relationships, treatment adherence, and mental health, frequently leading to depression. Correction of facial lipoatrophy is associated with significant improvement in quality of life.
OBJECTIVES: To evaluate the efficacy of poly-L-lactic acid (PLLA) in correcting HIV-related facial lipoatrophy.
METHODS: Sixty-one patients with HIV-associated facial lipoatrophy received PLLA injections once a month until clinical improvement. The primary endpoint was the need for retreatment. Two independent dermatologists and the researcher classified lipoatrophy according to photographs. Malar skinfold thickness was measured with an adipometer.
RESULTS: All patients showed improvement in facial lipoatrophy after receiving a mean of 7.9 vials of PLLA. Skinfold thickness improved by 105%. Maximum follow-up was 58 months, and the mean duration of the effect was 33.4 months. Patients who discontinued HAART or had higher CD4+ cell counts at baseline presented better responses. Lower responses were observed in patients with very severe lipoatrophy and thinner skin.
CONCLUSION: PLLA treatment is an effective and durable alternative for patients with moderate HIV-associated facial lipoatrophy, but of limited effectiveness for patients with thin skin and very severe lipoatrophy.
Keywords: HIV-Associated Lipodystrophy Syndrome; Polylactic Acid-Polyglycolic Acid Copolymer; Antiretroviral Therapy, Highly Active; Skinfold Thickness
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