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Surgical Technique
November 2004

The Use of Custom-Designed Midfacial and Submalar Implants in the Treatment of Facial Wasting Syndrome

Author Affiliations

Author Affiliations: Department of Head and Neck Surgery, UCLA David Geffen School of Medicine, University of California, Los Angeles (Dr Binder); and Department of Otolaryngology–Head and Neck Surgery, University of Washington, Seattle (Dr Bloom).

Correspondence: William J. Binder, MD, 120 S Spalding Dr, Suite 340, Beverly Hills, CA 90212 (info@doctorbinder.com).

Arch Facial Plast Surg. 2004;6(6):394-397. doi:10.1001/archfaci.6.6.394

Facial wasting syndrome is part of a lipodystrophy that occurs as a complication of highly active antiretroviral therapy. The loss of subcutaneous fat in the cheeks and temples results in a hollow-eyed, bony, emaciated appearance that is characteristic of the results of treatment of human immunodeficiency virus. Cessation of therapy results in a rebound in viral load and subsequent morbidity. The appearance of facial wasting syndrome is optimally treated with custom-designed implants that are made using high-resolution computed tomography combined with surgeon input and computer-aided design and manufacturing technology. Twenty-two patients with facial wasting syndrome were treated using either submalar implants (in more moderate cases) or custom-designed implants (in more severe cases). In each patient, the appearance of volumetric soft tissue restoration was successfully achieved, returning a permanent and more healthful appearance to the face.