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November 2004, Vol 6, No. 6 >

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Surgical Technique | November 2004

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

William J. Binder, MD; David C. Bloom, MD
Arch Facial Plast Surg. 2004;6(6):394-397. doi:10.1001/archfaci.6.6.394.
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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.
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Figure 1.

High-resolution computed tomographic 3-dimensional computer-aided design and computer-aided manufacture (CAD/CAM) model demonstrating the fabrication of custom-designed silicone midfacial implants that are used to correct the characteristic appearance of facial wasting syndrome. A, The line on the right side of the model indicates the inferior border of the maxillary bone. B, Note the thickness of the implant (9 mm).

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Figure 2.

A 38-year-old man before (A and C) and 9 months after (B and D) implantation of custom-designed midfacial implants.

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Figure 3.

A 33-year-old man before (A, C, and E) and after (B, D, and F) implantation of custom-designed midfacial implants.

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