Certain anti-retroviral medications commonly used for HIV treatment can cause significant alterations in fat distribution. No one really knows for sure exactly how this works, but some areas tend to atrophy and others tend to hypertrophy. Some areas on the face, including the nasolabial fold area and other parts of the cheek, frequently are plagued by lipoatrophy - that is, wasting away of the fat, which can cause an emaciated, ill, or notably unusual appearance. It's hard to treat this with collagen and most other "fillers" because large volumes are needed, and they are temporary - lasting 3-12 months. We are now starting to use AFT (autologous fat transfer). In other words, we use the patient's own living fat - taken from the abdomen or elsewhere - and then transplanted to where it is needed. The drawback is that only a percentage of the fat survives, and only a relatively small amount can be transplanted in one sitting and be expected to survive. Thus, multiple stages are required. The positive is that whatever fat survives is permanent - at least, we think so.
On the left are photos before AFT. On the right is one year later, following three rounds of AFT.
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