Lipodystrophy-like volume loss of the face.

Hello Doctor,


I am a 25 year old male. I have two questions. One about implant/filler and the other about scar.
I have a light brownish skin complexion. I have been diagnosed with En coup de Sabre Morphea on the right side of the face 3 yrs ago. Because of this decease I have almost totally lost fat/muscle below my right cheek – just beside nose area. I also have partial lipoatrophy. So far I have not lost hairs although I have hair-fall problem for some years now. I also have a dark linear band type mark on the right side of forehead. This area is also depressed slightly but visibly. The disease progression ‘appears’ to have stopped but doctors say they are not sure about lipodystropy.

So, I wish to know the opinion of other doctors about it. First, what is the best laser treatment for an atrophic hyper-pigmented scar on the cheek caused by Morphea? Is there a way to remove or lightened it? Note: it is my report which says it is an atrophic hyper-pigmented scar.
Secondly, my doctor has suggested Artefill to fill the cheek depression. Is it the best option or should I go for silicone implant or for some other option? According to my doctor I cannot have autologous fat grafting because of partial lipoatrophy.
Thanks and regards

When patients come to me with large surface areas of volume loss, such as what you are describing, I think that Sculptra is the best option out there. Hyaluronic acid and Artefill are for lines and areas of small surface area. Sculptra is a collagen stimulator – if you can imagine a fertilizer that grows collagen. It is a thin
suspension, so it distributes evenly and smoothly within the tissues. The results are gradual, over three or four monthly sessions, but the effect is very reliable and lasts for several years. It is important to go to an injector who has extensive experience with Sculptra because there is a technique to injecting it safely and most effectively. This is an injectable that was used extensively for lipodystrophy among the HIV population and has demonstrated its ability to provide significant re-volumization of cheeks, temples and other large surface area regions.
As regards the hyperpigmentation, that should be correctable with the appropriate laser – which one would depend on what we see in the consultation.

Was This Really in Newsweek This Week?

“Advances in nonsurgical techniques have created a whole realm of possibilities for those seeking a new and improved look without plastic surgery……. The Hotel Carlsbad Plaza in the Czech Republic offers cryotherapy, where guests, mainly locals, stay for several minutes in a room where the temperature is below freezing. The goal is to stimulate free-flowing collagen, the main hormone responsible for a silky-smooth complexion, which is plentiful in youth but fades with age (carlsbadplaza.net). Locals also can’t get enough of the dry carbon-dioxide bath, which wraps the body in a plastic bag filled with the natural gas, reducing swelling and allergic reactions, and healing any scars. At the Terme di Saturnia Spa & Golf Resort in Maremma, Italy, clients can try Isophoresis, an alternative to liposuction that uses ultrasound to force vitamins and plant extracts below the skin to break down fat deposits. They dissolve into the bloodstream and are eliminated through the bowels and kidneys (termedisaturnia.it; from $240, compared with $2,000 for a basic nip-and-tuck).”

Really?

I thought better of Newsweek. Perhaps the next article will be about how you don’t have to do all that messy surgery and nasty chemotherapy anymore. Just wear a few crystals and your cancer will melt away like butter!

I swear, I am so close to opening my cat poo spa at the Four Seasons. All cat poo, all the time. Tabby poo for cellulite, rare, expensive persian kitty poo for wrinkles, etc. I figure that if I price it high enough, there will be a waiting list in no time!

Seriously, though – be careful out there. There are few laws governing beauty treatments. As long as it is not harmful, no-one is going to prosecute a company for promoting treatments that do not work. So try to do some research on the treatments you are considering.

Do the cat poo test.

Is there any scientific evidence that the procedure you are considering works? If not, then it might be in the same wrinkle fighting category as cat poo.

Kenalog Dent

About 3 months ago I had kenalog injected into my TT scar and also lasered (whisper). 1 month ago I had my second laser treatment. Last night I noticed a dent near my scar and the skin looks thinner there. I say thinner because I can really see alot of veins I didn’t see before.
Googling this brings me to the kenalog? Is there anything that can be done to stop the dent from getting worse or fixing it?
I plan on calling my PS Monday but this is just really bothering me!
Thanks!
Melissa

Hi Melissa,
The dent is not going to be a major problem. It does sometimes happen from kenalog injection, but its easy to fill it in. It generally will not get worse and worse. It just happens and then either improves on its own, or we fill it in. Once it is filled in, collagen stimulation happens and we usually do not have to fill it in a second time.


WEST LA OFFICE: 11645 Wilshire Blvd., Suite 800. Los Angeles, CA 90025.    (310) 443-5273

  MALIBU OFFICE: 24955 Pacific Coast Hwy., Suite B101. Malibu, CA 90265.   (310) 456-8883