"It is better to look good than to feel good" a TV character once jokingly cautioned. But for Dr. Jaime Vasquez, it’s not really a question of choosing one or the other.
Vasquez has performed cosmetic procedures in his Cedar Springs-area clinic for about five years, initially motivated to help his patients with HIV look their best.
"It’s more than just cosmetic," he says. There is a psychological component, especially in restoring the face to its prior luster, that is essential for those with HIV to forget about the disease: "I compare it to breast reconstruction after a mastectomy."
Which is one reason why it has always irked Vasquez that the Food & Drug Administration has been slow to acknowledge the health element in looking good.
For instance, the FDA calls Sculptra a cosmetic treatment, even though it is only indicated in the U.S. for HIV-related lipoatrophy. But due to its "cosmetic" status, most insurance companies won’t recognize it.
"Hopefully, if we get more people hounding the insurance companies," that will change, Vasquez says. Until then, he notes there is a sliding scale for the product for patients who can’t afford the price.
But while his cosmetic work was driven by his HIV patients, Vasquez happily performs his services for anyone who wants to look their best. He shared facts about some of the most common treatments and some newer ones.
Botox. Most people are probably familiar, if only by reputation, with Botox, the botulism toxin injected to reduce wrinkles and frown lines by paralyzing the facial muscles. Unlike Sculptra, anyone can use it. But while crow’s feet often come with age, Vasquez has seen a change in those seeking Botox.
"Many of my patients are Baby-Boomers age in their 40s but younger women and gay men are starting out in the 20s or early 30s," Vasquez says. They often begin with Botox before moving on to other procedures. A treatment usually last three to five months.
Restylane and Juvederm. Remember the scene from "The First Wives Club" where Goldie Hawn gets collagen injected into her lips until they swell like bicycle tires? That’s old school by today’s medical standards, Vasquez says.
Old animal-based collagen has given way to products like Restylane an Juvederm, fillers that mimic the hylauronic acid that occurs naturally in humans when they are younger.
"Hylauronic acid gives us our plumpness as babies, like the fat in baby cheeks," Vasquez says. "As we age, we lose it." Because they are non-animal-based and not a drug like Botox, there are virtually no allergic reactions to either product. They do not change your body, but merely fill in the trouble areas.
Treatment consists of injections into the skin to restore volume and decrease lines. Juvederm is especially formulated to diminish the nasolabial folds the groves that run from the nose to the sides of the lips.
Restylane usually lasts for four to six months; Juvederm lasts up to a year.
ArteFill. While all the other treatments eventually wear off, ArteFill which Vasquez calls one of the "new age fillers" is permanent.
Rather than merely filling the space under the dermis (where lines form), ArteFill actually creates substrata that support the skin. Because it is not absorbed by the body, its effects are long-lasting.
There is a catch, of course. The product "is only indicated for nasolabial folds, and not for HIV treatment," Vasquez says. And because it is animal-based, "you need to get tested to make sure you’re not allergic to it."
Radiesse. This filler is one of the newer ones on the market, Vasquez says, and along with Sculptra is approved for treatment of those with HIV, though it also has cosmetic applications. Because it lasts up to 18 months, some have found it a next-generation treatment. Again, it is primarily intended to reduce "smile lines."
Indeed, Vasquez says he is often asked, especially by HIV patients satisfied by their treatments, whether the products can be used to re-sculpt their legs, arms, even chests. While off-label uses could, conceivably, do so, the treatments would be cost-prohibitive due to the must larger area required to be injected.
And there will be injections. Whatever procedure someone chooses, Vasquez notes that minor side effects from redness to swelling to some pain are common, if usually brief.
No one ever said being gorgeous was easy.
WHAT IS THE CAUSE OF FACIAL WASTING?
It’s often reported that lipoatrophy among the HIV-positive is the result of the "cocktail" the drugs that stave off AIDS. But Vasquez says the evidence is less than certain.
"It can be medication, or the virus itself, or a combination of the two," he says. And he says don’t discount genetics.
Whatever the cause, the technical term for the effect is HIV-related fat redistribution syndrome. When loss of fat occurs in certain areas, such as the face, it is called lipoatrophy, Vasquez says. Fillers return the effect of fat loss to those areas.
This article appeared in the Dallas Voice – Body & Fitness print edition February 15, 2008.