Cosmetic surgeon Anthony Caglia specializes in working with patients to reduce the effects of wasting syndrome

DAVID TAFFET  |  Staff Writer

An ever-evolving array of HIV/AIDS medications has transformed what was once a terminal illness that claimed its victims quickly into a chronic ailment that has to be managed long term — allowing people with HIV/AIDS to live much longer, much healthier lives.

But those medications come with a price. For many HIV/AIDS patients, that price is AIDS Wasting Syndrome, the involuntary loss of more than 10 percent of body weight accompanied by more than 30 days of either diarrhea or weakness and fever.

The syndrome also includes lipoatrophy, the gradual loss of fatty tissue and collagen in the face that results in sunken cheeks and deep lines in the face. As collagen production slows, the cheekbones slowly begin to protrude.

For some, that may seem a small price to pay. But for many others, lipoatrophy can have a significant impact on self-esteem, and that, in turn, can seriously impact a patient’s overall health.

But medical science has found ways to address the issue, and Richardson cosmetic surgeon Anthony Caglia is one of those that specializes in fighting the effects of lipoatrophy.

Caglia works with facial fillers and serves on the HIV Advisory Board of Suneva Medical Inc., a company that manufactures the filler Artefill.

Artefill is approved to correct wrinkles around the smile lines but may have applications for other parts of the face such as the cheeks, Caglia said. In fact, Caglia pioneered the use of facial fillers such as Artefill on persons with AIDS Wasting Syndrome.

Caglia said that he usually uses a filler to create thicker skin to replace the lost fat. Then he uses a product to stimulate the body to produce its own natural collagen.

“Artefill has microspheres in it and it doesn’t biodegrade,” Caglia said. That makes the product a longterm solution.

Caglia said that in contrast, Sculptura, a similar product, is a biostimulator. The particles biodegrade over two years, but it stimulates the body to create its own new collagen.

He said that using facial fillers like Artefill gives some quick results but “takes from five to eight months” to get back to their previous appearance.

“And they might need touch-ups” — or “maintenance” — “in 12 to 16 months,” the doctor added.
Caglia said most people he sees with HIV have undetectable viral loads but he said that people with low T-cell counts do just as well.


The treatment is expensive. Artefill, for example, costs $1,200 per syringe. The number needed varies per person.

“One patient had 13 syringes and two more since then,” Caglia said.

But he said there are patient assistance programs underwritten by the manufacturers of the products.

Generally, people with income under $40,000 can get on an assistance program and treatment is prorated with incomes up to $100,000.

Caglia suggested that even those who never considered cosmetic treatment because of the cost may qualify.

Medicaid is beginning to look at these treatments as more than cosmetic and is looking at covering the procedure for some persons with HIV, he said. And as government programs begin to cover it, private insurance carriers find it harder to deny coverage.

For others, payment plans are available.

The benefits

As people with HIV live longer with better medications and return to work, Caglia said, the facial filler treatments serve more than vanity. They may help someone get a job.

Caglia talked about one of his patients who was leading an OK life, but not looking good. But then at Parkland, the man heard someone say something that spurred him to inquire about treatment: “Oh, there’s one of those gay guys.”

He knew it was because of his gaunt, sunken cheeks.

Another patient slipped him Caglia’s card and said, “Someone takes care of this.”

Most people just get used to that look until someone else points it out to them.

Complications from treatment with fillers may include bumps and nodules, Caglia said, but added, “It’s about technique.”

Treatment takes about an hour and Caglia said he is very methodical, massaging the product evenly through the skin and agitating the cells to produce new collagen and avoid the bumps that occur when the product is not administered properly.

“There’s an artistry in reshaping the face,” the doctor said.

Dr. Anthony Caglia, Derm Aesthetics and Laser Center, 670 W. Campbell Road, Suite 150, Richardson. 972-690-7070.

This article appeared in the Dallas Voice print edition Jan. 14, 2011.