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Hình 9-12. Trước phẫu thuật một) trước và b) mặt bên của một 35 tuổi [người đàn ông / phụ nữ với HIV liên quan đến loạn dưỡng lipid đặc trưng bởi sự lãng phí submental và submandibular dư thừa và thiết bị ngoại vi chất béo sau khi điều trị kháng virus rất tích cực (HAART). c) trán và d) mặt bên của bệnh nhân sau 6 tháng. | Advances in Facial Aesthetic Surgery New Approaches to Old Problems and Current Approaches to New Problems 113 a b Figure 9-11. a Preoperative view of a 58-year-old woman who recently lost 110 pounds. b The patient 1 year after a facelift secondary direct excision of the nasolabial folds and CO2 laser resurfacing of the scars. Reprinted from Plastic Surgery 2 e Mathes SJ chapter Face Lift Lower Face Current Techniques by Fardo D Zins JE Nahai F 2005 Elsevier Inc. With permission from Elsevier. Correcting Lipodystrophy in HIV AIDS Patients Just as bariatric surgery has increased the number of patients seeking plastic surgery after massive weight loss successful treatment of patients with HIV AIDS has increased the number of requests for surgery in this patient population.77 78 Highly aggressive antiretroviral therapy is prolonging remissions in these patients but has also led to a clear lipodystrophy syndrome characterized by central obesity and peripheral soft tissue atrophy. Specifically these patients display facialwasting syndrome which is characterized by a loss of submalar soft tissue that increases the depth of the nasolabial fold and that exaggerates the prominence of the zygoma. This degree of facial wasting is variable and is graded 1 to 4 1 being the most mild and 4 the most severe.79 This syndrome has been recognized only since 1998 so few reports of surgical treatment for these patients have been published and no large series is available. The approach to these patients is not straightforward. They may have submental and submandibular lipodystrophy. However this lipodystrophy tends to be less fatty more fibrous and not easily amenable to routine liposuction. Therefore ultrasound-assisted liposuction is more efficacious and is recommended Figure 9-12 . Facial atrophy as described above has been treated with fat injections dermis fat grafts and Silastic submalar implants.80-83 The studies cited above are small retrospective patient series with short .
