Maple Leaf Clinic

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POLY-L-LACTIC ACID (New-Fill®/ Sculptra™)	POLY-ALKYLAMIDE GEL(Bio-Alcamid™)	LIQUID SILICONE OIL (Silskin, Silikon 1000)	HYALURONIC ACID(Restylane)
description	description	description	description	description
Stimulates skin cells to produce collagen Biodegradable Non-toxic Multiple treatment sessions required (at least 3, ~ every 2 weeks until desired effect is achieved) May require touch-ups as necessary Local anesthesia First filler approved by FDA for HAART-associated FLA Approved June 2006 by Health Canada	Class IIB Medical Device Becomes covered by collagen in the body Non-biodegradable Non-toxic Non-allergenic 1-3 treatments Local anesthesia May or may not require antibiotic prophylaxis Approved April 2006 by Health Canada	Non-biodegradable Approx. 4-8 treatment sessions Topical anesthesia Little information regarding treatment of FLA	Hyaluronic acid (dimeric sugar) is a naturally occurring substance in the human body. It provides volume and fullness to the skin Approved for treatment of wrinkles, little information regarding treatment of FLA Local anesthesia	Column reserved for future FLA products or procedures
Duration of Effect	Duration of Effect	Duration of Effect	Duration of Effect	Duration of Effect
Temporary filler Approx. 18 months Usually reabsorbs completely within 2-3 years	Permanent	Permanent	Approx. 6 months Temporary, so repeated treatments required every 4-12 months
Benefits	Benefits	Benefits	Benefits	Benefits
No over-correction if lipoatrophy resolves after modification of antiretroviral therapy Non-animal origin	Permanent Removable if necessary	Permanent Non-allergenic	No over-correction if lipoatrophy resolves after modification of antiretroviral therapy Non-animal origin
Potential Side Effect	Potential Side Effect	Potential Side Effect	Potential Side Effect	Potential Side Effect
Minimal, localized swelling (100%) Redness Mild-moderate pain (5%, 28%, 77%, 80%) Mild bruising (3%, 8%, 15%, 30%) or bleeding (4%) Malaise (7%, 12.5%) Anaphylactic reaction (1 case of painful generalized edema) Cellulitis (1 case) Palpable, non-visible subcutaneous micronodules (11.7%, 13%, 44%, 56%) Visible intradermal papules (3%)	Pain (3-4 days) Swelling (3-4 days) Bruising (6 days) Redness (2 days) Infection (Staphylococcus) (0.6%)	Redness Bruising Swelling Granulomatous inflammatory response (varying severity) Mild-moderate pain Pigmentation Recurrent cellulites with nodule formation Ulceration Implant migration Local lymph node enlargement Tissue scarring Embolism Acute pneumonitis Granulomatous hepatitis Particle migration	Redness Mild Bruising Mild Swelling Itchiness Nodules (potentially leading to abscess formation) Cutaneous necrosis (extremely rare) Hypersensitivity reaction (0.6%) Granulomatous foreign-body reaction
Cost	Cost	Cost	Cost	Cost
$500-1,000 USD per ml An average of 12.5 ml is required for a lipoatrophy case Average total $9,375 USD	Is priced per ml. In some cases the doctor will add their fee to the cost of the material. The procedure can cost ~ $2,800 to $6,000 CAD (average total $4,400 CAD). There are financing options through Medicard and subsidized pricing offered to those that qualify through the Face Forward Foundation	$1,000-3,000 USD per ml An average of 8.5 ml is required for a lipoatrophy case. Average total $17,000 USD	Costs range from $500+USD per ml. An average of 15 to 40 ml is required for a lipoatrophy case. Average total $13,750 USD
Treatment Providers in Canada	Treatment Providers in Canada	Treatment Providers in Canada	Treatment Providers in Canada	Treatment Providers in Canada
The following offer most or all of the FLA treatments discussed here: Burlington, ON Dr. Otto Weiglein 905.634.5573 Toronto, ON Dr. Frank Beninger 416.925.5775 Dr. Sean Rice 416.391.4048 Calgary, AB Dr. Wayne Perron 403.228.7076 Montreal, PQ Dr. Yves Hebert 514.524.1001 Dr. Francois Laplante 514.285.5500 Dr. Elise Bernier 819.822.2555 Vancouver, BC Dr. Jean Carruthers 604.730.6062 Dr. Alastair Carruthers 604.714.0222 Dr. Robert Thompson 604.681.5158 Dr. Andrew Denton 604.879.4949 Dr. Nancy Van Laeken 604.669.1623	The following offer most or all of the FLA treatments discussed here: Burlington, ON Dr. Otto Weiglein 905.634.5573 Toronto, ON Dr. Frank Beninger 416.925.5775 Dr. Sean Rice 416.391.4048 Calgary, AB Dr. Wayne Perron 403.228.7076 Montreal, PQ Dr. Yves Hebert 514.524.1001 Dr. Francois Laplante 514.285.5500 Dr. Elise Bernier 819.822.2555 Vancouver, BC Dr. Jean Carruthers 604.730.6062 Dr. Alastair Carruthers 604.714.0222 Dr. Robert Thompson 604.681.5158 Dr. Andrew Denton 604.879.4949 Dr. Nancy Van Laeken 604.669.1623	The following offer most or all of the FLA treatments discussed here: Burlington, ON Dr. Otto Weiglein 905.634.5573 Toronto, ON Dr. Frank Beninger 416.925.5775 Dr. Sean Rice 416.391.4048 Calgary, AB Dr. Wayne Perron 403.228.7076 Montreal, PQ Dr. Yves Hebert 514.524.1001 Dr. Francois Laplante 514.285.5500 Dr. Elise Bernier 819.822.2555 Vancouver, BC Dr. Jean Carruthers 604.730.6062 Dr. Alastair Carruthers 604.714.0222 Dr. Robert Thompson 604.681.5158 Dr. Andrew Denton 604.879.4949 Dr. Nancy Van Laeken 604.669.1623	The following offer most or all of the FLA treatments discussed here: Burlington, ON Dr. Otto Weiglein 905.634.5573 Toronto, ON Dr. Frank Beninger 416.925.5775 Dr. Sean Rice 416.391.4048 Calgary, AB Dr. Wayne Perron 403.228.7076 Montreal, PQ Dr. Yves Hebert 514.524.1001 Dr. Francois Laplante 514.285.5500 Dr. Elise Bernier 819.822.2555 Vancouver, BC Dr. Jean Carruthers 604.730.6062 Dr. Alastair Carruthers 604.714.0222 Dr. Robert Thompson 604.681.5158 Dr. Andrew Denton 604.879.4949 Dr. Nancy Van Laeken 604.669.1623

Sources:

Zimmermann, U.S. and T.J. Clerici, The histological aspects of fillers complications. Semin Cutan Med Surg, 2004. 23(4): p. 241-50.
Valantin, M.A., et al., Polylactic acid implants (New-Fill) to correct facial lipoatrophy in HIV-infected patients: results of the open-label study VEGA. Aids, 2003. 17(17): p. 2471-7.
Engelhard, P., Knies, M., Safety and efficacy of New-Fill (Polylactic acid) in the treatment of HIV-Associated Lipoatrophy of the face (HALF). in 14th Int Conf AIDS. 2002: Barcelona, Spain.
Lafaurie, M., Dolivo, M, Boulu, D, Finel, H, Porcher, R, Madelaine, I, Furco, A, Pavie, J, Decastro, N, Molina, JM., Treatment of Facial Lipoatrophy with Injections of Polylactic Acid in HIV-infected Patients: Results from a Cohort of 94 Patients., in 11th Conf Retrovir Opportunistic Infect. 2004: San Francisco, CA.
Claoue, B.L. and P. Rabineau, The polyalkylimide gel: experience with Bio-Alcamid. Semin Cutan Med Surg, 2004. 23(4): p. 236-40.
Jones, D.H., et al., Highly purified 1000-cSt silicone oil for treatment of human immunodeficiency virus-associated facial lipoatrophy: an open pilot trial. Dermatol Surg, 2004. 30(10): p. 1279-86.
Moyle, G.J., et al., A randomized open-label study of immediate versus delayed polylactic acid injections for the cosmetic management of facial lipoatrophy in persons with HIV infection. HIV Med, 2004. 5(2): p. 82-7.
Burnouf, M., et al., Evaluation of Coleman lipostructure for treatment of facial lipoatrophy in patients with human immunodeficiency virus and parameters associated with the efficiency of this technique. Arch Dermatol, 2005. 141(10): p. 1220-4.
Lafaurie, M., et al., Treatment of facial lipoatrophy with intradermal injections of polylactic acid in HIV-infected patients. J Acquir Immune Defic Syndr, 2005. 38(4): p. 393-8.
Burgess, C.M. and R.M. Quiroga, Assessment of the safety and efficacy of poly-L-lactic acid for the treatment of HIV-associated facial lipoatrophy. J Am Acad Dermatol, 2005. 52(2): p. 233-9.
Guaraldi, G., et al., Facial lipohypertrophy in HIV-infected subjects who underwent autologous fat tissue transplantation. Clin Infect Dis, 2005. 40(2): p. e13-5.
Sutinen, J., Interventions for managing antiretroviral therapy-associated lipoatrophy. Curr Opin Infect Dis, 2005. 18(1): p. 25-33.
Pacini, S., et al., Bio-alcamid: a novelty for reconstructive and cosmetic surgery. Ital J Anat Embryol, 2002. 107(3): p. 209-14.
Love, A.a.L.C.C., Facial lipoatrophy as part of Lipodystrophy Syndrome secondary to HIV, in SurgiNews. 2004. p. 7-9.
MedicisAestheticsHoldingsInc. Restylane - Efficacy. 2005 [cited 2005 November 17th, 2005]; Available from: http://www.restylaneusa.com/hcarepros_efficacy.asp.
Face Forward Foundation. 2005. http://www.faceforward.ca.
Medical Procedure Financing Company Medicard. 2005. http://www.medicard.com/