Late-appearing abscesses after injections of nonabsorbable hydrogel polymer for HIV-associated facial lipoatrophy.

Avariety of injectable fillers have been employed to correct the stigmatizing facial lipoatrophy associated with HIV infection. A novel filler is Bio-Alcamid (Bio-Alcamid, Polymekon, Milan, Italy), which has been described as an injectable ‘‘endoprosthesis.’’ This nonbiodegradable filler is composed of 96% water and 4% synthetic polymer polyalkylamide and is purported to be biologically inert. BioAlcamid is intended for large-volume augmentation as may be necessary in hemifacial lipoatrophy (Romberg’s disease) or HIV-associated lipoatrophy. Bio-Alcamid is intended for injection into the subcutaneous space in a bolus form. Fibroplasia ensues around the periphery of the balloon-like implant creating an injectable ‘‘prosthesis.’’ Recent reports have documented the success of Bio-Alcamid for the treatment of HIV facial lipoatrophy. We report a series of five patients who have received Bio-Alcamid for HIV associated lipoatrophy and who have developed late-appearing streptococcal bacterial abscesses. In all cases the abscesses resolved with incision and drainage and antibiotic therapy.