The Positive Side

Spring 2008 

Happy Birthday Handsome

Losing your looks to HIV can be devastating psychologically and emotionally. After a long time in denial, Derek Thaczuk decided to give himself the ultimate birthday present: reconstruction surgery for lipo. Here, he shares the details.


I SPENT A LOT OF TIME convincing myself that reconstruction surgery for lipo wasn’t that important, that I didn’t need it. So many other HIV-positive people I know have gotten really sick or died, so I gauged how I looked against that. It was like, “Look, you’re a long-term survivor. You’ve made it through 14 years of this alive and well, so if your cheeks are a little sunken, just suck it up.”

And yet, every time I looked in the mirror, I would play with my face, pulling my cheeks back and imagining how I might look with the treatment. I’d see pictures of myself and think, “You walk around looking like that?” Plus my outspoken aunt told me I looked awful.

I knew a fair bit about reconstruction for lipo in an academic way. But one night I attended an ACT (AIDS Committee of Toronto) educational forum where Dr. Mona Loutfy from the Maple Leaf Clinic gave a talk on the subject. I got so much positive information about the practicalities of the procedure, the cost and the results that I decided then and there that reconstruction lipo was going to be my birthday present to myself.

Through Face Forward (a non-profit organization that helps people manage lipoatrophy as well as the emotional effects of HIV/AIDS) I was able to get a partial subsidy toward the cost of the procedure. We’re still talking thousands of dollars out of pocket, which is a lot for me and completely out of reach for many, I totally realize that. I don’t know what the upper limit on cost might work out to but it’s directly related to the severity of the lipoatrophy and how much filler is needed.

I had a total of four visits to Dr. Sammy Sliwin at Toronto’s Forest Hill Institute of Aesthetic Plastic Surgery: a preliminary assessment, the actual procedure and two follow-ups. On the first day, he sat me down and quickly sketched a few lines on my face with a magic marker, showing where the filler would go: a lot in the temples, some in my cheeks. Then we booked the next visit.

The procedure itself took less than an hour. I made the mistake of driving. Don’t make that mistake! They couldn’t sedate me because of the driving and you definitely want that sedation.

The worst part of the entire procedure was the anesthesia. They use the needle from your nightmares (about the size of a hot dog). It’s filled with xylocaine that gets injected into about two dozen spots. I don’t want to scare anyone, but if you have a problem with needles, this is going to bother you. It’s a big scary needle, it hurts and it goes into your face.

I’m not sure why there wasn’t any preliminary freezing. My understanding is that sometimes you can use a topical gel to freeze the skin first. You might want to ask about that.

At first it hurt, but not too badly. I meditate and practice yoga, so I just kept breathing my way through it. But with each new shot, the pain felt a little worse and it started to, let’s say, damage my calm.

Luckily, that was the worst of it, and it was over in a few minutes. After the anesthetic, I was left to sit and numb out for about 20 minutes. When the doctor came back and I couldn’t feel him poke my cheeks, it was needle time again.

Now, from where I was sitting, this did not seem like a delicate procedure. It was more like pumping up my face like a bicycle tire. I’d sort of pictured this Zen thing with ambient music, a little fountain tinkling somewhere. In reality, not so much. I’m sure it was done with great precision and skill, but from the corner of my eye, I could see stabbing motions I decided I’d rather not see. I pretty much kept my eyes shut; I couldn’t feel a thing.

The procedure was over quickly; it didn’t even hurt when the anesthetic wore off a couple of hours later. But I looked ridiculous. I had huge chipmunk cheeks: puffed out, red and swollen. I actually did go in to work; I wanted to show people. There were mixed opinions on that! After about 20 minutes, people told me, “You’re all swollen, there’s blood and magic marker on your face. Please do us a favour and go home.”

At first the swelling went down quickly — but not completely. The whole process of “deflating” took a couple of months. That was longer than I’d expected, and there were times I thought, “uh-oh.” As it turned out, the doctor knew just what he was doing, but it would have been nice to know.

The two follow-up visits were both very quick — one after a month, another after three. Dr. Sliwin simply checked that there were no complications. (There weren’t. Five days of antibiotics following the procedure was a safeguard against infection.) And to make sure that I was happy with the results (I was) and whether I wanted anything else done (I didn’t).

I didn’t go in there to come out looking like Brad Pitt. I just wanted to look like myself again and now I do. I don’t think about my appearance like I used to; I don’t stand in the mirror and obsess. Just every once in a while I catch a glimpse and say, “Damn, I look good.” And I have no problem with that at all!

Now that the problem is fixed, I can admit how much it bothered me. I put a lot of time and effort into denying and minimizing the psychological impact of lipoatrophy. It’s there every time you look in a mirror.

Would I do it again? Absolutely, no question. Even if I had known exactly what I was in for. Again, I don’t want this to scare anyone off but you should certainly talk about the procedure first, ask questions and find out what you’re getting into, especially if you’re spooked by needles! I think I have a fairly good tolerance for stress and pain, and I got a bit rattled.

The cost — well, that’s something to be reckoned with. (My credit card took a while to recover.) But as far as I’m concerned, it was worth every penny. If you’re suffering from facial lipoatrophy and have the resources to do something about it, I’d say “Go for it.”

For information about lipoatrophy and its treatment, visit CATIE online or call 1.800.263.1638 and speak with an information educator.

Photograph: Nelson French

For more information

A Practical Guide to HIV Drug Side Effects

The Positive SideThe Lipo Files Fall 2003


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