Pan London Facial Lipoatrophy Service

What is NEW-Fill®?

New-Fill® is poly-L-lactic acid. Poly-L-lactic acid has been used safely in medicine and surgery for over 30 years. It encourages stimulation of the body’s own collagen. It is:

• Bio-compatible - it does not harm the body
• Bio-degradable - it is broken down and eliminated by the body [1]

New-Fill® is CE licensed and has been approved by NICE to use for Facial Lipoatrophy treatment since August 2004.

How does it work?

It is given by deep dermal injections. These are injected directly into the face which helps to restore facial appearance.

This has both an immediate and a delayed effect.

Your face will look fuller at the end of each treatment, which is due to the swelling where Poly-L-lactic acid is injected. This will go down within a few days.

Do not worry, this is normal and will be followed by the start of collagen production.

The delayed effect (collagen stimulation) usually takes place over several weeks and months after each treatment. New collagen production continues for several months after your final treatment.

Is it safe?

Data has shown it to be safe and effective in the correction of facial lipoatrophy [2].

Will it hurt?

The feeling can be uncomfortable more than painful. Ice packs or a local anaesthetic cream are applied prior to injecting to help reducing discomfort. In addition, a local anaesthetic is also injected with New-Fill®.

How long does an appointment take?

The initial visit can last up to 90 minutes. This will include photography, clinical assessment, consent and treatment. Each subsequent session will be around 60 minutes.

Photographs before and after your treatment are only for diagnostic purposes and to document your response to the treatment. Your photographs will be stored securely and cannot be deleted as they will form part of your health records. The Trust has a legal requirement to securely store your photographs and limit their access.

You can decline to give consent for photographs and this will not affect you having your treatment.

This will be fully discussed at your appointment.

How long will the effects last?

This depends on various factors; skin structure, degree of facial fat loss, lifestyle and the ageing process.

The improvements from New-Fill® may last up to 24 months [3].

What are the risks?

Immediate Risks

Pain/discomfort during and following the procedure, transient bleeding, erythema, swelling, skin itching (in the treated area) and bruising may occur during or shortly after the procedure. These are common risks (more than 1 in 20). These are usually temporary and resolve within a few days to 1 week.

Vascular occlusion (a blood vessel blockage) is a rare risk (fewer than 1 in 100) and a severe complication that could occur during or shortly after treatment. It is important to note that with experienced practitioners who are highly knowledgeable about facial anatomy and proper injection techniques, this remains a rare risk.

Early Risks

These risks may occur in the days after the treatment and might persist beyond the immediate post-procedure period. Papules, swelling or oedema, pain, infection/abscess, mass/induration (thickening and hardening of the skin), change in sensation, facial nerve paralysis and visual disturbance may persist beyond a few days. These are rare risk (fewer than 1 in 100).

Late Risks

These risks may occur in the months or years after the treatment. Discoloration at the injections site may occur. This is a less common risk (fewer than 1 in 20).

Nodules, inflammation, hypersensitivity, granuloma formation, deformity/scarring/atrophy (thinning of the skin) may occur. These are rare risks (fewer than 1 in 100).

All risks will be thoroughly discussed with you by your practitioner [4].

Please let your practitioner know if you suffer from any allergies or are taking Aspirin, NSAIDS (non -steroidal anti- inflammatory drugs) or anticoagulants (blood thinning agents).

Pregnancy The safety of Poly-L-lactic acid injections has not been studied in women who are pregnant or breastfeeding. If you think you may, be pregnant, please inform your practitioner.

What happens after my treatment has finished?

On completion of treatment, it is advisable that a period of up to 24 months pass before you access further treatment.

This will require a new referral from your referring clinician.

References:

[1]  Moyle, G. J., Lysakova, L., Brown, S., Sibtain, N., Healy, J., Priest, C. & Barton, S. E. (2004). 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 medicine, 5(2), 82-87.

[2]  Duracinsky, M., Leclercq, P., Herrmann, S., Christen, M.O., Dolivo, M., Goujard, C. and Chassany, O., 2014. Safety of poly-L-lactic acid (New-Fill®) in the treatment of facial lipoatrophy: a large observational study among HIV-positive patients. BMC Infectious Diseases, 14, pp.1-8.

[3]  (Bauer, U., & Graivier, M. H. (2011). Optimizing injectable poly-L-lactic acid administration for soft tissue augmentation: The rationale for three treatment sessions. The Canadian Journal of Plastic Surgery, 19(3), e22.).

[4]    How are the words ‘rare’ and ‘common’ defined for side effects? | Q and A | HIV i-Base accessed website 02/08/2024

Aftercare Tips

• Due to the local anaesthetic used, your face may feel numb for a short while after treatment. Please take care when eating or drinking hot substances
• Do not touch the treated area unnecessarily for first 12 hours
• Keep the treated area clean and dry
• Tenderness, discomfort, swelling and/or bruising may occur. An ice pack can be applied for a few minutes at a time during the first 24 hours to help reduce swelling. Avoid placing ice directly onto your skin by wrapping this in a clean cloth
• Massage is important and highly recommended in order to improve the breakdown of the product and thus stimulate collagen production. Massage twice a day for up to 5 minutes. When massaging use an appropriate fragrance-free cream to reduce friction (e.g. emollients)
• Do not apply any creams for 24 hours, other than those specified by your practitioner
• Do not apply make-up for 12 hours after treatment
• Whilst you are in the treatment phase, avoid exposure to UV light and use a sun protection of SPF50 or higher daily
• It is advisable to avoid the use of any Retinol A on your skin for 2 weeks before and after your treatment period
• Refrain from facial treatments such as eyebrow, eyelash or beard dyeing for at least a week each side of treatments
• Drink plenty of water (minimum of 2 litres) daily to maintain skin hydration

Facial Lipoatrophy (FLA) Service Contacts

If you need to cancel or change your appointment or wish to discuss any queries, you can reach us on:

Tel: 020 3315 6936 - Mob: 07586 554 536

Email: caw-tr.newfill@nhs.net

If you need to speak to someone urgently out of hours, please contact your GP or call 111.

If it is an emergency please call 999 or attend your local Emergency Department.

Patient Advice & Liaison Service (PALS)

If you have concerns or wish to give feedback about services, your care or treatment, you can contact the PALS office on the Ground Floor of the hospital just behind the main reception.

Alternatively, you can send us your comments or suggestions on one of our comment cards, available at the PALS office, or on a feedback form on our website Send us feedback — Chelsea and Westminster Hospital NHS Foundation Trust (chelwest.nhs.uk).

We value your opinion and invite you to provide us with feedback.

Chelsea Site:

T: 0203 315 6727
E: Chelwest.cwpals@nhs.net

West Middlesex Site: