Mark S. King

I'm Gonna Wipe That AIDS Right Off of My Face

Filed By Mark S. King | August 02, 2011 1:00 PM | comments

Filed in: Living
Tags: facial wasting, HIV/AIDS, lipodystrophy, radiesse

Several years ago, I told someone that I was HIV positive before I agreed to his invitation for a date. "Yeah, I know," he casually replied, and then he looked a little embarrassed, as if he shouldn't have said it. It was too late, of course; I knew exactly what he meant. He knew my HIV status because of the appearance of my face.

I was crestfallen and felt something close to shame - certainly embarrassment. Why is it that I can produce a blog, proudly march with HIV POSITIVE on my T-shirt in gay parades, and even write a book about coming of age during the dawn of AIDS - but I get upset if someone can tell I'm positive by how I look?

When I choose to disclose, privately or publicly, it's on my terms. I choose how and when to tell you. I want you to know. Facial wasting (known as lipodystrophy) takes that choice away. It's as if the disease is intruding, is taking the upper hand somehow, and worse, taking away my decision about when and to whom I disclose my status. And as much as I want to claim "Most Out Poz Guy Ever," I don't like wearing HIV across my face.

Most of us know "the look." It's the telltale gullies and sunken cheeks associated with longtime HIV infection or (more likely) medications (right). Many of my friends and colleagues in this struggle suffer from it, and they may either be comfortable with it, proud of it as a badge of honor, or simply resigned to it. I salute us all, whether our features tells our HIV story or not. But meanwhile, I'll do what I can to wipe that shit off my face.

Pierone.JPGA few years ago I visited Dr. Gerald Pierone in Vero Beach, Florida (regarded as the leading expert in fillers and one of the Ask the Experts team at TheBody.com), and I documented that first visit and my facial filler treatments in a video blog, Treating My Facial Wasting (right). In that video I focused on my own attitudes - Was I ashamed? Trying to look younger? Simply vain? - and on the procedure process itself. Nearly a year later I revisited Dr. Pierone and got another treatment and documented it in my video blog, A Facial Wasting Update.

In this video episode of My Fabulous Disease, I revisit Dr. Pierone for a new treatment with the facial filler products Sculptra and Radiesse. While I'm there, I learn enough about Artefill, the only FDA approved permanent facial filler, to make me strongly consider the product the next time my face needs fluffing.

This video also focuses on very specific information about the actual costs of facial filler treatment. Both Sculptra and Radiesse have patient assistance programs that significantly reduce the cost of the medication, but you still need to pay the physician to do the procedure, and that price can vary. TheBody.com has a great article that outlines all the facial filler choices and how much they cost.

Tip: Don't allow any street corner vendor (or gym or even doctor office) to inject stuff into your face. Do some research and above all, find a physician who has done this many, many times (over 500 would be a good start). Be a smart shopper and empowered patient and ask about their experience level first.

I hope you find the video helpful and that you aren't too afraid of needles!

In the meantime, my friends, please be well.


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Mark, thanks, as always, for your candid and honest and revealing communication of living with AIDS. Your piece explores that, despite our comfort with our own identities, we can still be knocked down by self-consciousness about our image.

I know that it is something I do at bars. I'll think to myself oh, well he has HIV, I can tell from his face. But it is always foolhardy. Not everyone with HIV has the wasting - some people just have skinny face.

Mark- are the fillers painful?

The injections were a lot more painful when Dr. Pierone used needles to inject each time. Now, as seen in this video blog, he uses a device that only requires one "stick" and then he reaches my whole face through that one hole. And since he mixes some anesthetic in with the product, I don't really feel much at all.

Dave Miller | August 2, 2011 2:56 PM

I'm genuinely glad there are remedies to help HIV+ people look and feel better about themselves, and you seem like a straight forward, nice guy. However, I've definitely had guys with visible facial wasting, in (ahem) a casual sex environment, trying to convince me that a condom wasn't necessary. No, I shouldn't waver on that front, and my decision shouldn't be swayed by someone's appearance of "health," but my worry isn't about the guy who discloses before going on a date. It's about the guy who doesn't tell you before having sex.

I used to have an HIV+ friend who liked to use online services to summon guys to blow him. I asked about disclosure or protection practices and he scolded me about taking away from the spontaneity. Those guys knew the risk was there, but my friend knew for sure.

There's probably more HIV virus per capita in a gay sex club than anywhere on the planet, so you're wise to use condoms and should probably forgo trying to judge someone's facial structure in the dark.

That said, in the interest of "risk reduction," I suppose we all use whatever visual clues we can collect. In the case of the suitor I mentioned earlier, he certainly pegged me correctly, but it didn't keep him from asking me out. We needed to take precautions and we did. And a good time was had by all.

Mark, I really appreciate you sharing this. There are so many PWA dealing with facial wasting and, yes, while they shouldn't be ashamed of being long term survivors, they only have one life and shouldn't have to justify to anyone why they don't feel the need to walk around with a 'scarlet A' on their foreheads.

And I'm sure there's a lot more of an emotional basis to to this need than... trying to 'trick guys into having unprotected sex.'