DOCTORS OF INTEREST
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Treasure Coast Medical Report
virus’s catastrophic toll. They started
listening to and working with AIDS
activists and doctors, slashing the
normal five-to-seven years “trial to
market” times for drug approval
because of AIDS.
In 1994 a faint shimmer in the world
of AIDs turned into light at the end of
the tunnel. Triple therapy drugs were
developed. “We were able to get viral
levels to undetectable,” says Pierone.
“And that would lead to immune
systems rebuilding. The disease
transformed from universally fatal to a
controllable disease.”
At the height of the epidemic, Pierone
was the director of a 12-bed, HIV unit
at Indian River Hospital. In 1994 the
average census was 13.4 patients. “And
literally within two months of these
medications becoming approved, our
census dropped to two or three, and we
closed the unit. It was that dramatic,”
he says.
APPROACH CHANGES
Of the 15,527 reported AIDS cases
in the U.S. in 1985, 12,529 resulted in
deaths, an 81 percent death rate. By
1996 the dramatic rate of infection
had climbed to 581,429, but the death
rate had dropped to about 62 percent,
according to amfAR, the Foundation for
AIDS Research.
King remembers the early days of
those life-saving drug treatments and
their side effects. “Issues of vanity got
pushed aside for issues of mortality.”
Later, that thinking changed. “We
thought to ourselves, ‘If I’m going to
live for another twenty years, I’d like to
fix my face.’ We still have many longterm
survivors who bear those physical
side effects,” King says.
Around 2003 word spread through
the gay community of a dermal filler
available in France that could restore
shrunken facial features. It was known
as New-Fill. “If people had money, they
were flying to Paris and getting treated
for HIV facial wasting,” says Pierone.
A Miami doctor, Peter Engelhard,
went to Paris to learn the injection
techniques. He returned to his practice
and treated patients who would bring
in their own New-Fill product that they
had acquired through “buyers clubs”
cropping up in the U.S. “I learned about
him,” says Pierone, “and I sent my
patients to him.”
In August 2004 the FDA approved
the new poly-L-lactic acid dermal filler,
by then known as Sculptra, for use in
Daniel Pearce, shown prior to treatment on the left, was the first patient Pierone treated for lipoatrophy.
Pearce’s sunken cheeks resulted from a side effect of early HIV/AIDS drugs. The treatments gave
treating facial wasting. The treatments
required several injections over periods
of weeks and months. Pierone and his
patients were looking for a solution
closer to home to avoid the travel to
Miami. But local plastic surgeons and
dermatologists were not prepared to
endure, as Pierone refers to it, “the
pretty onerous paperwork” that the
FDA attached to Sculptra as a remedy
for lipoatrophy.
Pierone then asked Engelhard to teach
him the technique so he could treat his
patients in Vero and Fort Pierce. “I told
my wife, I’m going to Miami to learn
how to inject Sculptra, and she said,
‘Gerry, you don’t even put the cap on
the toothpaste, how in the world are you
going to inject people’s faces?’”
Daniel Pearce was his first guinea
pig. Engelhard and Pierone shared the
injection responsibilities. “He injected
half the face,” says Pierone, “showed
me how to do it, and I injected the
other half.”
Pearce’s results were dramatic. “The
first time I thought, ‘This is wonderful,’
my face was back to normal,” says
Pearce. But those effects would require
subsequent injections to sustain facial
fullness. “I didn’t feel like I was a dead
skeleton anymore. I had a face again, I
had cheeks, bones, and a jaw.”
By then Engelhard had experience
with the injection process and also
with patients’ reactions. Pierone was
unprepared for what happened next.
He heard Engelhard say to a patient,
“I’m going to give you the mirror now,
FACIAL REJUVENATION
it’s OK to cry.” Pierone remembers
being confused by the comment. “But,
as if on cue, the patient looked in the
mirror and broke into tears. And I
thought this is not a trivial thing, this is
a real big deal for people,” Pierone says.
The results for King were just as
dramatic. “It’s not about erasing part of
my identity. I’m proud of my identity
and that includes living with HIV, but
I also just want to be Mark. Dr. Pierone
has allowed me to just be Mark again,
and not Mark, that guy who looks like
he has AIDS.”
Even though Sculptra was FDA
approved only for lipoatrophy, many
physicians began using it “off-label” as
an aesthetics facial filler. Subsequently,
Pierone began to get requests from
his family and friends. “’What about
treating me?’” Pierone remembers them
asking. “’I’m getting older, my face
is getting thin.’” Thus, the genesis of
Pierone’s Facial Rejuvenation practice
that thrives in Vero today. “I’m thrilled
for him,” says King. “It just turns out
that this compassionate HIV physician
had a remarkable talent for doing this,
and doing it cosmetically. More power
to him.”
CLIENTS INVOLVED
The Aids Research and Treatment
Center of the Treasure Coast has
changed over the years and grown.
Through creative partnerships with
available federally-funded pharmacy
and treatment programs, there are
now two clinics, one in Fort Pierce and >>
Pearce a new look, shown at right.