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Importance: Facial lipoatrophy is a common problem among the Human Immunodeficiency Virus (HIV) population. With highly active antiretroviral therapy, these patients are able to delay the evolution of the disease and live many more years; however, more than half of them are faced with difficulties in their social and professional lives secondary to the physical changes of their faces. Observations: The majority of HIV-positive patients exhibit significant facial soft tissue loss, especially in the buccal fat pad resulting in accentuation of the malar eminence and the inferior orbital rim. Reconstruction has been performed with many temporary and permanent methods, but no single satisfactory procedure has been universally adopted. Conclusions and Relevance: We present a new method of addressing the resulting facial hollowing by tailoring a multi-layered e-PTFE sheet in a customized fashion to camouflage the specific atrophic areas in the face. Our patient demonstrated a significant improvement in both cosmesis and social reintegration. A detailed surgical description along with a review of the literature is reported.

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Endonasal surgery of the cranial base requires extensive training in anatomy and endoscopic techniques. A training model for simulation of endoscopic surgery of the paranasal sinuses and cranial base was developed that 1) replicates the surgical experience and 2) provides a measurable learning curve. METHOD: The anatomical model is generated from CT data and has bone generated from a 3D printer and silicone applied to recreate nasal soft tissue. Design requirements were surgical simulation with real surgical instruments and the objective detection of injured structures at risk (orbit, dura, internal carotid artery, and optic nerve). RESULTS: Using this teaching model, it is possible to demonstrate a learning curve and track the progress of a surgeon (duration of surgery, number and location of injuries). Anatomical and pathological variations can be introduced to provide a varied surgical experience. CONCLUSION: This model replicates the surgical experience and allows the surgeon to monitor the learning curve. The use of actual surgical instruments provides realistic haptic feedback. Future trials will demonstrate the contribution of surgical simulation on surgical proficiency in the operating room.