As contemporary antiviral therapy provides patients who have HIV effective long-term management of their disease, the prevalence of HIV-associated lipoatrophy is increasing. Sculptra (injectable poly-L-lactic acid) is FDA approved for the treatment of HIV-associated lipoatrophy and has been shown to increase skin thickness for up to 2 years. The number of treatment sessions depends on the volume of deficiency to be treated. As is true for any cosmetic treatment, expectations must be carefully managed, especially considering the common need for multiple Sculptra treatments.