Q: What is thought to be the risk—nowadays—for contracting HIV from topping?

Ben in Maine

A: I can’t give you an exact answer, but I can help you understand the relative risks involved in various exposures. There are three factors to consider, only one of which is affected by which position you’re in: Dose—How much virus is present in various locations in your HIV-positive partner during sex. A person not on treatment and with a very high serum viral load is going to have a lot of virus at different sites. We don’t actually measure viral load at different sites but use the serum viral load to tell us what the relative amount will be in, say, the rectal tissues. It will be higher in someone not on treatment (and maybe not even aware that they are positive), and it will be lower in someone on treatment. Exposure—This refers to how much surface area of mucous membranes (where the virus can enter the body) is exposed and to amount of time you are exposed. Since the opening of the urethra is relatively small, being a top entails less exposure than being a bottom. Resistance—This refers to your own resistance to HIV at the mucous membrane location of exposure. If you have an STD, for example (which you might not even realize), your body’s resistance to HIV is reduced. All other things being equal—the length of a sexual encounter, whether your immune system is compromised by another infection—your risk is considerably greater as a bottom than as a top. However, reduced risk is not the same thing as no risk. Unfortunately, we have seen many men test positive for HIV after unprotected sex; they often incorrectly assumed they did not need to use condoms if they only had sex as a top. I applaud you for wanting to be aware of risk factors in order to make educated decisions about your health. Please protect yourself, and get tested regularly, regardless of whether you are a top, a bottom or you switch it up. —RB

MR. BRIGHTEYES

Q: I feel like I’m starting to age around my eyes as opposed to other spots on my face. More lines keep creeping in, and my under-eye area is sagging more. What’s the most effective method to brighten them back up?
“Bright Eyes” via instinctmagazine.com

A: The area around the eyes is a common place for us to begin to show our age. The crows-feet become more pronounced, and the skin under the lower eyelid can become loose. For the wrinkling around the eyes, freezing the muscle with Botox or Dysport can make a big improvement. There is no downtime, and it can make you look five years younger. The effect lasts four to six months. For deep tear troughs, fillers like Restylane or Juvéderm can be placed to restore the volume our faces lose as we age. This treatment is also temporary, but will last up to a year. For loose skin, a fractional CO2 laser can be used to tighten that sagging undereye area. It will leave your under-eye area red for at least two weeks, so plan for that downtime. Finally, minor surgery can remove excess skin or bags under the eyes. It can remove the unwanted luggage you’ve collected there and restore a smooth appearance. —DR

DROP THE BAGGAGE

Q: I’ve recently lost about 35 pounds through diet and exercise and finally feel really good about my weight. Some of my formerly fat, saggy skin—not so much! Especially around my neck and chin area, I feel like it still makes me look heavy. Would a face-lift help with the excess skin?

Martin via instinctmagazine.com

A: Congratulations on losing weight! That is fantastic! Sadly, sometimes the skin does not snap back, but there are ways to deal with that. The least invasive treatments are the skin tightening devices. They are like lasers, and they use radiofrequency energy to tighten lax skin. The results are not fantastic but can make a subtle improvement. It requires four to six treatments, which can get expensive, but there is minimal downtime. More significant tightening can be accomplished with liposuction of the neck. This is done as an outpatient procedure and involves just a small incision under the chin. It directly removes excess fat and helps to tighten the skin under the neck to restore a more youthful jaw and neckline; recovery is two to three weeks. Finally, if your skin has serious loss of elasticity and liposuction will not treat the problem sufficiently, you may need a neck lift. This involves making an incision just in front of the earlobe and around the back of the ear. Through this incision, the neck muscles and skin are tightened. It is also an outpatient procedure, but the recovery is longer: three to five weeks. Consult with a board-certified plastic surgeon and get the skinny on how you can get your neck in shape like you’ve done for the rest of your body! —DR