HIV-associated lipodystrophy is a frequent consequence of highly active antiretroviral therapy and has been associated with several metabolic disorders (increased triglycerides, hypercholesterolemia, insulin resistance) as well as altered fat distribution, including lipohypertrophy (neck, trunk, breasts) and lipoatrophy (nasolabial fold, cheek, extremities). Medical treatment of fat redistribution is usually ineffective. We evaluated the efficacy and safety of the surgical management of HIV lipodystrophy.
We performed a retrospective review of 12 consecutive patients (3 female, 9 male; mean age, 44.4 years; mean CD4+ cell count, 554/mm3; mean body mass index, 28.9 kg/m2; mean triglycerides, 421 mg/dL; no active opportunistic infections; mean duration of HIV infection, 11.4 years) who underwent surgical management of HIV lipodystrophy at a university hospital from 2001 to 2006.
Surgical intervention included a combination of ultrasonic-assisted liposuction (UAL) and suction-assisted lipectomy (SAL) of the anterior neck (7 patients), posterior neck (10 patients), and trunk (2 patients); direct excision of mastoid fat pads (1 patient); direct excision of thigh lipomata (1 patient); facelift/necklift (1 patient); browlift (1 patient); fat injections (1 patient); and blepharoplasty (2 patients). Mean lipoaspirate volume was 701 mL (range, 270–1400 mL). Complications and sequelae included seroma (1 patient), ecchymosis (1 patient), need for revision (2 patients), and recurrence (3 patients) but did not include nerve injury, fat necrosis, skin loss, or infection. Although all patients reported improvement in form and function, UAL/SAL of the anterior neck had limited efficacy in 3 of 7 patients. UAL/SAL of the cervicodorsal fat pad was initially successful in 10 of 10 patients, but 3 patients developed partial late (>1 year) recurrence, all associated with weight gain. Mean follow up was 30 months (range, 1–66 months).
Despite the potential for recurrence, surgical management of HIV-associated lipodystrophy is efficacious with minimal morbidity. UAL/SAL is particularly beneficial in reducing the cervicodorsal fat pad, whereas facelift and necklift may be necessary to adequately address anterior neck lipohypertrophy.
Twelve patients with HIV-associated lipodystrophy underwent correction with a mix of UAL/SAL, direct fat excision, face/neck/brow lift, blepharoplasty, and fat injection. Minor complications included 3 recurrences of the cervicodorsal fat pad that required retreatment.
From the Divisions of *Plastic and Reconstructive Surgery and †Infectious Disease, University of North Carolina, Chapel Hill, North Carolina.
Received September 15, 2006 and accepted for publication September 18, 2006.
Presented at the Annual Meeting of the Southeastern Society of Plastic and Reconstructive Surgeons, The Cloisters, Sea Island, GA, June 3–7, 2006.
Reprints: C. Scott Hultman, MD, FACS, Chief and Program Director, Associate Professor of Surgery, Division of Plastic and Reconstructive Surgery, Suite 7038 Burnett-Womack Building, CB#7195, University of North Carolina, Chapel Hill, NC 27599-7195. E-mail: firstname.lastname@example.org.