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American Association of Plastic Surgeons
10. Surgical Algorithm for Treatment of HIV Lipodystrophy
Steven Davison, DDS, MD.
Georgetown University Medical Center, Washington, DC, USA.

The gold standard treatment of HIV disease, highly active antiviral therapy, may cause significant side effects such as facial lipoatrophy and lipodystrophy. Facial wasting or a buffalo hump deformity may be pathognomonic for treated HIV disease. In addition to facial wasting, cystic parotid degeneration may further distort the faces. We outline the defects as a series of triangles defined by anatomical boundaries. This study evaluates the treatment of HIV antiviral side effects to develop a surgical algorithm.
A retrospective clinical review of a series of HIV antiviral patients with side effects. Review includes clinical details, surgical operative reports, before and after photographs and complication rates.
A total of 21 patients were treated - 3 with buffalo hump deformities, 13 with buffalo hump and facial wasting and 5 for facial wasting alone. The 13 patients who both underwent liposuction and had the aspirate used for facial fill. Of this fat grafting 50% survived. Extra fat graft was frozen and successfully used to reaugment 8 patients. Recurrent or severely fibrous humps were treated with UAL in three patients. In five patients, autographs were utilized. Two patients who underwent gynecomastia resection had successful grafting with the resected breast. Two patients with cystic degeneration of the parotid underwent superficial parotidectomy with rotation or grafting of the parotid into the defect. These patients experienced profound improvements. One patient was treated with dermal fat graft. Complications were limited to a mild transient facial nerve weakness and a poor dermal fat graft scar.
We present an algorithm for treatment of buffalo hump and facial wasting deformities associated with HIV lipodystrophy syndrome, with an emphasis on long term results with autogenous tissue. It is supported with long term clinical follow-up of up to two years.

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