Q: Dr. Eppley, I have three areas of concern physically. I have a buffalo hump frm HIV meds, relatively severe gynecomastia and belly fat also mostly from HIV meds. Those are in order of priority for me. Any experience with any or all of those? Is it possible to address all three? Is there chance of re-occurrence?
A: All three areas to which you are concerned are common sequelae from HIV medications, of which I have seen before. The neck and chest concerns can be surgically treated but the abdominal fat usually can not. Almost all of the belly fat that you see is located behind the abdominal muscles and around the organs. (intraperitoneal fat) That is why your belly most likely feels hard like a watermelon. This is surgically inaccessible fat. Only fat that is outside of the abdominal muscles (subcutaneous fat) can be treated by liposuction. Such fat location would make your belly feel much softer.
The buffalo hump deformity is commonly treated by either liposuction or direct excision. There are advantages and disadvantages to either approach. The simpler approach is liposuction although the fat in the buffalo hump tends to be more fibrofatty tissue than pure soft fat alone. This is why direct excision would produce a better result but creates a permanent scar down the middle of the hump afterwards. The gynecomastia is treated like any gynecomastia surgery using either liposuction with or without open excision.
I could provide more definitive answers if I saw pictures of the buffalo hump and your chest.
Recurrence of neck and chest fat can occur since the use of the medications (cause) is ongoing. But in most cases I have seen the results are fairly sustained.
Dr. Barry Eppley
Q: I have a very noticeable buffalo hump and I have tried the traditional liposuction and it didn’t work. I just recently tried smart lipo and the Doctor said the area was too fibrous and he could not get the laser probe in. He said that there was too much scar tissue. My neck is still swollen since this procedure was just attempted several weeks ago. Are there any other solutions to get this buffalo hump off of me?
A: When neither liposuction option will work, there is always the traditional method of excision for the buffalo hump neck deformity. This is actually more effective than liposuction in terms of the amount of reduction because the buffalo hump is a different form of fat that is not as easily removed due to its natural more fibrous composition. But there is the trade-off of a midline scar from the nape of the neck down into the upper back to do the procedure. The length of the scar would be no longer than the vertical height (length) of the buffalo hump. There will also be a need for a drain after surgery as the tendency to form fluid collections (seromas) after open excision is quite high.
While this approach may leave a scar, this may now be a good alternative given that two attempts at ‘non-scar’ liposuction has not worked. It is a matter of trading off one deformity for the other. You have to decide whether the scar is a better ‘problem’ than the buffalo hump.
Dr. Barry Eppley