Q: I am a 46 year-old male who has lived with HIV for over 20 years. Due to the medications I take, they have caused fat to collect under my jowlws and into my chin and neck area. I look like I have a small tire underneath my jawline that wraps around to the back of my neck. I want to see whether it could be removed by whatever means you see appropriate and safe. I’m going to forward several pictures to you for your viewing. Please let me know at your earliest convenience if you can help me.
A: Your pictures and your medical history show the classic HIV-related lipodystrophy that occurs in the head and neck area. A large tissue collection develops giving a bullneck appearance that is particularly large around the parotid gland and ears. While this is often thought of as just fat, the tissue composition is more of a fibrofatty growth which makes it more difficult to easily remove.
Treatment of this cervicofacial lipodystrophy can be done in one of two ways. Liposuction, specifically Smartlipo or laser liposuction, is the easiest approach to try and debulk some of the fat. How much can be reduced with this method of liposuction alone is difficult to predict and it does not come out as easily as regular fat that occurs by weight gain. The biggest risk with liposuction is that only a moderate change may result.To get the most amount of removal/debulking, an open approach can be used throughba facelift flap approach. This is the most effective method of cutting out the excess fibrofatty tissue but there are some real risks of facial nerve injury and after surgery fluid buildups. (drains are used for the first day or two)
These two approaches have their advantages and disadvantages and each has to be weighed carefully to balance the amount of improvement vs the risk of complications.
Dr. Barry Eppley