Open neck lipectomy for patients with HIV-related cervical lipohypertrophy

The advent of effective antiviral medications has revolutionised the management of the HIV-infected patients. Although this has helped in achieving prolonged symptom control, high numbers of these patients are left with the stigmata of complications associated with the medication. Lipodystrophy, either as lipoatrophy or lipohypertrophy, is a known complication of long-term HIV infection and aggressive antiviral therapy, leading to significant physical and psychological morbidity in these patients.

Eleven patients demonstrating HIV-related anterolateral neck lipohypertrophy were offered the option of an open cervicoplasty involving pre- and subplatysma lipectomy, platysmaplasty, liposuction, and face-lift in selected patients.

The amount of adipose tissue excised from each patient was higher than that normally achieved through liposuction, with the highest total of 140 g in one patient. The degree of cervical contouring was significant, with all patients reporting profound satisfaction in terms of restoration of a cosmetically acceptable neck contour. Complications included two hematomas and one seroma. There was no incidence of infection.

Open anterior cervicoplasty with subplatysma contouring is a powerful tool for predictable and safe results and should be considered as one of the valuable treatment options for HIV-related anterolateral neck lipohypertrophy. Although the incidence of complications is higher than that for similar non-HIV patients, the degree of improvement it provided was perceived by patients as very rewarding.