Rhytidectomy approach for recurrent Madelung disease

Benign symmetrical lipomatosis (Madelung disease) is a rare metabolic disorder characterized by the presence of multiple, symmetric, nonencapsulated fat masses in the face, neck, and shoulders. The clinical course is slow, typically one of slow progressive enlargement with cosmetic and functional sequelae. The authors describe a case in which an open surgical approach was performed to treat this disorder, with good results. There are many aspects of treatment currently lacking a consensus, and the authors discuss these, principally in relation to the location of the fat, the role of liposuction versus surgery, the staging of surgical procedures, and the placement of the incisions.