Is buffalo hump fat the perfect filler for facial wasting rehabilitation? Reflection on three cases

The development of effective antiretroviral therapies for the treatment of human immunodeficiency virus (HIV) has drastically changed the management of infected patients [1] with treatment methods now being similar to those of chronic disease rather than fatal illness. As rates of opportunistic infections and other conditions associated with immunodefi- ciency are minimized, patients are able to live longer with more fulfilling lives. However, these therapies are not without side effects, some of which can be very debilitating. One medication-associated condition that has become prevalent among HIV-infected patients is HIV-associated lipodystrophy, a syndrome characterized by abnormal fat metabolism and deposition [2]. Rates of lipodystrophy have been reported in 18–70% of patients taking protease inhibitors [3]. Clinically, the condition manifests as serum metabolic abnormalities and body fat redistribution characterized by both lipoatrophy in the face and extremities and lipohypertrophy in such areas ashe dorso-cervical region (buffalo hump deformity), lower abdomen, and breast (breast enlargement or gynecomastia). These physical manifestations of the condition can have a significant psychological impact on affected patients, both in serving as a visible reminder of the disease and in association with the social stigma of HIV infection [4]. The use of peripheral hypertrophied fat, harvested with cannulae, to restore hypotrophic areas, such as the face, theoretically seems the best option achievable; however, different results have been reported in the literature due to the different percentages of the transplanted fat resorption [5, 6]. We report three cases of facial wasting in HIV+ patients treated with structural fat graft harvested from different areas that showed different outcomes by ultrasonographic examinations.