The deep-plane facelift as a treatment modality for antiretroviral therapy induced cervicofacial lipodystrophy

PURPOSE Highly Active Anti Retroviral Therapy (HAART) has become an effective treatment modality to reduce HIV-infection to an undetectable viral load. These antiretroviral agents may, however, cause severe morbidity by inducing the syndrome of lipodystrophy. In the head and neck region antiretroviral agents generate an obtuse heavy neck in combination with an accelerated pattern of midfacial atrophy and ptosis. Modifying the antiretroviral therapy produces only limited improvement, therefore warranting a surgical approach. An extreme case of HAART-induced facial lipodystrophy is presented together with literature review to support the need for an extended surgical intervention in these patients. METHODS An overview of literature concerning the lipodystrophy effects of HAART and potential treatment modalities is carried out. This is illustrated with a case study of a 55-year old woman who received HAART therapy for 24 years and was particularly unhappy with her appearance due to cervical fat accumulation. Surgical technique and clinical results in this patient by means of deep-plane cervico-facial rhytidectomy including liposuction, subplatysmal lipectomy and platysma-digastric suspension are discussed. RESULTS The surgical technique has resulted in an aesthetically pleasing and predictable result with a quick recovery in this patient suffering from HAART-induced lipodystrophy. CONCLUSION The technique of deep-plane cervico-facial rhytidectomy including liposuction, subplatysmal lipectomy and platysma-digastric suspension is a valuable treatment modality in this patient group suffering from HAART-induced facial lipodystrophy. However, longitudinal studies of multiple subjects is required to assess stability of the outcome.