Is deoxycholic acid (Kybella) effective for treating buffalo hump?

Deoxycholic Acid for Buffalo Hump Treatment

Deoxycholic acid (Kybella) is not recommended for treating buffalo hump as there is insufficient evidence supporting its efficacy and safety for this specific condition.

Current Evidence on Buffalo Hump Treatment

Buffalo hump, characterized by abnormal fat accumulation in the dorsocervical region, is often associated with lipodystrophy in patients with HIV or other metabolic conditions. While deoxycholic acid (Kybella) is FDA-approved for submental fat reduction, its use for buffalo hump is not supported by high-quality evidence.

Surgical Approaches

Surgical interventions remain the most documented treatment options for buffalo hump:

• Liposuction: Traditional surgical approach with documented long-term efficacy

  • Studies show favorable outcomes in 91.1% of cases using techniques like TARD (Tumescent anesthesia, sharp cannula release and multi-port liposuction) 1
  • Surgical treatment has demonstrated long-term favorable effects in the majority of patients continuing antiretroviral therapy 2

• Ultrasound-assisted liposuction: Particularly effective for recurrent or severely fibrous humps 3

Minimally Invasive Alternatives

Some minimally invasive approaches have been explored:

• Adipocitolitic aqueous micro-gelatinous solution injections: Case reports suggest potential efficacy with no relapse during follow-up 4

Risk Factors and Considerations

Buffalo hump etiology is likely multifactorial:

• Often associated with antiretroviral therapy in HIV patients 5
• May occur with metabolic disorders
• Can cause both aesthetic concerns and functional limitations

Treatment Algorithm

1. Confirm diagnosis and rule out other conditions:

   • Evaluate for underlying causes (HIV medication, metabolic disorders)
   • Consider imaging (ultrasonography or DEXA scan) to confirm fat accumulation

2. For mild to moderate buffalo hump:

   • Consider minimally invasive techniques like TARD 1
   • Benefits include minimal scarring and rapid recovery

3. For severe or fibrous buffalo hump:

   • Surgical intervention with liposuction or ultrasound-assisted liposuction 3
   • May consider autologous fat transfer from the buffalo hump to areas of lipoatrophy if present

4. Post-treatment management:

   • Regular follow-up to monitor for recurrence
   • Address underlying causes if possible (medication adjustments if appropriate)

Important Caveats

• Deoxycholic acid (Kybella): No high-quality evidence supports its use for buffalo hump treatment
• Recurrence risk: Buffalo hump may recur if underlying causes (like antiretroviral therapy) continue 2
• Potential complications: Transient numbness (reported in 26.7% of cases with TARD) 1
• Patient selection: Consider severity, fibrous content, and patient expectations when selecting treatment approach

While some innovative approaches are being explored, surgical intervention remains the most established treatment with documented long-term efficacy for buffalo hump deformity.