Treatment Options for Dorsocervical Fat Pad
Surgical intervention through excisional lipectomy or liposuction is the most effective treatment for dorsocervical fat pad accumulation ("buffalo hump"), particularly when the condition causes functional limitations or significant cosmetic concerns.
Understanding Dorsocervical Fat Pad
The dorsocervical fat pad, commonly known as "buffalo hump," is a localized accumulation of fat in the upper back and neck region. It is particularly prevalent in:
- HIV-infected patients on antiretroviral therapy (especially those on protease inhibitors) 1
- Patients with lipodystrophy syndrome
- Some cases unrelated to specific medical conditions
Anatomically, the dorsocervical fat pad typically:
- Extends from the 3rd cervical vertebra to the 3rd thoracic vertebra
- Has average dimensions of approximately 114.5 mm in length, 89.2 mm in width, and 23.5 mm in thickness 2
- Consists of two layers of fat tissue 2
Diagnostic Assessment
Before initiating treatment, a thorough evaluation should include:
- Physical examination to assess the size and extent of the fat pad
- Evaluation for associated conditions (particularly in HIV patients)
- Ruling out Cushing's syndrome through appropriate testing (24-hour urinary free cortisol, overnight dexamethasone suppression test) 3
- Assessment of functional limitations (neck mobility, pain)
- Consideration of psychological impact and cosmetic concerns
Treatment Options
1. Surgical Interventions
Excisional Lipectomy:
- Complete surgical removal of the hypertrophied fat pad
- Suitable for larger accumulations
- Results in high patient satisfaction with low recurrence rates 4
- Typical specimen size averages 14 × 11 × 6 cm based on clinical experience 4
Liposuction:
- Ultrasonography-assisted liposuction is effective for removing the dorsocervical fat pad 5
- Less invasive than excisional lipectomy
- Particularly suitable for moderate-sized accumulations
- High satisfaction rates reported in clinical studies 2
2. Medical Management
For HIV-associated dorsocervical fat pad:
- Consider modification of antiretroviral therapy if possible
- Switching from protease inhibitors to integrase inhibitors may help prevent further accumulation 4
- Note that medication changes rarely reverse existing fat accumulation
3. Lifestyle Modifications
While lifestyle changes alone are unlikely to significantly reduce an established dorsocervical fat pad, they may help prevent progression:
- Regular exercise focusing on overall fat reduction
- Maintaining healthy weight
- Nutritional counseling
Treatment Selection Factors
The choice between treatment options should be based on:
Size and extent of the fat pad
- Larger accumulations (>5 cm thickness) may benefit more from excisional lipectomy
- Moderate accumulations may respond well to liposuction
Patient's underlying condition
- HIV status and current antiretroviral regimen
- Presence of other lipodystrophy manifestations
Functional impact
- Degree of neck mobility limitation
- Presence of pain or discomfort
Cosmetic concerns and psychological impact
- Patient's distress about appearance
- Impact on quality of life
Post-Treatment Considerations
- Follow-up monitoring for recurrence is recommended, particularly in HIV patients
- Continued management of underlying conditions
- Consideration of preventive measures to avoid recurrence
Clinical Outcomes
Studies show favorable outcomes with surgical interventions:
- In a cohort of HIV patients treated with excisional lipectomy, all patients reported satisfaction with results and no recurrence was observed during a median follow-up of 24 months 4
- Liposuction has demonstrated satisfactory outcomes in multiple studies 2, 5
The dorsocervical fat pad often coexists with other manifestations of lipodystrophy, such as pubic lipomas, particularly in obese individuals and those with HIV infection 6, suggesting a potential common pathogenesis that may inform treatment approaches.