What are the recommendations for surgery to treat a buffalo hump?

Surgical Management of Buffalo Hump

Liposuction is the recommended surgical treatment for buffalo hump, with long-term efficacy demonstrated in the majority of patients, even when continuing antiretroviral therapy. 1

Indications for Surgery

Surgery should be considered for patients experiencing:

• Considerable physical discomfort from the dorsocervical fat accumulation 1
• Significant psychological distress related to the cosmetic deformity 1
• Failure of medical management or inability to modify antiretroviral regimens 1

The buffalo hump represents a localized fat accumulation that is difficult to treat medically or by changes in drug regimens alone. 1

Surgical Technique

Liposuction Approach

• Liposuction is the primary surgical method for buffalo hump reduction 2
• This technique directly removes the accumulated dorsocervical fat pad 2
• The procedure can be performed while patients continue their antiretroviral therapy 1

Expected Outcomes

• Long-term favorable results occur in the majority of patients who continue antiretroviral therapy after surgery 1
• The surgical correction provides sustained improvement despite ongoing medication use 1

Alternative Non-Surgical Options

For patients who prefer minimally invasive approaches:

• Injection of adipocytolytic aqueous micro-gelatinous solution has been reported as an alternative treatment 3
• This technique showed no relapse during extended follow-up in case reports 3
• However, this represents emerging evidence with limited data compared to surgical liposuction 3

Important Clinical Context

Etiology Considerations

• Buffalo hump occurs in 1-2% of HIV patients (compared to 41% with general lipohypertrophy) 2
• The condition is not caused by hypercortisolism in HIV patients, despite the similar appearance to Cushing syndrome 4
• Development is not unique to protease inhibitor therapy and can occur with various antiretroviral regimens 4
• The mechanism involves regional abnormalities in lipogenesis and lipolysis, with significantly greater trunk fat accumulation compared to HIV-positive controls without buffalo hump 4

Key Caveat

• Relapses can occur due to continuation of antiretroviral therapy, though the majority of patients maintain long-term benefit 1
• Patients should be counseled that ongoing antiretroviral therapy may lead to recurrence, though this does not preclude surgical intervention 1