Lipohypertrophy - fat deposit under rib cage

Question

Hello Dr. Pierone: Briefly my story is that I contracted HIV in 1978, so have been poz now for 38 years. When meds that actually worked started coming on line in the late '90s, I thought the worst had passed. Then, around 2001 my weight dropped from 186 athletic pounds to 97 "walking death" pounds. Medi/Medi would not approve me for Serostim at that time. It took many months and all sorts of alternative treatments to strive back to around 150. Then I plummeted again, this time to 92 lbs. I finally got Serostim and have been using it ever since. But the damage had been done and it was hideous. My face looked like Freddy Krueger from Nightmare on Elm Street and I could only leave my home in the wee hours to grocery shop, shrouded in Winter scarves, shades, hats, anything to spare observers my gruesome deformity. But so, okay. Eventually my fortunes improved. I found a reputable doctor that accepted my insurance. He salvaged my face with micro-silicone injections. It felt strange to see who I actually was again. Later I had my butt repaired elsewhere, along with my thighs, biceps and pecs. It felt great. My mental state improved, it seemed like I had a whole new life. Then, last year I became immune to my HIV cocktail (Truvada and Isentress). Since I've been on so many regimens my doctor really had to search, and finally put me on Norvir, Intelence, Tivicay and Prezista. It's pretty nasty, compared to the Truvada, but my T-cells soared so I'm doing my best to somehow deal with the revolting medications. But a couple months later I started noticing a hard, embarrassing mass of fat, right under my rib cage. My doctor confirmed it it is Lipohypertrophy this time, but I don't know what to do to confront this latest assault? My doctor wasn't enthusiastic about possible treatments for weight loss, so I'm turning to you in desperation for some advice? Already my body is so saturated with fillers, I won't need to be embalmed when my time comes. I keep thinking of what a waste, all the effort I went to trying to look normal again. I can feel my MDD coming on again and I'm fighting hard not to let it in, but I'm seriously going into a frenzy of despair. I've already read that funding for research into the various "Lipo's" has been cut. Do you know if Liposuction is efficacious under these circumstances? Please help.

Answer

Thanks for sharing your story. I am sorry to hear about the latest challenge you are facing. Lipohypertrophy often involves the back of the neck, the so called "buffalo hump". But these odd fat deposits may occur in other sites as well. For example, I have seen them develop in the upper abdomen, sides of the chest, and just above the pubic bone.

You mentioned liposuction and this approach should work. Liposuction involves using a cannula inserted through a hole in the skin to suction out the unwanted fat (after instillation of lidocaine). This standard approach is safe and effective for removal of localized subcutaneous fat.

Another non-invasive technique that might be helpful is Cool Sculpting. This involves placement of an applicator to the region of unwanted fat and the area is frozen over the course of an hour or two. The area of frozen fat undergoes gradual resorption over the next couple of months. I have done several of these treatments for patients with HIV-related "buffalo humps" and it appears to work.

I hope that this information helps and best of luck to you!