The Buffalo Hump deformity, also known as a dorsocervical fat accumulation, is known to occur from many different diagnoses. It most commonly occurs in HIV patients from the effects of the antiviral medications. But chronic steroid use and certain endocrine disorders can also create a similar type posterior neck deformity, marked by a large fat accumulation from the upper neck into the back. Why it occurs is unknown and the trigger for adipocyte growth and/or replication is as mysterious as fat resorption is in drug-induced lipoatrophy. Affecting men and women alike, the Buffalo Hump causes more than just a large aesthetic distraction and stigmatizing effect, but limits neck movement and often is uncomfortable.
Liposuction is the most common method used to treat the Buffalo Hump. It is preferable not so much because of not leaving a long vertical neck scar but because it avoids the unavoidable postoperative fluid collection that would result and recur repeatedly for some time. The quality of this dorsocervical fat can be more fibrous and is not ideally removed by traditional liposuction methods. Numerous power-assisted methods are available including ultrasonic, vaser, and laser. While there are advocates for each of these technologies, none of them can claim to be truly superior over another. In the right hands, any of these power liposuction methods will produce good results. I currently used laser-assisted liposuction and like the concept of introducing a certain level of heat into the operative field.
Liposuction of the Buffalo Hump is performed under a general anesthetic, in the prone position and with infiltration of a hunstad solution. This liquid infiltrate causes the fat to become swollen which allows the liposuction probe or cannula to travel more smoothly beneath the skin as the fat is removed. The laser probe liquefies fat and fibrous tissue so that it can be suctioned out after adequate treatment time (melting) is achieved.
Some critical questions about liposuction of the buffalo hump are how effective it is and how long do the results last. The answer to both are not etched in stone but enough clinical experience has been reported throughout the medical literature to provide some reasonable answers.
It is clear that reduction of the Buffalo Hump can be done with liposuction. Complete elimination does not consistently occur, however, and it is best to think of it as improvement rather than a complete cosmetic recontouring. How much reduction is achieved is undoubtably influenced by the liposuction technique used and the skill and experience of the surgeon performing it. The size of the hump also has an influence on how well it is reduced. The dorsocervical area is a very safe area to be aggressive with liposuction as there are no major nerves or blood vessels in the area. Coming around the side of the neck is a different story. In Madelung disease where the neck is often more involved, liposuction must be done much more conservatively as there are more vital structures in the field and its treatment areas may need to be staged to avoid near circumferential neck swelling.
Will the Buffalo Hump return after liposuction? One hint comes from the origin of the problem. If the source is not eliminated (e.g., drug therapy), then some patients will experience some relapse or return of it. Various clinical reports have shown that pre-treatment levels have returned in some patients. While not the majority of most series, the return rate is not insignificant however. Long-term follow-ups beyond a year have rarely been reported so no one knows for certain. Like most problems where the source has not been removed, the long-term reduction rates (greater than a year) are less glorious than those shown early. (6 months or less) Any patient undergoing the procedure should be aware of this possibility.
Postoperative infection rates in Buffalo Hump reductions seem to be higher than what one would expect from more commonly performed cosmetic body contouring. This is a reflection of the underlying medical conditions of the patients being treated and the liberal and extended use of antibiotics is prudent.
Barry L. Eppley, M.D., D.M.D.
Indianapolis, Indiana