HIV-associated facial lipodystrophy, a frequent complication of long-term antiretroviral therapy (ART), is characterized by abnormal fat distribution in the face and neck. This condition, often presenting as midfacial hollowing and pronounced neck or parotid fullness, is not only a cosmetic issue but also a source of significant psychological distress and social stigma for affected individuals. According to Oxford Academic’s Journal of Surgical Case Reports, traditional treatments such as ART modification or non-surgical interventions often provide limited, temporary, or unsatisfactory results, especially once disfigurement is established.
A recent case report published in the Journal of Surgical Case Reports (September 2025) introduces a novel approach: the use of a modified facelift procedure to correct facial lipodystrophy in a 57-year-old HIV-positive man. The patient, who had been living with HIV since 1992 and on ART for over two decades, developed classic signs of facial lipodystrophy with additional symptoms of Frey’s syndrome (gustatory sweating).
Non-surgical options, including botulinum toxin injections and consideration of liposuction, proved ineffective or unsuitable due to risks like contour irregularity and neurovascular injury. Thus, the surgical team opted for a modified facelift combined with targeted neck liposuction. The procedure entailed standard facelift incisions, subcutaneous dissection, elevation and excision of the superficial musculoaponeurotic system (SMAS) over the parotids, and re-draping of facial tissues to achieve both aesthetic rejuvenation and functional improvement.
Post-operatively, the patient experienced an uncomplicated recovery. At the six-month follow-up, he reported high satisfaction with both the cosmetic outcome and a near-complete resolution of Frey’s syndrome. The only minor issue (a small standing cone at the scar) was scheduled for simple revision.
The article highlights that facial lipodystrophy in HIV is multifactorial, often persistent despite ART changes, and can have devastating psychosocial effects. It reviews the limitations of existing interventions: fillers provide only temporary relief, while traditional surgical approaches like facial liposuction risk complications due to the delicate and diffuse nature of facial fat compartments.
This case is notable as one of the first to showcase facelift surgery as a viable, low-morbidity option for HIV-associated facial lipodystrophy, especially when other treatments have failed. The facelift not only addressed the complex combination of midfacial atrophy and lower facial fullness but also treated coexisting symptoms of Frey’s syndrome by disrupting involved nerve pathways.
