Facelift as a novel surgical treatment for HIV-associated facial lipodystrophy: a case report and literature review

Human immunodeficiency virus (HIV)-associated lipodystrophy is a well-recognized complication of long-term antiretroviral therapy (ART), characterized by abnormal fat distribution. In the head and neck, it typically present as an obtuse heavy neck combined with accelerated midfacial atrophy, causing significant aesthetic concerns and psychosocial distress. Conventional treatments, including ART modifications, have limited effectiveness, and changes are often irreversible. We present a novel surgical approach, a modified facelift, to manage facial lipodystrophy in a 57-year-old HIV-positive man. Following unsuccessful non-surgical interventions, the facelift provided substantial aesthetic improvements and addressed functional concerns associated with coincidental Frey's syndrome. Postoperative recovery was uneventful, and at 6-month follow-up, the patient reported sustained aesthetic satisfaction and significant symptomatic improvement. This case demonstrates that a modified facelift is a promising low-morbidity surgical option for addressing complex facial lipodystrophy in HIV patients, offering durable cosmetic and functional outcomes where traditional methods have failed.