Lipodystrophy is the abnormal distribution of fat in the body, either due to an increase (hypertrophy) or decrease and absence (atrophy) of fat. Some forms can be hereditary and related to syndromes. But it can also be related to diseases such as HIV and scleroderma. Lipodystrophy caused by antiretroviral therapy is becoming increasingly frequent in all regions of the world, being one of the common disorders in patients infected with the HIV virus. In addition, other systemic and local medications (such as insulin and corticosteroids) can cause changes in fat deposition.

The diagnosis is mainly clinical. The investigation begins with general and specific questions to understand the patient's complaints and knowledge of their personal and family history. This way, it is possible to identify factors that favor its development and even hereditary and genetic conditions.

During the consultation, a complete body evaluation is important to characterize the abnormal fat distribution. Anthropometric measurements such as body mass index (BMI – ratio between weight and height) and complementary exams such as X-rays, ultrasounds, densitometry, computed tomography, and magnetic resonance can aid in diagnosis.

Many systemic diseases associated with lipodystrophy require a multidisciplinary medical team, such as an infectologist for HIV patients, and an endocrinologist for metabolic diseases.

Gynoid Lipodystrophy (GLD) – Popularly known as cellulite, GLD is a structural and inflammatory alteration of the subcutaneous tissue that causes changes in the skin, leaving it with that wavy appearance of the epidermis, similar to “orange peel” in some areas of the body. The problem affects up to 90% of female patients, practically at all stages of life, starting in puberty.

GLD can be treated with various procedures. Among them are liposuction, which can release the subcutaneous septa; lipolaser, which can loosen the septa and stimulate collagen; lipofilling, which consists of filling the subcutaneous tissue with fat, improving the appearance of depressions; and collagen biostimulators (Radiesse, Sculptra, Elleva, Ellanse), which improve the appearance by stimulating collagen production. The most important thing is to know when to use these options and combine them whenever possible!

Insulin lipodystrophy – The management of diabetes mellitus can be responsible for cutaneous adverse events, including lipodystrophy, which develop at the site of insulin injections.

An article from the Division of Diabetes, Nutrition and Metabolic Diseases, Department of Medicine, University Hospital Sart Tilman, in Belgium, explains that continuous subcutaneous insulin infusion and injections of insulin analogs with an altered amino acid sequence compared to native insulin can cause lipodystrophy in diabetic patients.

That is, when the rotation of areas where insulin is injected does not happen or when a needle is used multiple times, an abnormal distribution of fat occurs in that region. In addition to the appearance of nodules, swelling, and hardening of the skin, lipodystrophy also slows down insulin absorption by the body, thus being very harmful to diabetics.

In these cases, the recommendation is not to apply insulin to the region where the condition has already appeared and to alternate the injection sites within the chosen body area.

Trochanteric lipodystrophy – The one that bothers women the most, as the fat accumulation is located in the saddlebag region.

In this case, treatment may involve liposuction, dermolipectomies – surgical removal of excess skin, possibly combining gluteal lift and thigh lift – lymphatic drainage performed by a trusted professional of the surgeon, and dermatofunctional physiotherapy. It is worth remembering that a good way to prevent localized fat is by maintaining a healthy lifestyle with good nutrition and daily physical activities.

For patients who present with lipoatrophy (significant reduction of fat in the legs, arms, buttocks, and face), corrective treatment can be done through lipofilling – a plastic surgery technique that uses the body's own fat as filler.

During the procedure, liposuction is performed on parts of the body with more accumulated fat, such as the abdomen, back, or thighs. After treatment, this fat is injected into the desired region with fine needles. The procedure can even be done with local anesthesia, with or without sedation, and recovery is quite fast. The most common symptoms in the postoperative period are mild and controllable pain, slight discomfort, swelling, or hematoma.

The impacts caused by body deformities include depression, damage to social relationships, and poor acceptance of one's body image. “In this case, more than an aesthetic treatment, plastic surgery can help reconstruct the self-esteem of these people, contributing to their well-being and quality of life. It is an issue that goes far beyond image.

*Dr. Fernando Amato is a plastic surgeon, a full member of the Brazilian Society of Plastic Surgery, a member of the International Society of Aesthetic Plastic Surgery (ISAPS) and the American Society of Plastic Surgeons (ASPS).