Lipodystrophy is the abnormal distribution of fat in the body, either due to an increase (hypertrophy) or a decrease and absence (atrophy) of fat. Some forms can be hereditary and related to syndromes. But it can also be related to diseases like HIV and scleroderma. Lipodystrophy caused by the use of 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.

Diagnosis is mainly clinical. The investigation begins with generic 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 assessment 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-ray, ultrasound, densitometry, computed tomography, and magnetic resonance imaging can assist in the diagnosis.

Many systemic diseases associated with lipodystrophy require a multidisciplinary medical team, such as an infectious disease specialist for HIV carriers, and an endocrinologist for metabolic diseases.

Gynoid Lipodystrophy (LDG) – Popularly known as cellulite, LDG is a structural and inflammatory alteration of the subcutaneous tissue that causes modifications in the skin, leaving it with that wavy appearance of the epidermis, similar to an “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.

LDG can be treated with various procedures. These include 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 at the Sart Tilman University Hospital in Belgium, explains that continuous subcutaneous insulin infusion and injections of insulin analogues 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 applied does not occur 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 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, potentially combining a 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 to maintain a healthy lifestyle with good nutrition and daily physical activity.

For patients who present with lipoatrophy (significant fat reduction 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 a filler.

During the procedure, liposuction is performed on body parts with more accumulated fat such as the belly, back, or thighs. After treatment, this fat is grafted 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 post-operative 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 rebuild the self-esteem of these people, contributing to their well-being and quality of life. It's an issue that goes far beyond image.

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