Surgical Management of Dorsocervical Fibro-Lipodystrophy (Buffalo Hump): Systematic Review and Meta-Analysis

Background: Dorsocervical fibro-lipodystrophy, commonly known as “buffalo hump,” presents a challenging deformity often associated with HIV-related lipodystrophy or idiopathic etiologies. Although various surgical techniques have been reported, a comprehensive evaluation of their safety, efficacy, and recurrence rates remains lacking. This systematic review and meta-analysis aimed to evaluate outcomes of surgical interventions, particularly suction-assisted lipectomy, in managing dorsocervical fibro-lipodystrophy. Methods: A systematic review with meta-analysis was conducted using PubMed and ScienceDirect. Eligible studies reported surgical outcomes of dorsocervical fibro-lipodystrophy managed with suction-assisted or excisional lipectomy. Meta-analyses used a random-effects model, with heterogeneity and publication bias assessed. Sensitivity analysis was performed. Results: Twenty-two studies encompassing 218 patients were included. Most cases were associated with HIV-related lipodystrophy, and the average patient age was 47.4 years. Suction-assisted lipectomy was the most common approach. The pooled recurrence rate with liposuction was 10.6%, and revision procedures occurred in 15.3% of cases. Following sensitivity analysis, recurrence and revision rates decreased to 1.4% and 1.3%, respectively, with minimal heterogeneity. The pooled recurrence rate after excisional lipectomy and hybrid techniques was 0%. Reported complications included seroma, hematoma, wound dehiscence, and bacteremia, with higher rates observed in excisional or hybrid approaches. Methodological quality varied, with most studies scoring moderately. Conclusion: Suction-assisted lipectomy appears to be a safe and effective treatment for dorsocervical fibro-lipodystrophy, especially when performed with meticulous technique. However, the overall low quality of evidence underscores the need for prospective studies to optimize management strategies. Level of Evidence III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.