Shortly after the US Food and Drug Administration approved protease inhibitors for human immunodeficiency virus (HIV) therapy, clinicians began reporting unique changes in body fat distribution among treated patients. Lipodystrophy (fat loss in the face, arms, and legs) and lipohypertrophy (fat gain in the abdomen and back of the neck) accompanied elevated levels of triglycerides, cholesterol, and glucose. Rarer presentations of lipodystrophy include multiple lipomatoses and suprapubic fat pads. In this case series, Tierney and Hanke describe the dysmorphic features of the increase in neck circumference, or “bullfrog neck,” in patients with HIV lipodystrophy. Given the substantial effect on quality of life and the metabolic consequences, the authors deem further investigation into prevention and treatment of this condition essential.