Prior HIV lipodystrophy (LD) scales have been unidimensional, often combining changes of fat loss with fat accumulation with retinoid changes. Our objective was to determine the psychometric properties of a LD scale used in an outpatient LD subspecialty clinic at a university hospital HIV clinic. A patient and clinician self-administered LD scale was used to evaluate 107 patients referred to the Owen LD Clinic from March of 1999 to August of 2002. Sixteen measures of the LD syndrome were assessed on a severity scale ranging from 0 (none) to 3 (severe). SPSS was used to perform a reliability and factor analysis. A total of 150 paired patient and clinician assessments were performed. Thirty-one patients had repeat assessments. Reliability analysis of the patient and clinician self-administered LD scale revealed an alpha of 0.76 and 0.73, respectively. Factor analysis of patient self-assessment of LD identified 3 factors, which clustered in the following order: fat loss, fat accumulation, and retinoid changes. Factor analysis of clinician self-assessment of LD identified 4 factors. The first factor clustered around items of fat loss. A second cluster consisted of retinoid changes. The final 2 factors clustered around items consistent with fat accumulation. The patient and clinician self-administered Owen Clinic LD scale was found to be highly reliable and useful in the assessment of LD. Our analysis confirms clinical intuition that the evaluation of LD is a multidimensional construct and that 3 subscales may be used to evaluate dimensions of fat loss, fat accumulation, and retinoid changes.