The back is not spared from the extreme weight loss process. While skin may sag worse in the front (abdomen) after a lot of weight loss, sagging in the back occurs as well. It tends to not sag as much as other areas due to three factors: the thickness of back skin (one of the thickest in the body), the back skin has more attachments to the underlying tissues which hold it up better, and it was never expanded as much as the abdomen due to less fat initially. Back skin sag is usually a concern more in women than men due to the skin rolls that occur underneath the bra, being noticeable through certain types of clothing. These skin rolls frequently extend down to the side of the waistline and may consist of at least two distinct rolls in many patients.
A common misconception is that liposuction or fat removal will help tighten this loose sagging skin. Nothing can be further from the truth. Only removing the rolls themselves by cutting them out can make the back more flat and tighter.
Back lift surgery involves the removal of an elliptical (football-shaped) cutout of skin and its underlying attached fat. The cutout pattern and the final scar which results can be placed either in a horizontal or oblique orientation on the back. If done horizontally, the final scar will lie higher up within the bra line (ideally) so it can be fairly camouflaged. The back skin removal can also be oriented along the way the skin rolls fall in an oblique fashion. While the resultant back scars will be more obvious, this approach removes more skin and tightens the back better in my experience. Either way, a surprising amount of skin can be removed in a back lift.
Back lifts do not cause much discomfort and are often done in conjunction with other body contouring procedures. Like many body contouring operations, a drain will be placed in surgery to remove fluid from the space left under the skin after closure. These drains will need to stay about a week when the fluid output has dropped significantly.
Back lift surgery does produce scars but they usually heal surprisingly well compared to some other areas of the body. Back lifts are usually done as one of the last body contouring procedures as patient’s concerns about them are secondary to abdomen, breast, arm, and thigh skin issues.
Dr. Barry Eppley