Plastic Surgery
Dr. Barry Eppley

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Case Study – Power-Assisted Liposuction Buffalo Hump Reduction


Background: The buffalo hump deformity is a well known collection of fat in the back of the neck. It is a seemingly unusual place to develop a fatty collection given that it is a body area that is associated with becoming ‘fat’. But there is a congenital fat pad in the upper back known as the dorsocervical fat pad and an increase in its size may be a sign of excessive weight, a symptom of some diseases or a drug side effect.

Drug side effects that are known to increase cause lipodystrophy of the dorsocervical fat pad, the most recognized of which are some AIDS-treating medications. The other much more used drug that causes this effect are steroids including prednisone. Through an induced redistribution effect fat is directed to accumulate in the dorsocervical fat pad.

The formation of an increased upper back fat  pad causes multiple aesthetic and functional symptoms. The aesthetic deformity is obvious even though it is on the back rather than in the front of the neck. A hump in the upper back is not natural nor aesthetically pleasing. Its mass effect also causes neck movement restrictions and discomfort. In some patients they complain about difficulty sleeping due to the mass on the back of their neck.

Case Study: This 50 year-old female had developed a modest buffalo hump after years of taking steroids for her pulmonary condition. (asthma) While she was able to get  off this medication, the fatty collection did not recede. While it was not as large as many buffalo humps, it was still aesthetically disturbing.

Under general anesthesia and in the prone position, the upper back/neck fat collection was treated with power-assisted liposuction. (PAL) This was done in a cross-tunneling technique, removing a total of 225cc of fatty aspirate.

Regardless of the cause, buffalo humps do not recede or go away even when its etiology is eliminated. Liposuction is preferred over open excision as it is just as effective and avoids the risk of serum formation.


1) Buffalo humps come in a variety of sizes and causes.

2) Long term steroid use is known to cause more modest buffalo hump deformities.

3) Power-assisted liposuction is an effective aspiration technology for the fibrofatty tissue of buffalo humps.

Dr. Barry Eppley

Indianapolis, Indiana

Dr. Barry EppleyDr. Barry Eppley

Dr. Barry Eppley is an extensively trained plastic and cosmetic surgeon with more than 20 years of surgical experience. He is both a licensed physician and dentist as well as double board-certified in both Plastic and Reconstructive Surgery and Oral and Maxillofacial Surgery. This training allows him to perform the most complex surgical procedures from cosmetic changes to the face and body to craniofacial surgery. Dr. Eppley has made extensive contributions to plastic surgery starting with the development of several advanced surgical techniques. He is a revered author, lecturer and educator in the field of plastic and cosmetic surgery.

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