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Dr. Barry Eppley

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Double Board-Certified Plastic
Surgeon Dr. Barry Eppley

Posts Tagged ‘back rolls’

The Braline Backlift For Removal Of Back Rolls

Monday, December 24th, 2012


One of the many evolutions in plastic surgery has been the tremendous expansion of excisional body contouring procedures. Spurned on by the prevalence of extreme weight loss patients, particularly those from bariatric surgery in which large segments of loose body skin develops, the need for innovative and expanded uses of body contouring have been developed. Many of these bariatric plastic surgery procedures are more like reconstructive surgeries than cosmetic surgery per se. As naturally happens in plastic surgery, what was once a reconstructive procedure soon finds some more cosmetic applications.

One of these areas is that of the back and the development of back rolls. Even in women of more normal weight, back rolls can develop from aging. They occur above or below the bra line. Women detest them and they are evident in clothes as visible rolls. Wearing a bra accentuates them and can make their rolled appearance even more evident. Unfortunately they can not be exercised off nor lost by any amount of weight loss.

A modified bariatric plastic surgery technique, known as a backlift, can be very effective at getting rid of these back rolls. This is not a liposuction method that removes fat as this is not the major tissue component of most backrolls. It is the excision of loose back skin with some underlying fat that is oriented along the bra line. In an excisional pattern that looks similar to the infinity symbol, horizontal elliptical skin segments are removed from both sides of the midline spine. The vertical level of the ellipses is so oriented that skin is equally removed above and below so that their closure will place the final scar inside the cover of the braline. It is important to mark the outlines of the bra that the patient typically wears before marking the pattern of the skin excisions.

With skin closure after the excisions, a formal backlift is achieved effacing the rolls caused by the loose skin. This produces a dramatic tightening of the back at the price of a horizontal scar line. It is important that the excisional patterns do not cross the skin overlying the spine as this tissue is much tighter than that on the sides and will produce significant scar widening and hypertrophy. Usually drains are not used for backlifts due to the tightness of the closure and the fact that the patient provides natural compression of the surgical site by laying on it.

Like all excisional skin procedures, the scar tradeoff for a backlift must be carefully considered. While in a bariatric surgery patient, these scar concerns are often well worth it given the amount of loose skin and body dysmorphia that exists. But in more weight appropriate patients, which aesthetic concern is more relevant (backroll vs scar) will differ for each patient and that decision is never clear (or relevant)to an outside observer.

The recovery from a backlift is fairly rapid and one can return to work in just a few weeks. It will be sore for sure and will take up to a month until one can return pain-free to all physical activities. The back scar will be red for a while and can take up to six months for the redness to fade to a white scar line.

Dr. Barry Eppley

Indianapolis, Indiana

Smartlipo of the Back – Flanks, Bra Rolls, and Neck Humps

Tuesday, May 12th, 2009

Liposuction of the back and its rolls, while not one of the top two or three areas of requested body contour changes, can produce some noticeable changes to one’s figure. When considering liposuction, the back can be divided into three main areas, the upper back or neck, the bra or back rolls, and the flanks or waistline area. Fat in the back area is uniquely different in that there is no deep compartment to it so liposuction has to be done going right up against the underside of the skin.
By far, the common back area to treat is the flanks or posterior waistline. In my Indianapolis plastic surgery practice, almost every tummy tuck that I do gets ‘wrap-around’ liposuction into the back. If not, many patients will end up with ‘muffin tops’ at the side and back. The goal here is to be as aggressive as possible since what you are after is an indentation at the waistline, particularly as it comes across the top of the iliac crest (hip). This area can have a surprising amount of fat that can be removed. It is also important to go back far enough near the lumbosacral area to avoid leaving a bulge back there.


Bra roll, or infra-scapular fat, is the undesired fat that bulges just under the bra strap. Women notice this particularly in clothes where it bulges out and is quite aesthetically bothersome for many. This area tends to bulge quite prominently when a tight bra is worn. When excessive fat accumulates in this area, a roll is created that can even appear as two rolls in some. Fat in this area is quite fibrous due to the connective tissue present to hold it into place. It is not as easily removed by liposuction as other ‘softer’ areas of fat.

Less commonly, a prominent buildup of fatty tissue can develop in the upper back. This can occur naturally in some patients but it is often part of some other medical condition such as chronic steroid use or as a result of anti-viral medications in HIV disease. This area is commonly referred to as the cervico-dorsal hump, or the buffalo hump. Liposuction of this fat, while also usually fibrous in nature, comes out fairly easily and good reduction in size can be obtained.


Liposuction of the back areas, while effective, is usually one of the more uncomfortable body areas after surgery. The combination of a fibrous-type fat which does not surrender easily and the constant exposure of the back to pressure and movement make discomfort inevitable for a while. For these reasons, I prefer the use of Smartlipo liposuction where the heat of the laser can help cut through the fat easier and helps with having less pain afterwards.


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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