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