In my practice, I divide the back area into the "midback/bra line region" and the lower back/flank/"love handle" region. This page will concentrate on the midback/bra line region, although in many cases both areas are treated together.
As far as fat deposits are concerned, the back area develops less fullness than the other and more commonly requested portions of the torso, which are the abdomen (front side) and flanks (love handles). For this reason, sometimes we treat the lovehandles alone without treating the whole back. When the areas develop fat deposits and or rolls, we perform back liposuction.
The most common manifestation of back fat formation is a roll at the juncture of the lower back/flank region and the midback region back region.
If the roll formation is due to fibrous tissue attachments that divide fat accumulation below the fold and above the fold, each area may accumulate fat at a different rate, creating a multiple roll appearance. The rolls can often be improved, and sometimes even eliminated with liposuction or laser liposuction procedure. However, if there is loose skin, there may be some residual fat. If the back fat roll is small and early, flank liposuction with tapering into the area may suffice. Our back liposuction procedure can handle nearly every goal.
The fat in the back area is particularly resistant and difficult to treat. This is because the fat in that area is very "fibrous" which makes it much more attached to the body and therefore hard to extract. Liquefying the fat beforehand (via smartlipo or vaser), or using power assisted liposuction, will both help in the extraction process. positioning of the patient is also very important to allow thorough removal of the back fat. Over time, as I have migrated from traditional liposuction under anesthesia, to awake laser assisted liposuction, to have the patient fully cooperative and turn and twist the torso during the procedure to ensure my instruments can reach all the areas needing treatment. I have found the awake positioning particularly useful in that area, although I will also perform the procedure under general anesthesia if necessary. I have moved my incisions from the middle of the back, where they are more noticeable, to the posterior armpit, where they are less visible. I will also typically use a lower back/buttock junction single incision.
