I had an enlargement of the dorsocervical fat pad starting in January of 2017, it increased at a rapid rate and my doctors at the time were concerned that it may be cancer, a tumor, or a cysts. I had an MRI and it turned out to be “fiberous fatty tissue”. So I started the process of physical therapy as I wasn’t even able to move my neck without pain and was limited to 10/15 ROM on each side with my right side being worse. I do have cervical Dystonia and after multiple rounds of PT with no improvement, I did dry needling, as well as massage, nothing worked. I even lost weight and it actaually increased in size. I had labs done and everything came back fine (hormones, negative test for Cushing’s and cortisol was all normal, and I had never taken any steroids), my posture was perfect to the point of being painful and exhausting to be so erect all day - but still the hump on my neck and pain increased and my ROM decreased. I eventually decided because of stenosis in my C-spine to undergo a diagnostic and then theraputic cervical ESI (epidural) and nerve block all within a months time. It relieved a bit of pain but not much. The hump didn’t change. I remained in pain and in PT as months went by. I started to seek out my last resort - surgical removal. I was just starting that process when I relocated to San Francisco. I started more PT and treatments for my cervical Dystonia with no change in the dorsocervical fat pad and related pain. I was frustrated and constantly in pain with even more treatments (scrapping, manual PT and exercises, braces, you name it) and I had enough. I knew this was medically necessary to have this removed after speaking to my PCP I was referred to Dr. Hoffman. Dr. Hoffman is a really sweet man who cares about his patients greatly. He is very busy andnit took me quite some time to get into see him (about 3 months) and for a surgical date (about 4 months after my consult)! I honestly couldn’t wait. By the time Inwas ready for surgery I could hardly move my neck, couldn’t put my head down, or head back at all. It was so disabling for someone as young as I was. I had liposuction done 9 days ago on the dorsocervical fat pad (aka Buffalo Hump) and it really was a dramatic difference. I have a horrible sensitivity to adhesive so even if it were something offered to most patients - I’d have more complications and scarring if they used it so they didn’t but I did have a foam square placed on top of the site. My surgery start time was a bit late but it went well by all standards. After surgery at the PACU my pain was so bad that I ended up being admitted for two nights, and three days. I was in a ton of pain (possibly because of no compressions or just from having invasive surgery - I did go under general anesthesia), but I was medicated pretty heavily while there and I remained elevated in pain till the last few hours of my stay which was scary for me. I tried to take the recommended pain medication schedule the Pain Management doctors gave me (4mg Dilaudid for the first 4 days then scale to 2mg for 3 more days) but the frequency was too much for my system so I just cut it out all together. The Pain Management docs also started me on Advil and Tylenol on my last day of my stay and told me to also take that for the next 2 weeks or so. I was in still a moderate amount of pain. It’s been 10 days and I am still in pain though aside two doses of 1mg of Dilaudid and the regular schedule of Tylenol and Advil, I haven’t taken any meds for the pain. I have a lot of sharp hot poker feeling in between my shoulder blades and most of my neck is sore or totally numb. I wasn’t really expecting this but I can finally move my neck 95% freely than before with NO pain and full ROM. That in itself is just a blessing. I deducted 1 star for the complications and post op care (my discharge paperwork was a mess and I was very confused) and also for his office staff which was a mix of very helpful and not at all helpful and a bit abrasive at times. Medical billing and coding was an issue for my initial visit and I’ve already seen the claim come in for two of the bills which prior to insurance adjustments totaled over $62,000 (without the hospital stay). So I really hope I don’t have to hassle with my insurance or the hospital billing dept due to lazy paperwork which has been pointed out on other review sites to be a real issue with his staff. I go in for my suture removal in a few days and I am eager to see what he thinks and learn exactly what he did and what was removed since nobody had access to those notes while I was at UCSF. Dr. Hoffman is a kind man, he does great work, my scars are so minor (pre suture removal of course) and I have NO bruising whatsoever. Am I sore? Yes! Very! I’m in pain. I’m also only 10 days post op. So swelling and pain is to be expected. I would still HIGHLY recommend him. He’s great. Updated on 22 Aug 2018: Follow up went well. Dr. Hoffman is really great. Results are still about the same. No bruising but a lot of nerve pain (common 2.5 weeks post op) but I quit all pain meds and am just using normal meds I take for my cervical Dystonia. The fact I can actually take photos of my neck and back should assure people that I have much more ROM. I have some pain, yes, but it’s very limited to what I’ve had for the last couple of years. Medical bills so far are listed as still pending with insurance but are as follows: Anesthesia: $1885.00 - Amount billed $1401.40 - Allowed amount Surgical room & Post-Op Care: $61711.55 This amount is still pending but I believe as I posted before, the final bill after negotiated rate with insurance was about $42,000 but this amount included everything aside the anesthesiologist bill which is separate and shown above. I will cont. to update on progress. Actual cost of liposuction: $940 - Amount billed. This fee was denied and written off as the terms of the providers/hospitals agreement with my insurance, the provider/hospital did not comply with the prior authorization requirements. Patient bares no responsibility. I assume the total bill for the surgical room, post op care, PT, pain management etc. will be finalized soon. If it’s denied then it will likely go for medical review but I am very hopeful there won’t be any need. So far my out of pocket amount due was $0.00 Thankful for great insurance and amazing doctors. Updated on 30 Dec 2018: It been a few months and I’ve had another surgery since this one (vsg) and as I continue to lose more weight my neck looks amazing. Also my xrays at the spine clinic show HUGE improvement. So much so that my neurosurgeon wants to use me as a case study subject for patients with spinal stenosis who may also have enlarged fat pads that are not related to posture or genetics and used plastic surgery for a remedy. It’s amazing to know my health improving will help others as well. Dr. Hoffman is great and my follow up went perfect. I’m not sure if he would want me to come in at a 6mo mark but I’d be happy to if so. I walk with confidence and am so happy I had this done. Totally worth all the hoops I had to jump through for insurance to cover it in full. I am feeling great and neck is 100% better. Updated on 30 Dec 2018: Just so you can see the huge difference that has happened in my life thanks to this amazing doctor and his team.