Back Fat Rolls or Back fat skin? Is there anything that can be done??? I've had liposuction before. (photos)

An exam would be required for me to determine if additional liposuction could resolve or lessen the rolls.  If not, a bra line back lift would be reasonable with the incision line hidden under your bra.  Kenneth Hughes, MD, Board Certified Plastic SurgeonLos Angeles, CA

Hello,Although the rolls are clear to see in your photo, a determination if there is more that can be done by liposuction would need an examination.  Be careful of doctors peddling expensive, high tech devices to woo you into thinking much 'skin tightening' can be achieved above what liposuction alone can do; there is no evidence of such.  You should visit doctors who can do more than just liposuction: ABPS certified/ASAPS member surgeons who specialize in body contouring. Best of luck!

I suggest seeing an expert this can be treated with liposuction and surgery if needed.  We also use internal tightening with thermiRF or J Plasma.  You need a combination approach for the best results.  Dr. Emer.

Thank you for your question. You will need it in person consultation to determine whether you have extra fat versus extra skin. If it is just fat, liposuction would be able to solve the issue. If you have extra skin,  an upper back lift would remove the excess skin.  I recommend finding a board-certified plastic surgeon in your area who is also a member of the American Society of aesthetic plastic surgeons for a consultation. Best of luck. 

Thanks for the question and photos.The back rolls are a combination of fat and tethered skin creases with attachments between the dermis of the skin and deeper tissues. Even with aggressive liposuction (not sure how aggressive yours was), the folds may not go away in most patients unless a deliberate and concerted effort is made to try to "release" them with the hope that they can be obliterated. Most commonly, the apparent depth of the fold can be reduced significantly by passing the liposuction cannula under the fold repeatedly to break up the attachments and also suctioning the rolls very aggressively. This does not mean the lines fully disappear but it helps make them more subtle. Different positions in surgery could impact the success of this also. Direct excision of the rolls, which is sometimes done in patients who have massive weight loss, is another option but does leave scars that may be wide/unsightly due to the thickness and tension on back skin. In a massive weight loss/postbariatric patient it may be worth the scars but this is less commonly true for thinner patients where the scars are hard to justify.

The anatomy of the back bra roll is poorly understood by many.
The folds or back bra rolls are a combination of a skin attachment on the mid  back at the lower part of the rib cage in conjunction with loose skin from the army being in the down position.
Some people genetically have more skin laxity than others.
It doesn't necessarily have to do with weight loss though it is more common in patients with had substantial weight loss or are a little older.
If you look in the mirror, stretch your arm over your head and pull the skin on your back tight you'll see the rolls will go away.
The shoulder is the most mobile joint on the body.
In order to have this flexibility the skin has to be able to compensate for the wide reach of the shoulder.
With the army in the down position with the skin is laxed just like the front of the abdomen is laxed  in a sitting position.
When the arm is put down the skin drops to the point of the skin attachment on the mid back in the fold or crease is formed.
With aggressive liposuction the fold can at times be eliminated completely but in patients with more extensive skin laxity to fold will still be present after liposuction.
For this to happen to liposuction has to be aggressive.
I perform these procedures with the patient laying on their side arms over their head with an incision at the back of the arm pit.
I perform liposuction with my patients awake avoiding General Anastasia.
This body position is more challenging when patients are under General Anastasia.
It is certainly possible to do a direct skin excision removing the back bra roll(rolls) but it leaves a highly visible scar.
The skin on the back is the thickest on the body and leaves some of the worst appearing scars.
The results from secondary liposuction varies greatly but are generally substantially less impressive than primary liposuction.
My practice is devoted exclusively to liposuction and fat transfer procedures.
I perform approximately 400 of these procedures per year.
75% of these are full abdomen including the back.
This week I liposuctioned seven backs(with other areas included as well)
I feel like I can speak with a certain level of authority when it comes to these procedures.
Based on your pictures and history I'm afraid to say there is no great procedure to take care of your concern.
Secondary liposuction results are highly dependent on how the first procedure was performed.
Direct skin excision is highly dependent on your sensitivity to having visible scars.
Best,
Mats Hagstrom M.D.