Hello, LEVITATINGII in Charlotte, North Carolina. Thank you for your question regarding being 28 years old with lupus and type one diabetes and whether you need a back lift or lipo? Thank you for your history and your pictures. First, let's analyze your pictures. You have three rolls of fat on your torso's left and right sides. These areas of excess skin and fat must be treated with a torsoplasty. Because of the excess back skin, you will be left with skin rolls if only liposuction is performed. You would still have remaining skin rolls even if you use VASER liposuction with a skin tightening device (like radio frequency or Reneuvion). Therefore, most experienced board-certified plastic surgeons would recommend a torsoplasty. There are two types of torsoplasties, namely, a vertical and horizontal torsoplasty. During a vertical torsoplasty, an incision is made from the armpit down your sides through and past these three folds. A large elliptical area of skin and fat is removed from each side, and these back skin rolls are disrupted and eliminated. The vertical torsoplasty is called an hourglassing procedure because it leads to more of an hourglass figure after the surgery. Alternatively, you could have a horizontal torsoplasty. During a horizontal torsoplasty, a butterfly-shaped area of skin and fat is removed from the upper back. This type of procedure is also called a bra strap plasty or a braplasty because the incision is ideally hidden under the bra strap. Most plastic surgeons specializing in back lifts would recommend the horizontal torsoplasty or bra strap plasty because the horizontal torsoplasty would eliminate more skin than vertical torsoplasty. However, if you cannot cope with the scar across your back, consider a vertical torsoplasty. The vertical torsoplasty scar is usually hidden when your arms are by your side. As long as your diabetes is stable, and you are otherwise healthy and don't smoke, I think it would be a good candidate for either the vertical or the horizontal torsoplasty. Good luck. I hope I've answered your question regarding being 28 years old with lupus and type one diabetes and whether you need a back lift or lipo?