Hello, and thank you for your question regarding whether an extended tummy tuck, 360 liposuction, and J-Plasma will help with back rolls and loose skin. I appreciate your history and pictures. Based on your description, you have excess skin (cutis pleonasmus), loose skin (dermatochalasis), and excess fat (lipodystrophy) on your back, along with multiple back skin rolls and fat pockets. If you proceed with back liposuction alone, it will remove the fat, but it will not address the skin laxity. In fact, liposuction may make the back rolls appear worse by deflating the fat but leaving the excess skin behind. Even advanced liposuction techniques such as VASER or radio frequency-assisted liposuction (like J-Plasma) will not adequately tighten this degree of loose skin. The best surgical approach for treating back rolls and loose skin is either a horizontal torsoplasty or a vertical torsoplasty. A horizontal torsoplasty, also known as a bra strap plasty, involves an incision across the upper back, allowing for the removal of a large, butterfly-shaped area of skin and fat. This results in a smoother, flatter back. A vertical torsoplasty involves an incision from the armpit down the sides, removing an elliptical section of skin and fat. This technique hides the scar along the torso’s natural contour, but it may not provide as dramatic of a result as the horizontal torsoplasty. Unfortunately, an extended tummy tuck or even a 360 circumferential lower body lift will not remove back skin or back rolls. The extended tummy tuck extends to the hips but does not address the back. The 360 body lift lifts the buttocks and outer thighs but does not pull down the back skin. If your goal is to eliminate significant back rolls, I recommend discussing a horizontal torsoplasty (bra strap plasty) as part of your surgical plan. This procedure can be done simultaneously with an extended tummy tuck or a 360 circumferential lower body lift for the most comprehensive contouring. I hope this helps answer your question, and I wish you the best in achieving your desired results. Sincerely, Dr. Katzen, MD