Thank you for your question and for sharing your pictures. Based on the images, I strongly recommend a backlift, also known as horizontal torsoplasty. Given the presence of deep skin folds in your pictures, I don't believe liposuction alone, even with advanced methods such as J-Plasma, would yield satisfactory results. These techniques might not effectively address your skin rolls. In contrast, a backlift could offer a more permanent solution. During this procedure, an incision is made across the back, and the excess skin and fat are surgically removed, leading to a flatter, smoother contour. The procedure is typically performed under general anesthesia and takes about four hours. It usually requires the placement of drains on each side, which stay in place for about 10 days. Expect to refrain from heavy lifting and sit-down jobs for three to four weeks or more. During recovery, lying on your back will be ideal to help minimize swelling and optimize scar healing. I hope this helps answer your question regarding the need for a back lift. Sincerely, Dr. Katzen