Upperback liposuction (Photo)
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Doctor Answers 5
Lose weight first before getting a liposuction
Liposuction may help
Liposuction to this area can help lessen some of the fullness that you are unhappy with. Incisions for liposuction are very small and are often nearly invisible when healed. You will need to wear a compression garment for a few weeks after this procedure, but it can fit easily underneath clothing. I recommend a visit to a Board Certified plastic surgeon for a detailed consultation.
The importance of a correct diagnosis
In your case, your diagnosis is loose skin and not subcutaneous fat (the kind that can be removed with liposuction).
Further liposuction can make the skin appear even looser.
The two areas of greatest patient dissatisfaction after liposuction are the banana roll, or crease under the buttocks, and the back bra roll.
The back bra roll responds poorly to liposuction in general because it represents loose skin rather than subcutaneous fat (the kind of fat that can be removed with liposuction).
There are, of course, patients who are great candidates and have thick layers of fat in this area and do great with liposuction.
Still, this is an area I see more unhappy patients coming back for second opinions than just about anything else in my office (our practice is devoted almost exclusively to liposuction and fat transfer).
It is also a repeating theme on RealSelf.
When I consult a patient and make an assessment of how thick the fat layer is in the back bra roll, I first ask the patient to take one arm and stretch it straight up in the air.
I then ask them to take their other arm and reach around their chest and try to pinch the back bra roll (it takes a little bit of contorting).
Comparing the thickness of the fat layer with the arm in an upward versus downward position can be drastically different.
When assessing subcutaneous fat thickness by pinching the skin, it's important to remember we are grabbing two layers of skin and two layers of fat.
The skin on the back is the thickest on the body, almost a quarter inch thick.
That means if someone can pinch 1.5 inches, then half an inch of that is skin and one inch represents two layers of fat, so the true thickness of the fat layer is half an inch.
A better way to assess how much body fat we have below the skin is to take your finger and gently press until you feel the muscle layers below.
Another common misunderstanding is that the back bra roll skin fold or crease will disappear from liposuction. Skin creases form from skin attachments to the underlying muscle layer.
As the skin drops from gravity, these skin attachments hold up the skin, creating a crease.
Some women have skin folds or creases on their back. Some women do not.
Some women have skin folds just below their breasts. Some do not.
During a consultation, it is my responsibility to differentiate, make the correct diagnosis and give an honest explanation of what can be achieved with each procedure.
Finally, I would like to address liposuction before-and-after pictures posted by some providers.
People's body shapes can easily be manipulated by altering someone's position or posture while photographing them.
At times, providers will ask their patients to keep their arms down while the before pictures are taken and then ask the patients to hold their arms up in the after pictures.
This technique can give striking results even without surgery!
Using deceptive before-and-after pictures leads to many patients to be dissatisfied with their procedures.
Patients look at their results in comparison to before-and-after pictures and say, "Why don't I look like that?"
It not only gives the provider a bad reputation, which only hurts him or her in the end, but it also leaves the patients to believe their procedure was done incorrectly.
This perception is something the patient will carry with them for the rest of their life.
Patients end up seeking second opinions, sometimes having revisions that can lead to more frustration and confusion because results that were never possible in the first place cannot be delivered.
In my career, I have found the philosophy of "promise half and deliver twice" has served me well.
I apologize if my message has been long, drawn out and perhaps cynical, but we must all take responsibility for keeping the practice of medicine, including cosmetic surgery, reputable.
If you are still reading this, then I thank you for your time.
Best of luck,
Mats Hagstrom, M.D.
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The upper back excess tissue is made of thick skin, fibrous tissue and fat. Although liposuction can improve this area, the amount of improvement is often less than ideal and limited by the amount of fat. There is often additional improvement with the secondary scarring. You should seek consultations with Board certified Plastic surgeons to get an examination of area to get a better sense of the degree of improvement that can be achieved with liposuction alone.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.