Excess fat/fat roll. Can it look better by losing tons of weight? Or with surgery? (Photo)

Localized fat such as the bra or back rolls can improve with liposuction but the scalp rolls or head rolls, cannot be improved with body contouring. There are too many vessels or nerves here that can be damaged.  Surgery can be performed to remove the fold but this would leave a big scar.  You need a formal evaluation by an expert in body shaping and contouring to determine what is best. Traditional liposuction awake and smartliposuction are old methods and do very poorly for tightening skin or significant skin tightening or contouring.  Small problem areas can be improved slightly by these methods.  The best in body contouring not only removes fat with energy devices like VASER ultrasound but also internally heat the skin with radiofrequency devices such as J PLASMA/RENUVION, InMode BodyTite, ThermiRF to heat the under surface of the skin and tighten it at the same time as fat removal. These combinations are called 4D HIDEF VASER contouring and can only be done by a well-trained body contouring specialist. At the same time fat should be harvested, PRP and stem cells added and injected into muscles or indentations/cellulite to get body shaping and contouring.  This is known as a Brazilian Butt Lift when you inject the fat to the buttock for contouring and lifting, but fat can also be used in areas such as the chest/breast, arms/shoulders, calves and face. Cellulite should also be treated with cellfina, sculptra, subcision and/or fillers such as bellafill, renuva synthetic fat, or sculptra.  If skin is very loose before surgery then it will need to be removed such as lower abdominal skin (tummy tuck/abdominoplasty), breast skin (breast lift), arm skin (brachioplasty).  Overall you need a full assessment, but simple liposuction alone will not tighten skin and needs a combination of various methods -- fat removal, skin tightening, defining, fat grafting, skin removal -- to get the best in body contouring and body sculpting. Weight loss can sometimes improve the rolls on the back of the head, but often this is genetic and needs a surgical treatment which has the risk of scars.  Kybella can be tried if there is localized fat, but often this is more skin than fat.Please see an expert.  Best, Dr. Emer.

Patients will often ask if they should consider losing weight prior to surgery. The reality is that there is no ideal weight goal. I typically recommend that patients reach a stable weight at which they are happy prior to surgery.Liposuction should not be viewed as a weight loss option but rather a tool for fine tuning body contour once a patient has reached their "ideal" weight. Significant changes in weight post surgery (either +/-) can affect the final outcome. Ultimately, this will optimize your overall results. 
 As always, discuss your concerns with your board certified plastic surgeon (ABPS).