Hello and thank you for your question! In general, liposuction is a great procedure to remove stubborn fat cells and help to flatten, debulk, shape and contour different body regions including the "back bra roll" region. Everyone's body is different and the main layers of the anatomy that we see there are the skin, the subcutaneous (under the skin) fat, followed by your back muscle layer. Liposuction only removes the subcutaneous layer of fat cells and does not affect the muscle and only mildly affects the skin layer (the skin can contract/shrink up a very small amount on its own). In your case, there appears not only to be excess subcutaneous fat but also excess skin. Even the best liposuction procedure will still leave you loose skin and extra tissue in that region. There are skin-tightening adjuncts that can be added to liposuction such as Renuvion/Quantum which use radiofrequency energy to help promote greater skin contraction (30-50% in some cases). However, with severe skin excess/laxity, even getting an amazing 50% improvement in the skin will still leave you with loose/extra skin and tissue post operatively. In my opinion, only a surgical back lift, in which skin is physically excised and removed, will result in the "best" contour with the least amount of residual laxity. Of course, the trade off will be the scar (along the bra line), the risks/downtime. If those are unacceptable to you, then the best alternative would be the former suggestion of liposuction + RF skin tightening, which will leave behind very small scars and have a much faster recovery/downtime, but the trade off will be leaving behind some extra/loose skin. The next best step would be a consultation with a board certified plastic surgeon to review your case in its entirety and find whats right for you!