back looks like close to what it did before - do I need another round of lipo? (Photos)

Very common complaint. Another round of lipo might make the smallest of differences, with you going through the same rollercoaster of happiness then disappointment. There are no skin tightening devices that will help. The cold hard truth is you need a posterior upper body lift, that will leave a transverse scar across your back at the bra line.

Dear Bright834458,
it is hard to tell for sure without an examination. If you are considering surgery, I would suggest you consult a board-certified plastic surgeon. Only after a thorough examination, you will get more information and recommendations.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Hello,
I'm sorry you haven't found satisfaction with your procedures.

The area beneath the bra strap and slightly below it is a skin problem not a fat problem.
Liposuction can help reduce some of the fullness and I have had patients who responded to a special technique of releasing that deep crease and flattening of the skin. If liposuction was not effective then a skin excision is required to flatten the area and will give you reliable results. There is no ability to completely prevent keloids but the scar can be treated with available modalities if a keloid starts to develop. Best of luck

You appear to have residual loose skin and Renuvion in that area could be very helpful an examination is needed to see if additional liposuction would be helpful or if it is just excess skin.

You may have some improvement with liposuction and J Plasma to tighten the skin. To best address skin laxity you would need to consider a bra line lift, but this would result in a scar across the back. I encourage you to visit with a board certified plastic surgeon to further discuss your options.

Dear Bright,
Your 1 month post-operative photo does show great results. Remember that there is some swelling still present in the tissues at that point that may have contributed to the "tighter" appearance then. The missing information here, that prevents any recommendation, is what has your weight done over the last year. Results would of course be dependent on weight fluctuations, in either direction. Finally, perhaps you should be wearing a larger circumference bra. The one you are using looks to be too tight and compressing your back tissues. Good luck!

Based on the posted photos in your history of keloids, which you have not substantiated, I would recommend additional Lipo with J plasma skin tight technique fee $5000. Best virtual consult with.

It looks to me like you have more of a skin laxity problem than a problem with fat distribution on your back.
Skin laxity often looks like excess subcutaneous fat.
Skin laxity worsen with age due to loss of skin elasticity.
I’m very careful to differentiate the difference between skin laxity and excess fat during in person consultations before scheduling surgery on all my patients.
To make a quality assessment we generally need a complete set of proper before and after pictures.
If you don’t have proper before, and after pictures and ask your surgeon to forward the pictures they took.
Did your surgeon mention that you had skin laxity on your back during your in person consultation?
Best,
Mats Hagstrom MD