Hello, and thank you for requesting information on what would be the best approach to address your back rolls at the bottom, as well as your sacral fat pad. Thank you for sharing your history and pictures. Upon analyzing your pictures, you appear to have excess skin and fat in the middle and lower third of your back. To remove skin on the back, the affected area has to be resected. Liposuction, even if you undergo it with VASER and Renuvion, will still leave you with excess back skin. Therefore, your back skin rolls need to be surgically removed. There are two surgical methods for removing back rolls. There is the vertical torsoplasty, and then there is the horizontal torsoplasty. During a vertical torsoplasty, an incision is made from the axilla (armpit) down the side of your chest and abdomen to the top of your hip bone. It is called a vertical torsoplasty because the incision is perpendicular or parallel to the floor. When your arms are held by your side, the scar is concealed. During the vertical torsoplasty surgery, a large elliptical area of skin and fat is removed from the armpit to the top of the hip bone. This is performed on both sides. The result is the elimination of your back skin rolls as well as the accentuation of an hourglass figure. Another alternative is a horizontal torsoplasty. A horizontal torsoplasty is also called a bra strap lift or a bra plasty. During a horizontal torsoplasty, an incision is made across the back underneath the bra strap line. After the initial incision is made, tissue dissection is carried down the back. After the dissection, a large butterfly-shaped area of skin and fat is removed from the back. The back rolls are permanently eliminated. Then, the lower back is pulled upward and sutured together. The eventual horizontal torsoplasty scar should be able to be concealed under a reasonable bra.
