What would be best to get rid of the back roll at the bottom and the sacral fat pad? Lower body lift? Airsculpt? Lipo? (Photos)

If you are on a weight loss journey you may want to wait until you complete that before considering surgery as you may have improvement to the areas that bother you. If you do not want to wait you should have nice improvement of your contour with liposuction. It may not be completely smooth with liposuction alone, but if you are considering losing significant weight you should postpone skin removal surgery until after you are at your goal weight.

Ultrasonic liposuction combined with plasma skin tightening is an ideal treatment option for improving back rolls and skin laxity in the upper and mid-back area.

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.
Regarding your sacral fat pad, I suggest further liposuction; however, I also recommend using VASER to help liquefy the scar tissue and fat in this region. The vertical torsoplasty and horizontal torsoplasty should be performed under general anesthesia. The vertical and horizontal torsoplasty take about 4 and 5 hours to complete. Plan on a 2- to 3-week recovery. If your job entails heavy lifting, you should postpone returning to work by approximately 3 to 4 weeks. Drains are typically involved, but they are usually removed within 7 to 10 days after surgery. Your recovery position will be on your back to minimize tension on the incision. I hope that I have answered your questions regarding what to do with your back rolls in the middle of your back and your sacral fat pad.
If you have any further questions regarding vertical or horizontal torsoplasty, bra straplasty, or bra-plasty, please contact a specialist. Since the vertical and horizontal torsoplasty, or bra straplasty or bra-plasty is a big procedure, please seek an experienced, board-certified plastic surgeon with significant experience performing the vertical or horizontal torsoplasty. Do your research. Ensure they have performed numerous horizontal torsoplasty surgeries and have the before-and-after pictures to prove it. Carefully examine their before-and-after pictures and check their reviews on RealSelf. If you cannot find an experienced vertical or horizontal torsoplasty, bra straplasty, or bra-plasty plastic surgeon in your neighborhood, consider traveling out of state if you must. Sincerely, Dr. Katzen, MD, MBA (Aesthetic, Cosmetic, and Reconstructive Plastic Surgeon), President of the American Society of Bariatric Plastic Surgeons, certified by the American Board of Plastic Surgery, Fellow of the International Society of Aesthetic Plastic Surgery, and International College of Surgery and member of the American Society of Plastic Surgery, American Academy of Cosmetic Surgery and RealSelf Hall of Fame.)