Hello, and thank you for your question regarding a patch of fat on your lower back and could you get it removed with lipo? Thank you for your history and your pictures. Based on your pictures, you have an isolated area of fat in the lower sacral region above the vertical gluteal crease. Liposuction is ideal for isolated pockets of fat. Therefore, in your condition, since you have an isolated pocket of fat in the lower sacral region, this could be removed with liposuction. Low back / sacral liposuction can be done either in the office under local or twilight anesthesia or in the operating room under general anesthesia, depending on your comfort level. Recovery is approximately one week for low back / sacral liposuction. You will need to wear your compression garment for the six weeks to minimize swelling. Most plastic surgeons offer free virtual or in-office physical consultations. Therefore, explore what other plastic surgeons have to say. If you have any further questions about low back/sacral liposuction, please consult an experienced plastic surgeon. Please consult an experienced, board-certified plastic surgeon with a proven track record in liposuction. Ensure they have performed numerous liposuction 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 plastic surgeon in your area, consider traveling to another state. Sincerely, Dr. Katzen. ( Plastic Surgeon, President of the American Society of Bariatric Surgeons, certified by the American Board of Plastic Surgery, Fellow of the International Society of Aesthetic Plastic Surgery, American College of Surgery, and International College of Surgery and member of the American Society of Plastic Surgery, American Academy of Cosmetic Surgery, RealSelf Hall of Fame, and RealSelf Doctor Advisory Board for Medical Review and Consumer Panel.)