Fat in these areas can be accessed through different incisions. My personal preference is to make a 2mm punch through the skin and not an incision. This heals almost without a trace. For the back I place a punch hole at the bra line in the midline, for the lower back at the superior fat pad area in the midline and at the top of the buttock cleavage. I can access both sides from these 2mm openings. I do not suture my punch holes, allows for drainage afterwards with less bruising, faster recovery. Fat is removed from between the skin and the underlying muscle fascia or cover. It is more difficult to have a surgical misadventure and injury to internal organs from the back as opposed to abdominal liposuction. Although these severe and at times fatal complications are rare, they are not unheard of (recent articles in USA Today). That is why it is very important to do your homework and seek a consultation with a board certified plastic surgeon and discuss these issues. Unfortunately, in the US ther's no law which restricts physiciands and surgeons to practice within their scope of practice (the things they went to school for and were trained in).