Hi Surgery402 in Woodbridge, thank you for your question regarding whether you should get a back lift or back lipo. Thank you for your history and your pictures. Let’s analyze your pictures. You have excess middle and lower back skin and fat. I think if you just do back liposuction, you will be left with rolls of back skin. Therefore, my route vote is for a back lift or back reduction. Most plastic surgeons called the back lift a torsoplasty. There are two types of torsoplasties: vertical and horizontal. During a horizontal torsoplasty, an incision is made across your back. The incision is made so that the final back scar can be covered by a reasonable bra. Indeed, some plastic surgeons call a horizontal torsoplasty a bra-plasty, or a bra strap-plasty. During a horizontal torsoplasty, a large butterfly-shaped area of middle back skin and fat is eliminated. The middle and lower back are lifted and reduced. The horizontal torsoplasty would eliminate the rolls of skin in the middle back, lower back, and in your love handles. Alternatively, if you cannot live with the scar that goes across the back, you may consider a vertical torsoplasty. During a vertical torsoplasty, an incision is made from the armpit down your sides. During a vertical torsoplasty, a large, elliptical area of excess skin and fat is removed from each lateral torso (that means it’s removed from the area from your armpit to your hips). This means the vertical torsoplasty pulls your back skin to the side and eliminates your back skin and fat rolls. The benefit of the horizontal torsoplasty is that more back skin and fat can be removed than the vertical torsoplasty. The downside of the horizontal torsoplasty is that the scar is quite visible. The advantage of the vertical torsoplasty is that the scars are hidden when your arms are down by your side. Also, with a vertical torsoplasty, you get more of the waist line or hourglass shape when compared to the horizontal torsoplasty. The disadvantage of the vertical torsoplasty is that it does not remove as much skin and fat as the horizontal torsoplasty. Thank you for your question regarding whether you should get it a back lift or lipo. I hope you see why I would recommend a back lift. Good luck with your back liposuction or back lipo. Sincerely, Dr. Katzen.