The back, especially in the female, tends to have pads of expanded fatty areas, not a diffuse thickening of the tissues as will most males. These areas are: infra scapular; posterior axillary; posterior waist; lumbo-sacral; and the buffalo hump at the upper central spine.

Liposuction of these pads will improve the general appearance of the back, the greatest benefit is in the patient who is otherwise reasonably slender save for the padded areas. Liposuction only removes the fat, it does not tighten the skin, and where there are very large deposits liposuction alone may not suffice.

Another issue comes from the removal of certain pads of fat, and not others. Fat deposition is rarely a solitary feature, and it is probable that if there is significant deposition in pads around the back, there will be similar pads elsewhere – dealing with only one part of the body may leave a sense of disproportion on incompleteness elsewhere – the reason for the “makeover.”

Lipoplasty of the buttocks is probably more demanding than any other area. What constitutes a desirable shape is very much a matter of judgment, and obviously the two buttocks are expected to look the same when the lipoplasty is completed. There are folds of fat to remove from the lower back above the buttocks and from the dependent lower aspect of the buttocks. Then the fat over the buttocks will be removed somewhat in keeping with the patient’s own view of how large she wishes them to be – there is remarkable variation of opinion on what is desirable.

The aspiration is performed through a metal tube (cannula) of a few mms diameter which is inserted through an incision no larger than needed, and moved moderately vigorously in the tissues to be removed. Fluid with local anesthetic and hemostatic epinephrine might be used as a preliminary to swell the tissues (tumescent lipoplasty) and the area might be warmed or energy otherwise applied to make the fat more fluid (laser, ultrasound, radio waves etc.). The aspiration is by a vacuum source attached to the cannula, or some surgeons use a syringe attached to it. There are power assisted cannulae with rotating tips to open the fatty tissues more effectively, with less physical effort, and perhaps more precisely.