Lower Back Fat above Buttocks

What Lower Back Fat above the Buttocks Is

Lower back fat above the buttocks is the pad that sits on the lower back, over the sacrum, just above the upper glute. It is a central pad. It is not the fat on the side of the waist, and it is not the fold under the buttock. When that sacral pad is full, the lower back looks thick where it should narrow into the upper buttock.

People often give this pad the same name as the flank. The flank is the side fullness, the part that sticks out at the waist. The pad on this page is midline, along the sacrum. Treating the flank and leaving the sacral pad, or treating the sacral pad and calling it a flank, leaves the outline unfinished. The two deposits are marked separately.

The Banana Roll Is a Different Fold

The banana roll is the crescent of fat below the buttock crease, on the upper back of the thigh. It sits under the buttock, not above it. The sacral pad is on the other side of the glute, between the waist and the top of the buttock. Liposuction planned for one of those folds does not treat the other. A patient who points to the crease under the buttock is describing a banana roll. A patient who points to the pad over the sacrum is describing this lower back pad.

The two areas also behave differently when fat is removed. The sacral pad can be reduced to open the line between the lower back and the upper buttock. The banana roll is a support under the buttock, and aggressive removal there is a different operation from clearing the sacrum. This article is about the pad above the buttock.

Why Exercise Does Not Clear This Pad

Diet and exercise can lower overall body fat. They do not select the sacral pad. Spot reduction of this sacral pad is not how this deposit behaves. Strength work for the back and the glute changes muscle. It does not suction the fat that sits on the sacrum. A patient who is already active and still has this pad is the usual person who asks about surgery.

Liposuction for Lower Back Fat above the Buttocks

Liposuction removes the sacral fat. A small incision lets a cannula suction the pad. On the central lower back, that pad lies along the sacrum. Taking it down is what creates the central diamond: the lower back narrows, and the upper buttock reads as a separate curve instead of one continuous thickness.

For this pad, ultrasound-assisted liposuction is the tool used on the back. VASER liposuction loosens the fat before it is removed, which matters on the back because the fat there is fibrous. The same pass can include the flanks when they are marked, but the sacral pad is still its own zone. High definition liposuction of the back is the setting in which that central diamond is planned, not a general thinning of the whole trunk.

In the case above, the back was treated with VASER together with the abdomen, flanks, axilla, and neck, and fat was grafted to the buttock. The lower back portion of that plan is the sacral pad and the flank, not the banana roll. Swelling and bruising follow. For liposuction limited to this pad, early recovery is described as a few days to a week, with the swelling lasting longer than the first discomfort. Infection, bleeding, and uneven fat removal are the risks named for this suction.

Where Renuvion Fits after the Fat Is Gone

Renuvion does not remove this sacral pad. It is helium plasma and radiofrequency used under the skin after the fat has been suctioned, to tighten the skin that covered the pad. On the case above, Renuvion was used on the back and the flanks after the liposuction. The tighter skin is what lets the central diamond show. Renuvion used alone, with the sacral fat still in place, does not create that line.

Bruising, swelling, and soreness at the treated skin are expected after that tightening, just as they are after the liposuction. The skin tightening and the fat removal are two steps. Patients who want only the fat gone still need the suction. Patients whose skin will not redrape after the pad is gone are the ones who need the tightening added.

Who Is Considered for This Pad

The candidate has a localized sacral pad and is in good health. The fat has not gone away with weight change or training. Skin that can still lie flat after the fat is removed can be treated with liposuction, with Renuvion added when the skin needs help to tighten. A roll of extra skin, rather than a fat pad, is a different problem and is not solved by suction of the sacrum.

The waist is judged at the same time. Narrowing the waist by treating the flanks, while leaving the sacral pad, keeps a thick band just above the glute. Body contouring of the lower back means both marks are made before the cannula is chosen: flank, sacral pad, and, if it is present, the banana roll under the crease.

How the Sacral Pad Is Marked

Marks for lower back fat above the buttocks are made with the patient standing, seen from the back. The sacral pad is the fullness over the tailbone and the upper sacrum, between the posterior dimples and the top of the gluteal cleft. The flanks are marked out at the sides, where the waist would narrow. If a banana roll is present, it is marked below the crease and is left out of the sacral suction. A pad that looks central while the patient is prone can turn out to be a flank once the patient stands, so the marks are finished before positioning.

The central diamond is judged in that same standing view. After the pad is removed and the skin redrapes, the lower back should meet the upper buttock as a narrower point, not as a shelf of fat sitting on the glute. Full flanks hide that narrowing from the side. Skin that hangs after the fat is gone will not form the diamond from suction alone, and tightening is added for that skin.

What This Liposuction Does Not Do

Clearing lower back fat above the buttocks is not a buttock lift, and it does not replace a lower body lift. The case shown also had a lower body lift and a modified abdominal skin resection, because that patient had extra skin as well as fat. Those skin operations are separate from suction of the sacral pad. A patient whose only finding is the pad does not need the lift. A patient whose finding is hanging skin does not get a diamond from suction alone.

Grafting fat to the buttock, which was part of the same case, changes buttock volume. It is not the treatment for the sacral pad. The pad is removed. When a graft is used, it is placed in the buttock, not returned to the lower back. Mixing those two steps, by taking the sacral fat and then putting volume back above the crease, would rebuild the thickness the suction was meant to clear.

Back fat is held by denser fibrous tissue than abdominal fat. That is why ultrasound-assisted suction is used here. The cannula stays in the marked pad over the sacrum. It does not wander into the flank marks, and it does not cross the buttock crease. Crossing the crease is how a sacral plan becomes an unplanned treatment of the banana roll. Staying above the crease keeps the two areas apart.

Uneven removal is the contour risk on this small pad. If one side of the sacrum is taken further than the other, the narrowing tilts. The endpoint is a symmetric diamond, checked before the incisions are closed, rather than a maximum volume taken from whichever side is easier to reach.