Back Fat is the New Muffin Top

Why back fat appears as we age, and what to do about it — from good old healthy living to aesthetic treatments.

By Genevieve Monsma
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What's going on behind your back

In the mid-2000s, low-rise jeans plus post-pregnancy bodies provided a perfect storm for what was unaffectionately coined the muffin top: squishy, stretched skin that spilled over the top of our bootcut J Brands. More than a decade later, with our childbearing years winding down (or far in the rearview mirror), most of us have more or less come to terms with the mummy tummy — or invested in Pilates (or even lipo) to get rid of it. But another midsection indignity is likely to strike soon, if it not already: the lower back bulge: 

As we age, our fat gets redistributed, and not usually where we want it,” says Karen Horton, M.D., a San Francisco plastic surgeon. That means, just as we are losing fat in our faces, which can cause the skin there to sag, we gain it in other areas such as the lower back.

Why does it collect there?

“After menopause, women tend to store fat in a more typically-male pattern, known as the androgenic  body fat distribution,” explains Dr. Horton. “Before menopause, higher levels of estrogen and progesterone promoted a gynecoid  body fat distribution in the hips and thighs, but with fewer circulating female hormones, the fat starts to accumulate more in the midsection — like men.”

Hormone replacement may help to counteract the fat redistribution, says Dr. Horton, but she stresses that it would have to be done under the strict guidance of a doctor. (And, let’s be real: back fat is probably not a reason a reputable M.D. will approve hormone therapy.)

How to get rid of it

Other ways to counter lower-back fat accumulation include the usual tenets of healthy living: “Stay active, do weight-bearing exercise and cardio, get enough sleep, avoid too much negative stress and avoid unnecessary excess calories in desserts, alcohol, and too many carbohydrates,” says Dr. Horton. 

There are also several medical treatments that can help diminish lower-back bulge. On the noninvasive front, Dr. Horton has found success with CoolSculpting, which uses cold temperatures to target and injure fat cells, causing the body to flush out the damaged fat over the course of three months. “Patients usually get about a 25 percent improvement,” says Dr. Horton, who adds that areas may be treated more than once to accentuate the results (Note: There are other fat-injuring or dissolving devices, such as EmsculptTruSculpt and SculpSure, that can provide similar results).

On the surgical side, liposuction typically provides the most dramatic results, says Robert M Schwarcz, M.D., a Manhattan oculofacial cosmetic and reconstructive surgeon and associate clinical professor at Mount Sinai School of Medicine.Dr. Horton concurs, though she adds that not just any lipo will do the trick:

 “Back fat tends to be a whole different animal than the soft, squishy fat in the front of the body. Fat on the backside is firm and fibrous and usually requires ultrasound-assisted liposuction for effective removal.  This can require a trip to the operating room and general anesthesia,” she explains, adding that you can expect swelling and bruising for two to three weeks and will likely have to wear an abdominal binder under your clothes for about six weeks.  

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