Ultrasound-Assisted Liposuction for Idiopathic Buffalo Hump: Anatomical Considerations and Technical Implications

Background: Posterior neck lipomatosis, commonly referred to as a buffalo hump, is characterized by abnormal accumulation of adipose and fibrofatty tissue in the dorsocervical region, leading to aesthetic deformity and functional discomfort. Ultrasound-assisted liposuction (UAL) has been widely used as a minimally invasive treatment option, particularly for fibrous adipose tissue; however, surgical outcomes may vary depending on regional anatomical characteristics. Methods: This retrospective observational study included five patients with idiopathic posterior neck lipomatosis who underwent UAL using a superwet infiltration technique. Liposuction was performed through three access ports, with initial deep-plane debulking followed by contour refinement. Postoperative outcomes were assessed based on clinical examination, standardized photographic documentation, and patient-reported satisfaction during follow-up. Results: The mean follow-up duration was 8.2 months (range, 7-10 months). All patients demonstrated visible improvement in dorsocervical contour following UAL. The mean volume of tumescent infiltration was 176 mL (range, 100-250 mL), and the mean lipoaspirate volume was 178 mL (range, 110-280 mL). Four patients achieved satisfactory contour improvement and reported high satisfaction. One patient exhibited residual dorsocervical prominence consistent with relative undercorrection, despite adequate aspiration volume and ultrasonic application. No major perioperative or postoperative complications were observed. Conclusions: Ultrasound-assisted liposuction appeared to provide favorable short-term contour improvement in this small series of idiopathic posterior neck lipomatosis. However, dense fibrous septation and deep fascial tethering in the dorsocervical region may limit complete correction in selected patients, even when aspiration volume and ultrasonic application are considered adequate. Recognition of these anatomical constraints may help refine surgical planning, improve preoperative counseling, and guide expectations regarding residual fullness.