A mother of 2 in her early 50’s who is bothered by laxity and rolls of the back around her bra area. She had a breast augmentation/ lift elsewhere 20 years before, and an abdominoplasty elsewhere 10 years before. She was seen by another plastic surgeon who had recommended liposuction but I did not feel that this was likely to be helpful in her specific case as the skin calipers showed just 3 cm of pinch in her back, the same as the skin thickness in her abdomen. This is a normal pinch and because this grasps a double layer of skin shows that the actual thickness of the skin and fat is just ½ that or 1.5 cm. Her issue is laxity of the skin, not excess fat and can be demonstrated by a “lift” maneuver. When the skin is manually lifted the rolls go away. The only way we know to reliably tighten loose skin is to take out a piece- in this case the incision is carefully hidden under the bra strap. A “bra-line back lift”. The results as seen here at just 6 week after surgery are dramatic. The scar will continue to fade over the next 2 years but is hidden under the bra. She is already thrilled with her new contour. EXPAREL was used at her request and she did need to take any narcotics after surgery. Tattoos are blurred for her privacy.