Combining Underarm and Upper Back Liposuction for a Seamless Silhouette

By Dr. Thomas Su | August 20, 2025

Have you ever felt like your workouts are finally paying off, except for that persistent back bulge just under your bra strap?

Fat around the underarms and upper back is notoriously difficult to reduce. These areas store fat differently, often resist exercise, and tend to lose elasticity with age. That’s what makes them common sources of frustration, even for patients in great shape.

This blog explores how combining liposuction under the arms with upper back sculpting creates a more natural-looking transition. Instead of treating each zone in isolation, this approach supports smoother contours, better outcomes, and long-term satisfaction.

Why Underarm and Upper Back Fat Are So Difficult to Target

Fat around the underarms and upper back is influenced by more than lifestyle. A 2023 study led by Kurtzman et al. notes that axillary breast tissue affects 2–6% of women and 1–3% of men. These deposits may contain fat, glandular tissue, or even residual breast structures. They’re most visible along the axillary fold and bra line.

Fat in this region often clusters due to hormonal shifts and structural differences in the skin. Aging, posture, and poorly fitted bras can deepen these folds. 

What’s more, these areas don’t respond to exercise the way many patients hope. Spot reduction isn’t physiologically possible, and standard strength training only tones the underlying muscle, not the superficial fat or sagging skin above it.

How Does Liposuction Under the Arms Work?

Liposuction under the arms is a precise procedure that targets fat along the underarm crease, outer chest, and upper side of the torso. It’s performed using a cannula, typically just a few millimeters wide, that removes unwanted fat through suction. The technique works through tiny entry points, most around the size of a grain of rice.

Most surgeons use tumescent local anesthesia, which keeps patients awake but comfortable. This allows for quicker recovery and fewer risks compared to general anesthesia. It also makes real-time contouring possible in some advanced practices.

This type of liposuction is not intended for weight loss. It’s a sculpting method for patients at or near their goal weight who have pockets of fat that don’t improve through exercise. 

The Case for Treating Upper Back Fat Together

Treating the underarm without also addressing the upper back can leave patients with uneven results. The bra bulge is a continuation of the axillary zone. If fat is removed from only one area, the result may look abrupt or even draw more attention to the untreated folds nearby.

The posterior axillary fold, which often collects fat and loose skin, overlaps visually with the lower part of the scapula. For many patients, this area needs sculpting along with the underarm to restore a sense of symmetry and flow.

Clinical Study Insights

In the 2023 study by Kurtzman et al., patients with moderate to severe skin laxity benefited most when liposuction and excision were performed together. In some cases, surgeons removed as much as 208 mL of fat and 40 g of soft tissue per axilla. These procedures often included treatment of the bra line for contour continuity.

Advanced Techniques That Make a Difference

Some techniques go beyond traditional fat removal to help ensure a smoother finish.

At ArtLipo, we use microcannulas to allow for extremely fine incisions, around 2 mm in diameter. These usually fade into small freckles after healing. Unlike larger tools that risk uneven fat removal, microcannulas give the surgeon more control over shaping the underarm and back folds.

We also perform awake liposuction using our interactive lipo technique. Because patients remain conscious, they can flex their muscles during surgery. This helps our team identify anatomical boundaries in real time, which leads to more defined results, especially around the axillary and shoulder regions.

In cases where skin elasticity is limited, we may recommend Renuvion. This energy-based device supports moderate skin tightening by stimulating subdermal collagen. While not required for every patient, it’s a useful tool for maintaining smoothness after fat removal.

What to Expect From Recovery and Results

Most patients need one to two days of full rest after the procedure. We generally recommend taking at least a week off from work, especially if the job involves movement or travel. Compression garments are worn for two weeks, though some patients prefer to continue wearing them longer for added support.

Swelling tends to peak between days three and five, then gradually improves over the following months. Final results are most visible by the three-to-six-month mark. As swelling fades, patients often notice a more cohesive silhouette between the underarm and back area.

Experience the Artistry of Seamless Contouring

At ArtLipo, we believe liposuction under the arms should never stop at the edge of the triceps. We use a 360-degree approach that includes the bra bulge and upper back. It’s this comprehensive sculpting that sets our results apart.

Our Celebrity Arms™ procedure is exclusive to our practice. Combined with microcannula precision and awake liposuction, it allows us to achieve results that are both functionally effective and visually refined.

We walk every patient through preparation, recovery, and garment use to help them protect and enjoy their new silhouette. If you’re ready to explore what’s possible, schedule a free virtual consultation and begin your journey with our team.

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