It’s only slightly less annoying than ‘muffin top’ or ‘belly bulge.’ Those rolls of fat that form on the back and overhang bra straps can be stubborn and unsightly. But when diet and exercise fail, there are options for eliminating back fat.

“In many individuals, back fat tends to be very resistant to weight loss, and some patients state that it is the absolutely last area improved with diet and exercise,” says Dr. Christian Prada, a plastic surgeon with St. Louis Cosmetic Surgery. “For these patients, power-assisted liposuction remains an excellent option for removing unwanted fat from the back, flank, bra-line, underarm and hips. It can easily be done with very small incisions either in an office setting, for small areas; or the operating room, for more extensive treatment.”

Prada notes that getting as close as possible to your ideal weight will help ensure the best outcome. In addition, patients who have liposuction can form new fat deposits in other areas, sometimes resulting in aesthetically unattractive contours. However, liposuction remains a standard approach to removing localized fat deposits that don’t respond to overall weight loss.

“When it comes to noninvasive procedures, I haven’t seen terrific results,” says Dr. Richard Moore, medical director of The Lifestyle Center. “The noninvasive tools just don’t destroy and remove the fat cells. The reason is the back area is so fibrous, and there’s a lot of connective tissue among those fat cells.”

Moore assesses patients and then recommends either Vaser Lipo, a form of liposuction that uses ultrasonic waves to break up and separate fat cells for removal, or what he refers to as ‘microliposculpture.’ “We use a small cannula and go in and remove the fat that way,” he says. “The skin is very thick in the upper and middle back area, and the small incisions heal a lot nicer than the larger incisions required with the Vaser.”

Regardless of the specific type of liposuction used, “most patients do choose to have liposuction to other areas of the body, and this may include the hips, abdomen, thighs, knees and arms,” Prada says. “Other patients may choose to have other additional body contouring procedures, such as an abdominoplasty, breast augmentation or facial rejuvenation.”

For those who don’t want liposuction, there are noninvasive options to try. For instance, Coolsculpting is a non-invasive treatment to permanently reduce fat, notes Avani Nayak of Avani Day Spa. “It works great on any ‘bulge’ areas, such as the rolls of fat on one’s back either on the love handle area or around the bra. There are no needles, no surgery, no downtime and the treatment takes an hour.”

Coolsculpting works by gathering the bothersome bulge and ‘freezing’ it at a temperature at which fat cannot survive, Nayak explains. “People will see up to a 30 percent reduction in fat in the area, and it is permanent.”

Eat right and exercise, and if all else fails, talk to a plastic surgeon to learn more about your options for banishing back fat.