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.

Lower eyelid ectropion is commonly associated with anterior lamellar shortening after transcutaneous lower eyelid surgery; however, severe ectropion may also develop in older adults even in the absence of skin deficiency. We report a case of marked lower eyelid ectropion in a 78-year-old woman following orbital floor blowout fracture repair via a subciliary incision. Despite minimal anterior lamellar involvement, revision surgery revealed dense middle lamellar fibrosis resulting in significant vertical restriction of eyelid excursion. Targeted adhesiolysis at the level of the arcus marginalis, combined with lateral tarsal strip fixation, successfully restored eyelid position, with stable results maintained at 1-year follow-up. Notably, retrospective review of postoperative magnetic resonance imaging demonstrated an early preseptal hematoma followed by fibrotic changes in the septal region, providing radiologic correlation with the intraoperative findings. Although this case originated from reconstructive surgery, it delivers a cautionary message relevant to aesthetic lower eyelid procedures: in older adults undergoing subciliary incisions, postoperative hematoma may precipitate middle lamellar fibrosis and severe ectropion even without an anterior lamellar defect, underscoring the importance of meticulous hematoma prevention.