Buffalo Hump in 2025: How GLP-1 Weight Loss Drugs Are Changing Who Gets It and What to Do

Patients come to me after months, sometimes years, of noticing a soft, rounded protrusion at the base of their neck and upper back. Some have mentioned it to their primary care doctor and been told it is just weight gain. Others have been fitted for posture braces or referred to a chiropractor. A few have Googled it late at night and found conflicting, often alarming, information. By the time they sit across from me, most of them just want a clear answer: what is this, why do I have it, and can it be treated?

The answer to all three questions is yes, there is a name for it, yes, there are known causes, and yes, buffalo hump treatment is available. But it requires a clinical process, not just a procedure.

“I am seeing this condition more frequently in my practice, and I believe part of that is the dramatic rise of GLP-1 receptor agonist medications like semaglutide (Ozempic, Wegovy) and tirzepatide (Mounjaro). These drugs have produced remarkable weight loss results for millions of patients. But rapid, significant weight loss does not always redistribute body fat uniformly, and the dorsal cervical fat pad is one of the areas where this becomes visually apparent. For some patients on GLP-1 medications, the buffalo hump either persists or becomes proportionally more prominent as the rest of the body slims down. This is a new and underreported clinical reality, and patients deserve a straightforward explanation of what is happening and what to do about it.”

Dr. Giselle Prado-Wright, MD | Medical Director, Exert BodySculpt

What Is a Buffalo Hump?

A buffalo hump, or dorsal cervical fat pad, is a soft tissue accumulation of adipose (fat) tissue at the base of the neck and upper back, roughly between the shoulder blades and below the cervical spine. It is not a bony protrusion. It is not structural. It is fat.

I want to be specific about this distinction because it matters enormously for treatment. A buffalo hump is frequently confused with a dowager’s hump, which is a forward curvature of the thoracic spine, often associated with osteoporosis or age-related postural changes. A dowager’s hump is skeletal. Correcting it requires orthopedic or chiropractic management, and in some cases, it cannot be reversed at all.

A true dorsal cervical fat pad is soft to the touch, moves with the tissue, and is entirely separate from the spine. In my clinical experience, even some well-meaning clinicians conflate these two presentations and send patients down the wrong treatment path. If your physician has told you the protrusion at the back of your neck is a spinal issue without any imaging to support that, it is worth getting a second opinion. Understanding which condition you have is the foundation of any effective treatment plan.

What Causes a Buffalo Hump?

This is what I spend the most time on with patients, because buffalo hump causes are not one-size-fits-all. There are three main categories, and the cause determines the treatment path. Cosmetic correction without identifying the root cause leads to inconsistent outcomes and, in some cases, can mask a serious underlying condition.

Hormonal Causes

The most clinically significant cause of a dorsal cervical fat pad is Cushing’s syndrome, a condition of excess cortisol, or hypercortisolism, in the body. Cortisol is a stress hormone produced by the adrenal glands. When cortisol levels are chronically elevated, whether from a tumor, adrenal dysfunction, or prolonged use of corticosteroid medications, the body redistributes fat in characteristic patterns: central weight gain, rounding of the face (sometimes called a “moon face”), and accumulation at the back of the neck. Cushing’s syndrome symptoms also include easy bruising, stretch marks, fatigue, and hypertension.

Metabolic Causes

Obesity, insulin resistance, and metabolic syndrome can produce a dorsal cervical fat pad as part of a broader pattern of central and upper-body fat distribution. In these cases, the fat pad is one piece of a larger metabolic picture. Patients often also carry excess fat in the abdomen, lower neck, and upper chest. Managing the metabolic root, through weight management, dietary changes, and in some cases medication, is the appropriate first intervention.

Medication-Induced Causes

Long-term antiretroviral therapy (ART) for HIV is the most extensively documented iatrogenic, meaning physician-caused or treatment-related, cause of buffalo hump. Certain older classes of HIV medications cause lipodystrophy, a condition of abnormal fat redistribution that can include dorsal cervical fat accumulation. This is a well-established side effect that has been studied for decades.

More recently, GLP-1 fat redistribution has emerged as a clinical observation worth monitoring. Patients on semaglutide or tirzepatide can experience uneven changes in fat distribution during rapid weight loss. The dorsal cervical fat pad is one area that does not always respond proportionally to overall fat reduction. I will address this in more detail in a dedicated section below.

The bottom line: before we discuss any treatment, we identify the cause. That is not a bureaucratic hurdle. It is how medicine should work.

When Should You See a Doctor?

If you have noticed a soft accumulation at the back of your neck and it is growing, I want you to see your primary care physician before you call a cosmetic surgery practice. Including mine.

Here are the signs that should prompt medical evaluation:

Rapid or unexplained growth of the fat pad
Central weight gain, particularly around the abdomen, that does not correlate with dietary changes
Facial rounding or puffiness
Easy bruising without explanation
Persistent fatigue
High blood pressure that is new or worsening
Stretch marks, particularly purplish ones on the abdomen or thighs

Potential Metabolic Benefits

These findings, particularly in combination, point toward Cushing’s syndrome symptoms and require endocrine evaluation before any cosmetic intervention is considered. Cushing’s syndrome is treatable, and treating it first may reduce or resolve the fat pad without surgical intervention.

At Exert BodySculpt, my protocol is straightforward. I require medical clearance from a primary care physician or endocrinologist before I will surgically treat a buffalo hump. This is not a barrier to care. It is responsible care. I would rather delay a procedure by six weeks and confirm the patient is healthy than perform liposuction on someone with an undiagnosed cortisol disorder.

Treatment Options for Buffalo Hump

Assuming the underlying cause has been identified and managed, or ruled out, buffalo hump treatment follows a logical pathway.

Step One: Address the Root Cause

For patients with Cushing’s syndrome, endocrine treatment comes first. For patients on corticosteroids, a medication review with the prescribing physician may identify alternatives or dose reductions. For patients with metabolic syndrome or obesity-related fat distribution, sustainable weight management is the foundation. In some cases, managing the underlying condition reduces the fat pad significantly on its own. Surgery, when indicated, produces far better and longer-lasting results in a medically stable patient.

Step Two: Liposuction for Direct Treatment

Once the medical picture is stable, buffalo hump liposuction is the most effective direct treatment for a fat-based dorsal cervical fat pad. The procedure uses tumescent liposuction technique, in which the target area is infused with a saline and anesthetic solution before fat removal. This allows for precise contouring, reduces bleeding, and makes the procedure safe to perform under local anesthesia.

At Exert BodySculpt, our Xpress Lipo approach is performed while the patient is awake. The procedure typically takes one to two hours. Most patients return to normal activity within one to three days. There is no general anesthesia involved, which significantly reduces recovery time and risk. The approach is physician-led body contouring, guided by clinical assessment at every stage.

Results are significant and long-lasting when the underlying condition is managed. That is the key point I emphasize to every patient considering this procedure: the surgery addresses the fat that is there. It does not prevent new fat accumulation if the hormonal or metabolic driver is not controlled. A well-evaluated, medically cleared patient who maintains healthy cortisol and metabolic function after surgery can expect durable, meaningful improvement.

According to the American Society of Plastic Surgeons, liposuction remains one of the most commonly performed cosmetic surgical procedures in the United States, with hundreds of thousands of procedures performed annually, reflecting its proven track record for targeted fat removal in appropriate candidates.

The GLP-1 Connection: A New Patient Population

This is what I want clinicians and journalists to pay attention to, because it represents a genuinely emerging clinical pattern.

GLP-1 receptor agonists, including semaglutide and tirzepatide, have transformed the treatment of obesity. According to Grand View Research, the global GLP-1 receptor agonist market was valued at over $30 billion in 2023 and is projected to continue significant growth, driven by unprecedented adoption rates for weight management indications. Millions of patients are now losing 40, 50, 60 or more pounds on these medications.

That kind of weight loss changes body composition in ways that are not always aesthetically uniform. Fat redistribution is a documented physiological reality during significant, rapid weight loss. The body does not lose fat evenly from every region at the same rate. The dorsal cervical fat pad is one area where residual fat can become more visible, and in some cases more prominent, after overall fat reduction.

The clinical picture I am now seeing regularly: a patient loses a substantial amount of weight on a GLP-1 medication. Their overall silhouette changes dramatically. But the buffalo hump remains, or becomes proportionally more noticeable as surrounding tissue volume decreases. This patient is presenting to cosmetic surgeons in growing numbers, and they are often confused and frustrated, because they have done everything right from a weight management standpoint, yet this one area has not responded.

Managing this patient requires understanding both the medication history and the tissue finding. Physician-led practices with clinical oversight are better positioned to evaluate GLP-1 fat redistribution cases because the treatment decision involves more than aesthetics. We need to understand where the patient is in their medication course, whether weight has stabilized, and whether any metabolic or hormonal factors are contributing alongside the medication effect.

For patients in the Fort Myers area and those traveling to our The Villages location, we are seeing this presentation with increasing regularity and have developed a consultation process specifically designed for post-GLP-1 body contouring evaluation.

Prevention and Management for High-Risk Patients

If you are on long-term corticosteroid therapy, certain antiretroviral medications, or have a known hormonal imbalance, there are proactive steps worth taking.

Maintaining a healthy weight reduces the overall fat burden the body has to redistribute. Prioritizing strength training helps preserve lean muscle mass, which supports metabolic health and can modestly improve body composition in the upper back and neck region. Monitoring hormonal health regularly, particularly cortisol levels if you are on chronic steroids, is practical medicine, not excessive caution.

I want to be honest about the limits of conservative management, because I think patients deserve that honesty. Once a true dorsal cervical fat pad has formed and the underlying condition is stable, lifestyle measures alone rarely eliminate it. Fat cells in that region do not selectively disappear with diet and exercise at the rates patients hope for. Managing expectations while addressing root causes is the right clinical approach. If conservative management has been maximized and the fat pad persists, that is when a surgical consultation becomes appropriate.

A Final Word: What Patients Should Take Away

A buffalo hump is a real, treatable medical and cosmetic condition. It is not something you imagined. It is not simply a consequence of aging that you have to accept. And it is not something that should be dismissed by a clinician who has not considered the full differential diagnosis.

What I want every patient to know:

Get a medical evaluation first. Rule out Cushing’s syndrome and other hormonal causes before pursuing any cosmetic intervention.
Identify the root cause. The cause determines the treatment path, and skipping this step leads to inconsistent outcomes.
If you are on GLP-1 medications and have noticed a persistent fat pad after significant weight loss, you are not alone, and there are treatment options designed for your specific situation.
When the medical picture is stable, buffalo hump liposuction is safe, effective, and produces lasting results in the right candidate.

For patients who have completed medical evaluation and are exploring surgical options, Exert BodySculpt offers consultations at our Fort Myers and The Villages locations. Our consultations are physician-led and begin with a clinical assessment, not a sales conversation. If surgery is not the right step for you at this time, we will tell you that directly, and we will point you toward the resources that are.

Dr. Giselle Prado-Wright, MD

Medical Director and Cosmetic Surgeon | Exert BodySculpt