What is a Buffalo Hump?

A buffalo hump, also known as a neck hump, is a condition characterised by the buildup of fat at the base of the neck, between the shoulders, leading to a noticeable curvature at the top of the back.

The medical term for a buffalo hump is dorsocervical fat pad hypertrophy, referring to the enlargement of the fat pad found at the junction between the base of the neck and the top of the spine.

A buffalo hump usually develops as a result of one of several medical conditions. Although the accumulation of fat may be a sign of an underlying health concern, the hump itself usually poses no inherent harm or medical concern. That being said, a buffalo hump can have several impacts on the body:

Physical discomfort – Increased weight and pressure on the shoulders and neck can cause muscle strain and headaches
Restricted mobility – The enlarged fat pad may reduce the range of motion in the neck and upper back
Loss of confidence – Many individuals affected by a buffalo hump find that they feel self-conscious and that clothing is uncomfortable or doesn’t fit as it should

A buffalo hump can have a significant effect on comfort and quality of life. Physical discomfort and restricted mobility can impact daily activities and exercise, and reduced confidence can affect social and professional life.

Cadogan Clinic has brought together a team of the UK’s leading Consultant Plastic Surgeons, who are committed to providing the best possible treatment and care for all concerns, including buffalo hump. Our award-winning hospital is based in Chelsea, London, and our expert patient advisors are on hand to match you with the best surgeon to address your concerns.

Buffalo Hump vs. Dowager’s Hump

Buffalo hump is often confused with a similar condition, known as dowager’s hump, due to their similar external appearance. Both buffalo hump and dowager’s hump cause a visible curvature at the top of the back. However, the underlying anatomy differs for each condition.

Buffalo Hump

The enlargement of the dorsocervical fat pad found at the base of the neck, between the shoulders
Results in a firm but movable lump at the top of the back
Caused by certain underlying metabolic medical conditions or medication

Dowager’s Hump

The outward curvature of the upper spine, known as kyphosis
Feels hard and bony through the skin and isn’t movable or malleable
Caused by conditions such as Osteoporosis or poor posture, affecting the structure and stability of the spine

Both buffalo hump and dowager’s hump can affect comfort and mobility and look very similar. If you are unsure about whether the upper back curvature you are experiencing is caused by fat accumulation or bone structure, it is important to speak with a qualified medical professional to establish the best treatment.

Infographic showing the placement of the dorsocervical fat pad at the base of the neck in cases of buffalo hump

What are the Symptoms of a Buffalo Hump?

Although the neck hump itself is the primary buffalo hump symptom, there are other accompanying signs and symptoms which can also occur.

Symptoms of buffalo hump include:

Rounded upper back – Caused by an enlarged dorsocervical fat pad at the base of the neck, a protrusion develops, resulting in a rounded appearance to the shoulders and upper back
Postural strain – The enlarged fat pad places pressure on the neck and shoulders, pushing the head into a forward posture, a primary cause of tech neck and other musculoskeletal concerns
Muscular discomfort – The unbalanced distribution of weight places strain on the upper back, neck and shoulders, causing muscular tension and strain
Reduced mobility – Individuals may find that their field of head and neck movement is limited by the enlarged fat pad and associated muscle strain
Headaches – Upper back and neck strain can result in regular headaches

In severe cases, often when left untreated, buffalo hump symptoms may extend to:

Nerve compression – The dorsocervical fat pad may place pressure on the surrounding nerves, causing pain or numbness
Sleep disturbance – It may be uncomfortable to lie in certain positions, as the alignment of the spine and head is affected

If you have any concerns about buffalo hump symptoms, it is important to speak with a doctor who can assess your condition and provide a bespoke treatment plan to achieve your desired results.

What Causes a Buffalo Hump?

There are many reasons a buffalo hump can develop. While some people may be aware of the reason a buffalo hump has occurred, others may require further assessment and investigation by a qualified doctor to establish the exact cause.

Buffalo hump causes include:

Cushing Syndrome

Cushing Syndrome is a medical condition characterised by increased levels of cortisol in the body.

Cortisol is a hormone produced by the adrenal glands, which is responsible for regulating stress and managing immune response, energy and blood pressure levels.

When cortisol levels are increased, the body forms more fat tissue than usual, leading to excess fat collecting in certain areas, including:

Face
Abdomen
Upper back (buffalo hump)

There are two reasons why cortisol typically becomes elevated:

Natural increased production caused by a problem in the adrenal glands
Long-term use of corticosteroid medication, strong anti-inflammatories and immunosuppressants, often used to treat Asthma, Arthritis, Crohn’s Disease, Ulcerative Colitis and Lupus

Cushing Syndrome requires medical treatment and management. If you are concerned about your cortisol levels, it is essential to speak with your doctor as soon as possible to ensure you receive timely treatment.

Obesity

Obesity is a medical condition characterised by excessive fat accumulation that impairs health.

Generally speaking, in adults, Obesity is typically defined as a body mass index (BMI) of at least 30. However, other personal health factors, such as muscle mass, can revise this measurement.

Having Obesity can increase the risk of developing serious health concerns, including:

Type II diabetes
High blood pressure
Sleep apnoea
Certain cancers
Heart attack or stroke

As with all individuals, fat distribution varies among those affected by Obesity. Not everyone with Obesity will have a buffalo hump, but it is an acknowledged cause.

Genetics

The distribution of body fat varies from person to person, and genetics can play a strong role in determining where fat accumulates.

In some cases, genetics causes Lipodystrophy, a condition that results in an abnormal distribution of fat, leading to a higher-than-usual accumulation of fat at the base of the neck. Individuals with close family members who have a buffalo hump due to Lipodystrophy are more likely to have the same trait.

A buffalo hump caused by Lipodystrophy can develop at any stage in life, but is most likely to occur during adolescence or early adulthood, when hormonal changes trigger fat redistribution.

Antiretroviral Therapy (ART)

Antiretroviral Therapy, sometimes shortened to ART, is a combination of medications prescribed to manage HIV. ART works by reducing the levels of HIV in the body, protecting the immune system, and often results in the HIV being undetectable.

Certain medications used in Antiretroviral Therapy affect the immune system and can impact adipose (fat) tissue function, leading to abnormal fat distribution. In some cases, this can include the development of a buffalo hump.

However, the ART medications that have most often been associated with a buffalo neck hump in the past are now used less frequently, as more effective options with fewer side effects have been developed.

How to Get Rid of Buffalo Hump?

Buffalo hump treatment varies by individual, depending on the severity, symptoms, and cause.

In cases where the cause is a medical condition or medication, buffalo hump treatment usually begins with addressing the underlying cause. However, some patients find that although their condition has been managed, the buffalo hump persists.

If you have a buffalo hump caused by a medical condition or medication, it is essential to discuss your concerns with a medical professional who is already overseeing your treatment, as they will be able to suggest the most effective options for your individual circumstances.

Beyond treatment and management of medical conditions, other buffalo hump treatment options are effective for many patients.

Weight Loss Medication

For patients whose buffalo hump is caused by Obesity, Weight Loss Medication can be a highly effective treatment, in cases where other weight loss methods, such as diet and exercise, have not achieved the desired results.

Weight Loss Medication is available in different forms depending on the needs of the patient:

GLP-1 Receptor Agonists – These are self-administered injectable treatments which lower blood sugar levels and suppress appetite by slowing the speed at which food moves through the stomach
Dual GIP/GLP-1 Agonists – Similar to GLP-1 Agonists, these are also self-administered injections which control blood sugar and suppress appetite levels. They are the most common option for patients who only require weight loss support, rather than medication for other conditions
Orlistat –Orlistat is a tablet which prevents up to a third of the fat consumed from being absorbed. It is an alternative Weight Loss Medication, and often requires more diet and lifestyle adjustments than other options

Weight Loss Medication must be prescribed by a qualified medical professional who also closely monitors your health and progress to ensure you are achieving your expected results, without any unwanted side effects.

Although Weight Loss Medication is often highly successful and can result in a dramatic decrease in weight, it isn’t possible to determine exactly which areas of the body fat will be lost. Some patients may find that they don’t experience as much reduction in their buffalo hump as they would like, or that they require additional treatment.

Liposuction

Liposuction is the most common type of surgical buffalo hump removal. It is a surgical procedure which involves a cannula extracting the excess from between the shoulder blades via a small incision.

Buffalo hump Liposuction is suitable for patients with various concerns:

In cases where a buffalo hump is caused by genetics, Liposuction is a highly effective body contouring procedure which improves the alignment of the upper back and removes pressure from the neck and shoulders
For patients whose buffalo hump is caused by a medical condition or treatment, Liposuction may be suitable if controlling the condition has not reduced the neck hump
Where a buffalo hump caused by Obesity has been resistant to other weight loss methods, Liposuction as part of Post Weight Loss Body Contouring is often the most suitable treatment

Depending on the extent of the procedure, buffalo hump Liposuction can be performed under general or local anaesthetic, and takes around one hour to complete.

In most cases, surgeons will recommend trying other buffalo hump treatment options before Liposuction. However, for patients who have found that other treatments haven’t been effective, Liposuction provides long-term and high-quality results.

Words From Our Founder

Mr. Bryan Mayou

Having a buffalo hump can have a hugely detrimental impact on comfort and confidence. Since introducing Liposuction to the UK over 40 years ago, it has been highly gratifying to see it used so effectively to dramatically improve patients’ quality of life with a relatively simple procedure.

Mr. Bryan Mayou

Frequently Asked Questions

If I lose weight, will my buffalo hump go away?

In cases where a buffalo hump is caused by weight gain or Obesity, losing weight, either through diet and exercise, or Weight Loss Medication, may help to reduce the size of the neck hump. However, with any weight loss method, it is not possible to guarantee the areas fat will be lost from, so some patients may find that their buffalo hump either doesn’t reduce in size, or only reduces partially. In these cases, patients may wish to consider further treatment, such as Liposuction.

Can a buffalo hump be removed?

It is possible for a buffalo hump to be reduced or removed, but the treatment will depend on the severity, symptoms and cause.

Buffalo hump is primarily characterised by an accumulation of fat between the shoulder blades, in the upper back, at the base of the neck, in a fat pad called the dorsocervical fat pad. This can be caused by:

Increased levels of cortisol, known as Cushing Syndrome
Weight gain or Obesity
Genetics
Antiretroviral Therapy (ART)

In cases where a neck hump is caused by an underlying medical condition or treatment, the initial treatment will always involve controlling the condition or adjusting medication levels. For buffalo hump caused by Obesity a weight loss plan will usually be put in place ahead of any other treatment. If these initial steps have not been effective, Liposuction can be used to extract the excess fat between shoulder blades and reduce the curvature in the shoulders and upper back.

Does buffalo hump hurt?

Although a buffalo hump is unlikely to hurt itself, the pressure it places on the upper back, neck and shoulders can cause physical discomfort:

Postural strain – A neck hump can push the shoulders and neck forward, causing a forward head tilt, and impacting posture long-term
Muscular pain – A buffalo hump puts extra strain on the muscles in the neck, shoulders and upper back, resulting in chronic discomfort which can be difficult to manage
Headaches – Adjusted posture and muscular strain increase the risk of developing headaches
Sleep disturbance – Having a buffalo neck hump can make it uncomfortable to sleep in certain positions, affecting sleep quality and overall wellbeing

If you are experiencing discomfort due to a buffalo hump, speaking with a doctor is the most important first step to getting the right treatment.

Does buffalo hump go away?

It is unlikely that a buffalo hump will resolve on its own without addressing the underlying cause. In cases where a neck hump arises from genetics, fat distribution rarely alters so dramatically without other medical intervention. For patients whose buffalo hump is caused by medical conditions or antiretroviral treatment, management and ongoing treatment are necessary to address the buffalo hump.

Is a buffalo hump a lipoma?

Although both buffalo hump and lipoma are benign accumulations of fat which result in unwanted lumps and contour changes, they are different conditions.

Buffalo hump – The enlargement of the dorsocervical fat pad, at the junction between the top of the back and base of the neck, caused by genetics, medical conditions or treatment
Lipoma – A benign fatty tumour beneath the skin, which can appear anywhere on the body, but is common on the upper back and shoulders. The cause is not fully understood, but it may be due to medical conditions or dysfunctional adipose production

If you have an accumulation of fat, and you aren’t sure whether it is a buffalo hump or a lipoma, speaking with a Consultant Surgeon will ensure you receive a comprehensive assessment and diagnosis.

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