Buffalo Hump Removal Instruments | Justin Yovino MD | Beverly Hills

24 Jan 2026 · 2 min

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1:33

In this clinical presentation, Dr. Justin Yovino explains the instrument set and procedural steps he uses to achieve complete removal of a fibrous "buffalo hump"—a mixed fat and fibrous tissue deposit on the back. He emphasizes that success hinges on selecting the right cannulas and auxiliary tools. He starts with a thin, flexible numbing device to bathe all tissue layers, then adds a powered numbing injection cannula that both injects anesthetic and spreads it throughout the fat. He proceeds through a series of small-diameter cannulas (3 mm or smaller) with varied tip shapes and hole patterns to penetrate different fibrous zones. A basket cannula is employed—not for suction but to mechanically break up dense fat. Larger‑hole cannulas and a specialized "pickled fork" are used to free stubborn fibrous strands, followed by an ultra‑thin 2.1 mm cannula for sculpting the superficial layer. By combining these tools, he fully sculpts the area, leaving the hump completely flat and the patient satisfied.

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Buffalo hump. One reason we have so much success with buffalo hump removal, while a lot of other surgeons don't, is the cannula choices. So for instance, this week I had a gentleman that came with a buffalo hump, and it is very fibrous. It's mixed with fat, fibrous tissue. It takes a lot of special instrumentation to remove it all. Otherwise, you leave some behind and patients aren't satisfied. So you want to get it all out. So with Him, I used a bunch of different devices. So one, this is the numbing device, right? And so it's very thin, it's flexible, allows me to really bathe all the layers. Then I also use this device, which also allows for numbing, but it's powered. And so this one is like our aspiration cannulas, but it's an injection, so it really spreads numbing out and really bathes all the fat. And then we went through a series of cannulas with all different sizes. They're all 3mm and smaller. Multiple different hole arrangements, different tip arrangements to penetrate different fibrous areas more. This one I actually use a basket cannula. This one I use not on suction, but just to go in and break up the fat even more. Then different size holes. These are larger holes. And I also use what's called a pickled fork to free up some of the fibrous tissue and then further sculpt out some of the superficial layers, which is even thinner, down to a 2.1 millimeter cannula. So with all of these, I was able to fully sculpt him and get the buffalo hump completely removed and totally flat. That's how we do it.