A buffalo hump is a buildup of fat at the base of the back of your neck, between your shoulder blades. Its medical name is dorsocervical fat pad hypertrophy. It creates a visible, rounded lump that can range from a subtle fullness to a pronounced mound, and it signals that something is driving your body to deposit fat in an unusual location.
This isn’t the same as a rounded upper back from poor posture or osteoporosis (sometimes called a dowager’s hump). A buffalo hump is specifically a fat deposit, not a curvature of the spine. The distinction matters because the causes and treatments are completely different.
What Causes Fat to Build Up There
Fat doesn’t normally concentrate at the base of the neck. When it does, it’s usually because something is altering how your body stores and distributes fat. The most common culprits fall into a few categories.
Excess Cortisol
Cortisol, your body’s primary stress hormone, directly influences where fat gets stored. When cortisol levels stay elevated for a long time, fat migrates toward the trunk, face, and upper back. This pattern is a hallmark of Cushing’s syndrome, a condition caused by prolonged exposure to high cortisol. Cushing’s can develop from a tumor on the pituitary or adrenal glands, or, more commonly, from taking corticosteroid medications like prednisone for extended periods.
Corticosteroid Medications
Prednisone and similar drugs are prescribed for autoimmune diseases, severe asthma, organ transplants, and many inflammatory conditions. They work by mimicking cortisol, which means the same fat-redistribution side effects can follow. Fat pads at the base of the neck and above the collarbones are common in people on steroids. The good news: these deposits generally shrink on their own as the dose is tapered below about 10 milligrams per day. If you’re on a steroid and notice this developing, it’s worth discussing the timeline with your prescriber, but stopping abruptly on your own is dangerous.
HIV-Related Lipodystrophy
Certain HIV medications, particularly older classes of antiretroviral drugs, can cause a syndrome where fat accumulates in the trunk and upper back while thinning in the face, arms, and legs. A dorsocervical fat pad is one of the more recognizable signs. This doesn’t happen with all HIV treatments, and newer drug regimens carry a lower risk, but it remains a known side effect that many people living with HIV have experienced.
Obesity and Metabolic Syndrome
In some cases, a buffalo hump develops simply as part of overall excess weight, particularly when combined with insulin resistance or metabolic syndrome. The fat deposit may be less dramatic than what you’d see with Cushing’s, but it follows a similar pattern of central fat accumulation. When obesity is the primary driver, weight loss through diet and exercise can reduce the hump over time, though results vary depending on genetics and how long the fat has been present.
A Rare Look-Alike: Madelung’s Disease
Occasionally, symmetrical fat deposits around the neck, shoulders, and upper arms point to a rare fat metabolism disorder called Madelung’s disease (also known as multiple symmetric lipomatosis). It primarily affects men between ages 30 and 70, and roughly 90% of people diagnosed have a history of heavy alcohol use and alcohol-related liver damage. The fat masses are painless but can grow large enough to compress the airway, voice box, or esophagus, causing difficulty breathing, speaking, or swallowing. Limited neck mobility and sleep apnea can develop as it progresses. It’s sometimes mistaken for simple obesity because of how evenly the fat distributes.
How It Gets Diagnosed
The bump itself is easy to identify on physical exam. The real diagnostic work is figuring out why it formed. Your doctor will likely start by checking your cortisol levels. The standard tests include a blood cortisol test, a 24-hour urine cortisol collection (where you save all urine for a full day so the lab can measure total cortisol output), and a dexamethasone suppression test, which involves taking a small steroid pill at night and having blood drawn the next morning to see if your body responds normally by lowering its own cortisol production.
If you’re taking corticosteroid medications or HIV treatments, the cause may already be obvious, and testing might focus on ruling out additional contributing factors. Your doctor will also review your medication history, check for signs of metabolic syndrome, and look for other symptoms of Cushing’s like a round “moon” face, purple stretch marks on the skin, easy bruising, and muscle weakness.
Treatment Depends on the Cause
There’s no single fix for a buffalo hump because the treatment has to match whatever is driving the fat accumulation. Treating the symptom without addressing the root cause leads to recurrence.
If corticosteroid medication is the culprit, gradually reducing the dose (under medical supervision) is usually enough. The fat pads shrink as cortisol levels normalize, though it can take weeks to months. For Cushing’s syndrome caused by a tumor, treating or removing the tumor brings cortisol levels down and allows the fat redistribution to reverse over time. For HIV-related lipodystrophy, switching to a different antiretroviral regimen may help prevent further accumulation, though existing fat deposits don’t always fully resolve.
When obesity is the main factor, sustained weight loss through calorie reduction and regular exercise can reduce the hump. However, targeted exercises for the upper back and neck won’t selectively burn fat from that specific area. Fat loss happens systemically, and the dorsocervical area may be one of the last places to slim down.
When Liposuction Is Considered
For people whose buffalo hump persists despite treating the underlying cause, or in cases where the cause can’t be fully corrected, liposuction is an option. The procedure is typically done with the patient lying face down, with the neck flexed forward to expose the area. Surgeons usually create small access points near each shoulder and at the lower midline of the hump, then use specialized cannulas to break up and suction out the fat.
Ultrasound-assisted liposuction, which uses sound waves to liquefy dense fat before removal, has shown good results in this area. In a study of five patients who underwent this technique, four achieved results they were highly satisfied with, and even the one case with some residual fullness didn’t require additional treatment. The dorsocervical area contains particularly dense, fibrous fat compared to other body areas, which is why techniques that soften the tissue first tend to work better than standard liposuction alone.
Recurrence after liposuction is possible, especially if the underlying hormonal or metabolic issue isn’t controlled. The limited follow-up data available makes it hard to pin down exact recurrence rates, so managing the root cause remains essential even after surgical removal.
What It Feels Like Day to Day
A buffalo hump isn’t always painful, but it can cause stiffness and discomfort in the neck and upper back, especially as it grows. Some people experience restricted range of motion when turning their head. The cosmetic impact often weighs more heavily: the hump is visible in clothing, affects posture appearance, and can make people self-conscious. Sleeping on your back may become uncomfortable, and finding well-fitting shirts or jackets with higher necklines can be frustrating. These quality-of-life effects are a legitimate reason to pursue treatment, not just the medical concerns underneath.