A buffalo hump is a visible buildup of fat at the base of the back of the neck, between the shoulder blades. Its medical name is dorsocervical fat pad, and it can range from a small, barely noticeable mound to a large, firm lump that changes posture and appearance. While it sometimes develops from weight gain alone, a buffalo hump often signals an underlying hormonal or medication-related issue that deserves attention.
What It Looks Like and Where It Forms
The fat pad sits right where the neck meets the upper back, roughly centered between the shoulder blades. It’s made of adipose tissue, the same type of body fat found elsewhere, but concentrated in one specific spot. Some people notice it first in photos or when clothing starts fitting differently around the collar and upper back. The lump itself is typically soft to the touch, though it can feel firmer if it’s been present for a long time.
A buffalo hump is not the same thing as a Dowager’s hump, which is a forward curvature of the spine caused by weakened vertebrae, often from osteoporosis. The key difference is tissue: a buffalo hump is fat accumulation sitting on top of a normally shaped spine, while a Dowager’s hump involves actual changes to the bone structure underneath. A doctor can usually tell the difference through a physical exam, and imaging can confirm it when there’s any doubt.
Why It Develops
Several distinct conditions cause fat to accumulate in this area, and identifying the right one matters because the treatments are completely different.
Excess Cortisol (Cushing Syndrome)
Cushing syndrome occurs when the body has too much of the stress hormone cortisol over a long period. One of cortisol’s effects is redirecting where the body stores fat, pulling it toward the midsection, face, and upper back. A fatty hump between the shoulders is one of the hallmark signs, often appearing alongside a rounded “moon” face and pink or purple stretch marks on the skin. Cushing syndrome can be caused by a tumor on the pituitary gland, a tumor on the adrenal glands, or long-term use of corticosteroid medications.
Corticosteroid Medications
Drugs like prednisone mimic cortisol in the body, so taking them for weeks or months can trigger the same fat redistribution pattern seen in Cushing syndrome. The higher the dose and the longer you take these medications, the more likely a buffalo hump becomes. This is one of the most common causes, since corticosteroids are widely prescribed for conditions like asthma, autoimmune disorders, and organ transplant recovery. In many cases, the fat pad gradually shrinks once the medication is tapered or stopped, though this can take months.
HIV-Related Lipodystrophy
Some people living with HIV develop a condition called lipodystrophy, where the body abnormally redistributes fat, pulling it away from the face, arms, and legs and depositing it in the abdomen and upper back. Both the virus itself and certain antiretroviral medications have been linked to this pattern. The exact mechanism isn’t fully understood, but specific drugs in the protease inhibitor class are most commonly associated with the change.
Obesity
General weight gain can also lead to fat accumulation in the upper back, particularly when combined with poor posture or a genetic tendency to store fat in that area. In these cases, there’s no hormonal abnormality driving the process. The fat pad simply grows along with fat deposits elsewhere in the body.
How It Gets Diagnosed
The buffalo hump itself is easy to spot, but figuring out why it appeared is the important step. A doctor will typically start with a medical history: what medications you take, whether other symptoms are present (weight gain around the midsection, skin changes, fatigue, muscle weakness), and how quickly the hump developed.
If Cushing syndrome is suspected, testing focuses on measuring cortisol levels. The Endocrine Society recommends starting with one of three approaches: collecting urine over 24 hours to measure free cortisol (repeated at least twice), testing saliva late at night when cortisol should naturally be at its lowest, or taking a low dose of a synthetic steroid called dexamethasone to see whether the body’s cortisol production shuts down the way it should. A random blood draw for cortisol is not reliable for this purpose, because cortisol levels fluctuate throughout the day.
If medication or HIV-related lipodystrophy is the likely cause, cortisol testing may be skipped in favor of reviewing the treatment history and adjusting the medication regimen.
Treatment Depends on the Cause
There is no single fix for a buffalo hump because the treatment hinges entirely on what’s driving the fat accumulation.
When corticosteroid medications are responsible, the most effective approach is reducing the dose or switching to an alternative drug, done gradually under medical supervision. The fat pad often begins to shrink over weeks to months once cortisol levels normalize, though it doesn’t always disappear completely.
When Cushing syndrome is caused by a tumor, treating the tumor (through surgery, radiation, or medication) addresses the root problem. As cortisol levels come down, the abnormal fat distribution typically improves over time.
For HIV-related lipodystrophy, switching to antiretroviral medications less associated with fat redistribution can slow or partially reverse the process. This requires careful coordination to make sure the new regimen still controls the virus effectively.
When the cause is general obesity with no hormonal component, weight loss through diet and exercise can reduce the fat pad along with overall body fat. However, spot reduction isn’t possible, so the upper back may be one of the last places to slim down.
Surgical Removal
For buffalo humps that persist despite treating the underlying cause, or for people who want faster cosmetic improvement, liposuction is the most common surgical option. According to the American Society of Plastic Surgeons, the procedure involves suctioning out the excess fat through small incisions. In some cases, direct excision (cutting out the fat tissue) is used instead, particularly for denser or more fibrous deposits.
Some patients undergo the procedure with local anesthesia while fully awake, depending on the size of the hump and the surgeon’s approach. Recovery is generally straightforward, with swelling and soreness lasting a few weeks. One important caveat: if the underlying hormonal or medication issue isn’t addressed, the fat pad can return after surgery. Liposuction removes the fat that’s already there, but it doesn’t prevent the body from depositing more in the same spot.
What a Buffalo Hump Can Feel Like Day to Day
Beyond appearance, a buffalo hump can cause real physical discomfort. The weight of the fat pad pulls the head and shoulders forward, creating neck stiffness, upper back pain, and tension headaches in some people. Sleeping on your back can become uncomfortable as the lump presses into the mattress. Clothing with higher necklines or collars may fit differently or feel tight.
For many people, the cosmetic and emotional impact is just as significant as the physical symptoms. The hump is visible to others and can be a source of self-consciousness, particularly when it develops quickly and people don’t understand the medical reason behind it. Knowing that effective treatments exist, and that the hump often improves once its cause is managed, is worth keeping in mind if you’re dealing with one.