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If you don't naturally have back dimples at all, the only way to get them is with cosmetic surgery. This is accomplished by removing fat from the areas where you would like the dimples to appear. Traditionally, this is done with liposuction, in which a needle is inserted under the skin and a little bit of fat is suctioned out.  The liposuction procedure used specifically to create back dimples may go by a variety names, including V-spot treatment, Dimples En V, or Barbie Back surgery. This type of liposuction is usually performed under local anesthesia. Possible risks of liposuction include numbness around the liposuction site, infection of the skin, bleeding, or fat embolism (a blood vessel blockage caused by a loose piece of fat). Deoxycholic acid (Kybella) can be injected under the skin to dissolve fat without damaging the surrounding tissues. Targeted injections can be used to simulate back dimples. Deoxycholic injections require less downtime and are less expensive than liposuction, but you may need several treatments to get the results you want.  Common side effects of Kybella injections include swelling, bruising, pain, numbness, redness, and hardening of the tissue around the injection. Kybella is only FDA approved for treatment of fat below the chin. However, cosmetic practitioners may still legally use it for off-label uses, such as creating back dimples. Cosmetic surgery to create back dimples can be extremely expensive. If you go the liposuction route, you could be looking at around $6000 USD. While a single treatment with Kybella costs less than liposuction, you may need multiple treatments. Because of this, Kybella can add up to about the same or even more than what you would pay for liposuction. Most insurance plans will not cover the costs of these types of procedures, so you will almost certainly have to pay the whole cost out of pocket.
Get targeted liposuction to create back dimples. Use deoxycholic acid injections as an alternative to liposuction. Be prepared for the cost.