Surface-aligned lithographic patterning approaches for back end of line (BEOL) interconnect fabrication, and the resulting structures, are described. In an example, an integrated circuit structure includes a substrate. A plurality of alternating first and second conductive lines is along a first direction of a back end of line (BEOL) metallization layer in a first inter-layer dielectric (ILD) layer above the substrate. A conductive via is on and electrically coupled to one of the conductive lines of the plurality of alternating first and second conductive lines, the conductive via centered over the one of the conductive lines. A second ILD layer is above plurality of alternating first and second conductive lines and laterally adjacent to the conductive via. The second ILD layer has an uppermost surface substantially co-planar with the flat top surface of the conductive via.