First let me address the banana roll. It is not an area of excess fat. It is a skin folds or skin bulge. Just like the lower abdomen when in a sitting position. When we set the skin on the abdomen is compressed causing the skin to bulge forward. The laxity of the abdominal skin allows us to stand up without excessive tension on the skin. The same is true on other parts of the body. In order to have the skin flexibility to lean forward without being excessively tired the skin is in its most laxed state when standing up right. This causes the skin bulge to form on some people. The skin on the lower buttocks and back of the thigh also has lots of connective tissue. The best analogy is using the palm of the hand. If you pinch a lift the skin on the back of your hand then try that on the palm you'll realize that you can't. This is because of the connective tissue that anchors and stabilizes the skin on the palm. The hand can tolerate an immense amount of pressure. To do this the connective tissue gives the skin rigidity and stabilizes it. The back of the thigh's and the lower buttocks can tolerate our entire weight when sitting. This area also benefit from having the same connective tissue bands. These are the connective tissue bands that help contribute to cellulite. They also are part of what helps form the banana roll. If you look in the mirror and go from a standing position to leaning forward about 20° you'll notice that the banana roll shrinks substantially if not disappears totally. There is no good treatment for this. If anything adding volume with fat transfer is an option. I would not even offer this as a single procedure but often graft this area in conjunction with a BBL( Brazilian butt lift) The best treatment for cellulite is a process of cutting these connective tissue bands selectively through a procedure called subscision. A device called Celfina sometimes used to do this. This procedure in conjunction with adding some form of volume whether fillers or fat probably works best. Some people have a flat lower half of their buttocks. This is again from connective tissue anchoring the skin to the underlying muscle fascia constructing the distance the skin can hold from the muscle layer. During a BBL this area often fails to respond leaving the area flat while the surrounding area's expand nicely. Patients often post on real self being upset that the doctor did not put the fat in the right place. In reality they had a flat but that simply will not expand regardless of volume of fat at it. Again, it is almost always the lower inner part of the buttocks that has these amounts of connective tissue. I hope this gives some explanation or at least my interpretation of it as well as treatment options. My recommendation is avoid liposuction. Possibly consider Celfina but in reality there is no single great treatment for what you have. Best, Mats Hagstrom MD
