What is the best treatment for post-liposuction irregularities on thighs? (Photos)

Question

I had lipo on my thighs and banana roll about a year ago. The procedure created dimples on the legs and didn't get rid of the saddlebags. I would still like to remove some fat and eliminate the irregularities with a non-invasive treatment. Any thoughts or ideas would be much appreciated.

George Marosan, MD · Answer

Thank you for your question and photos. Non invasive treatment would not be a choice I would recommend to correct your issues. Without the benefit of preoperative photos, it seems to me that you have problems and asymmetries as a result of your surgery. It seems that your banana rolls were not treated adequately (very difficult area), but your surgeon liposuctioned you in the gluteal fold, causing your buttock to drop (side view). If you were my patient, I would do VASER release of the scared areas, liposuction of the remaining saddlebags and upper buttock/hips junction. Right now you have a long square looking buttock which needs to be shortened and rounded off superior/laterally to give you a feminine curve. You will also need judicious fat grafting to the irregular and depressed areas created by your previous procedure.Just an observation, energy devices are not a panacea of correcting problem areas, matter of fact in the poorly trained hands they can be outright dangerous. They are tools that a well trained board certified plastic surgeon can use to deliver excellent results in these difficult cases. Over 50% of my body sculpting patients are redos from other surgeons' offices. Without using my VASER, Power X and J-Plasma, I could not achieve the great results I do in these difficult cases.See a board certified plastic surgeon with extensive experience in body sculpting (who knows how to use the appropriate tools for the best results) for an in person consultation/evaluation. Good luck.

Gerald Minniti, MD, FACS · Answer

Hello,The proven technique for post liposuction irregularities is SAFElipo, which does not involve light, radiofrequency, ultrasound, or any other heat generating input; it is technique based, and involves breaking up old scar tissue, and both removing and grafting fat to smooth areas. Surgeons buy energy based machines thinking they will be a panacea for all problems, and not really have any idea how to make the problem better. Experience is key to getting a good revision liposuction result.

Daniel Barrett, MD · Answer

Dear Pebbles.1,
I would have to examine you but it appears that this is a contour irregularity after liposuction.  This happens often when areas the undergo liposuction are not feathered appropriately.
The good news is that it can be fixed and I have done so with good results before. The revision can often be done under local as well.While there is always a chance for contour irregularities with liposuction, someone who takes their time and uses the appropriate sized cannulas should give you a superb result.I have all my patients wear compression garments and I use multiple sized cannulas to feather out the result.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Jason Emer, MD · Answer

Pending a formal evaluation, you may be a good candidate for a Revision Liposuction. You need a formal evaluation by an expert in body shaping and contouring to determine what is best. 
The best in body contouring not only removes fat with energy devices like VASER ultrasound but also internally heats the skin with radiofrequency devices such as Renuvion (J-Plasma), InMode BodyTite, and ThermiRF to heat the undersurface of the skin and tighten it at the same time as fat removal. These combinations are called 4D HI-DEF VASER Liposuction and can only be done by a well-trained body contouring specialist. At the same time, fat should be harvested and purified, with PRP and stem cells added, and then injected into muscles, indentations and cellulite to get body shaping and contouring. For a Brazilian butt lift (BBL), we inject the fat into the buttock for contouring and lifting, but fat can also be used in areas such as the chest/breast, arms/shoulders, calves and face. Cellulite should also be treated with a combination of Cellfina, subcision, and/or fillers such as Bellafill, Renuva synthetic fat, or Sculptra. If skin is very loose before surgery, then it will need to be removed: tummy tuck/abdominoplasty for lower abdominal skin; breast lift for excess breast skin; and/or a brachioplasty for loose arm skin. Overall, you need a full assessment, but simple liposuction alone will not tighten skin and needs a combination of various methods -- fat removal, skin tightening, defining, fat grafting, skin removal -- to get the best in body contouring and body sculpting. See an expert. Best, Dr. Emer.

Arian Mowlavi, MD, FACS (license on probation) · Answer

We can not only fill out the dents using fat transfer and VASER liposuction but also tighten the skin using our Renuvion technology, which requires no cutting of the skin. The definitive correction for liposuction deformities requires the advanced technology of ultrasound assisted VASER liposuction. As an official trainer of VASER liposuction, I encounter suboptimal liposuction outcome referrals weekly. VASER liposuction has been the only modality that has consistently corrected liposuction caused deformities. VASER liposuction ensures a smooth contour regardless of severity of contour irregularities by virtue of being able to remove any and all remaining fat comprehensively and uniformly. Finally, when skin redundancy irregularities are observed, as in your case, Renuvion technology can be simultaneously applied to tighten your skin to optimize your overall contour outcome. A Skype or Facetime consultation with a VASER specialist will help you get an accurate recommendation and pricing. 
Respectfully, 
Arian Mowlavi MD, FACS
Realself 100 Hall of Fame Inductee

Mats Hagstrom, MD (license on probation) · Answer

The banana roll is a skinfold that forms on the upper posterior aspect of them upper thigh in a standing position. The skin bulges as it is constructed by being pushed into the buttocks.   Similar to help people form a skinfold on their lower abdomen in a sitting position.  The skin on the back of the thigh hast to have some laxity in this anatomic position in order to accommodate for bending forward.  If you look in the mirror you'll probably see that your banana roll goes away when you lean forward about 30°.  Poorly done liposuction is difficult to correct. The options are revision liposuction or fat transfer.  In your case fat transfer may actually work because there appears to still be some tissue they could hold the fat graft.  Non-invasive fat manipulation is non-selective and will most likely not correct the irregularities.  Revision liposuction may or may not work depending if you were over treated in the problem areas or not.  Sometimes a combination of the two will give the best results.  When using fat transfer to correct liposuction results patient often do best having several treatments.  Your situation is too complex to get an accurate assessment on real self. I recommend having several in person consultations.  Check out the word by Dr. Sidney Coleman of Tribeca plastic surgery in New York.  He said some nice results correcting this situation.  In general the banana roll should not be treated with liposuction.  It's best left alone.  Best, Mats Hagstrom MD

Jon Ver Halen, MD, FACS (license suspended) · Answer

Hello and thank you for your excellent question. Based on your photos, I think that you can likely obtain a significant improvement with revision liposuction. I do not think that it will be possible using only energy-based techniques. I think that you will need real liposuction, as well. It is best to answer your question during a face-to-face evaluation, when you can discuss your goals and expectations for the procedure, and you can have a physical examination to evaluate for that procedure. I recommend that you find a board-certified, or board-eligible plastic surgeon with whom you are comfortable. Be sure to have all of your questions answered during a face-to-face meeting with your surgeon, and review before and after pictures of similar patients whom have had this procedure. Good luck!

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