What should I do to fix banana roll? Fat graft or remove excess skin? (photo)

A hi definition 4D contouring procedure can help give you the shape and fat reduction you are looking for. I suggest you see an expert in VASER HI DEF procedure. Excess skin may need skin removed at the same time. I suggest a formal consultation, someone who is 4D VASER trained. Best, Dr. Emer.

Before an operation can be prescribed an accurate assessment post be made which includes having an underlying primary diagnosis.In other words the plastic surgeon has to understand what the problem is before deciding what's an appropriate procedure.The banana roll his often mistaken for excessive subcutaneous fat and inappropriately treated with liposuction.Banana roll is a skin condition.In order to have skin flexibility to allow full flexion of your hips like when you're touching your toes you need enough skin  on the back of your thighs to accommodate for this.This means the skin is also contracted or  pushed together when you're in an upright standing position.certain anatomic areas have it skin attachments to the underlying muscle structure giving stability.And example of this is the palm of your hand where the skin does not move around easily but on the back of the hand it does.That's because the skin on the palm of your hand has lots of connective tissue holding it in place.This is also true of the bottom of the buttocks. This means that when the skin on the back of the thigh is pushed together when in a standing position A bulge forms.For almost everyone the banana roll disappears when people lean forward and even just slightly.so the banana roll represents not excess skin but the skin and being pushed together in a standing position.excising the skin can certainly remove the banana roll.It will however leave a significant scar. This scar is fairly well concealed in the crease.If too much skin is removed the area could potential he feels very tight when leaning forward.Adding volume with fat transfer could potentially fill out the area to accommodate the skin bunching.if you're interested in having a Brazilian butt lift then it makes sense to go that route and see what adding volume will do.If your only goal is to remove the banana roll then the skin excision may be more effective.I have seen all too many patients having thi treated incorrectly with liposuction leaving either minimal improvements or even disfiguration.My vote is for a skin resection if you don't mind the scars.Scars typically fade out with time.The timeframe for scars to fade completely is usually about a year.Best,Mats Hagstrom M.D.

Thanks for your photograph and question.  If you are willing to accept a long incision line that will remain present permanently I would suggest surgical excision.  If not however I do not think that fat grafting would be of any significant benefit to you.Best wishes.Jon A Perlman M.D., FACSDiplomate, American Board of Plastic SurgeryMember, American Society for Aesthetic Plastic Surgery (ASAPS)Beverly Hills, California