Hello, Thank you for your question regarding options to address sagging around your knees. Based on your history and the pictures provided, it seems that cellulite is the primary concern. Cellulite is often caused by the contraction of fibrous bands that connect the skin to underlying fascia. Here are two main treatment options to consider: Cellulaze Treatment: Cellulaze is a specialized procedure designed to cut through these fibrous bands and release the skin, helping to reduce the appearance of cellulite. This treatment can effectively address the dimpling and uneven texture often associated with cellulite. Specialized Liposuction Technique: Although traditional liposuction might not be suitable in your case due to the lack of excess fat, specialized liposuction techniques focus on cutting the fibrous bands without removing fat. In this procedure, the suction feature of the liposuction machine is turned off, and a specialized cannula is used to target the fibrous bands causing the cellulite. Considering your situation, where excess fat is not a significant issue, I would recommend exploring the Cellulaze treatment or the specialized liposuction technique that targets fibrous bands. These options are less invasive than a medial thigh lift, which involves removing skin and fat and may be too extreme for your needs. It's important to consult with a board-certified plastic surgeon who can assess your specific case and recommend the most appropriate treatment. They can provide you with detailed information about each procedure, including expected outcomes and recovery times. I hope this guidance helps you in making an informed decision about the best way to address sagging around your knees. Good luck with your treatment. Sincerely, Dr. Katzen