Abnormal fat accumulation beneath glutes? (Photo)

Question

Hi, I’m a 30 year old female about 5’2 in height, and 240 pounds. I’ve always had thunder thighs and about 7 years ago I loss 80 pounds my legs just got undefined and weird looking. I’ve gained the weight back and I have fat and cellulite oddly distributed everywhere. The fat pocket pushes in to my inner making mobility difficult, chaffing is an issue and moisture. I know I need lose weight but even when I was 80 pounds lighter this was still am issue. I don't think I have lipedema, no pain

Rajaie Hazboun, MD, MBA · Answer

Thank you for posting your question here!My answer will be based on the limited information and pictures provided, for a detailed and bespoke plan please consult with your plastic surgeon.
The skin of the thighs is held to the underlying tissues by fibrous bands that keeps it in place, when you gain weight the skin can deform as fat will accumulate in areas while it is held to the underlying tissue in other areas, and when you lose weight the areas that used to hold the fat will have skin laxity. Best case scenario to deal with such an issue is to get to your goal weight and then consider potentially a thigh lift procedure (depending on how things look, and how the skin contracts at that point) .
I hope this helps , best of luck!

J. Timothy Katzen, MD, FACS · Answer

Hello, and thank you for your question about abnormal fat accumulation beneath the glutes and inner thighs. I appreciate the history and pictures you provided.

Based on your description and photos, you have excess fat and skin in the inner thighs that extend from the groin to the inner knee. This is medically referred to as cutis pleonasmus (excess skin) and dermatochalasis (loose skin). The best long-term solution is to lose as much weight as possible since overall fat distribution and skin laxity will significantly improve with weight loss. If weight loss has been challenging, you may consider vertical gastric sleeve surgery or FDA-approved weight loss medications like GLP-1 receptor agonists (Ozempic, Mounjaro, Tirzepatide, and Zepbound). While these treatments will not completely eliminate your concerns, they will improve your overall body contour and reduce the amount of excess fat and bulk in the thighs.

If weight loss alone does not fully address your concerns, there are two primary surgical options to consider: VASER liposuction and a thigh lift (thigh reduction surgery). VASER liposuction removes excess fat from the inner, anterior (front), and outer lateral thighs, effectively reducing the overall thigh circumference. The procedure takes about 3 to 4 hours under general anesthesia, and while it will significantly reduce fat volume, it will not address excess skin. This means that while your thighs will be slimmer, you may be left with sagging or wrinkled skin. Compression garments must be worn for at least 6 to 8 weeks post-op to promote skin contraction. If you have a sitting job, you can expect to return to work within 7–10 days after liposuction.

For patients with significant skin laxity, a thigh lift is the better option. This procedure combines liposuction with skin excision, using an incision that extends from the groin to the knee to ensure optimal skin tightening. A thigh lift is performed under general anesthesia and takes about 4 hours to complete. Drains typically remain in place for 2–3 weeks to prevent fluid buildup, and a compression garment must be worn for 6–8 weeks to optimize healing. Recovery time depends on your occupation; if you have a sitting job, you can return to work within 2–3 weeks, while a standing job may require 3–4 weeks of recovery.

Regardless of the procedure chosen, a compression garment is essential for 6–8 weeks postoperatively to promote healing and improve contouring. If you are considering surgery, I strongly recommend consulting with an experienced, board-certified plastic surgeon who has performed at least 100 thigh lifts and can provide a detailed portfolio of before-and-after results. I hope this information helps answer your question, and I wish you the best of luck with your transformation.

Sincerely,
Dr. Katzen

Connie Hiers, MD, FACS · Answer

That area we refer to as the "banana roll" and can be easily treated with liposuction.  You can have other areas treated as well, or just these spots.

Camille Cash, MD · Answer

From the photos it appears you can consider liposuction which will reduce the fatty pockets, but likely leave you with loose, potentially hanging, skin.  If so you can consider a thigh lift.  It's best to lose the weight first and then consider the best option based on how your thighs appear at that time.

Mats Hagstrom, MD (license on probation) · Answer

In reality, we don’t have great treatments for women with flabby thighs.
The treatment options generally come down to Liposuction and or thigh lift surgery.
Any other procedure is going to Deliver less than liposuction and thigh lift surgery and these two procedures only help to some degree.
 Most likely your best approach is going to be aggressive Liposuction recognizing that this is going to leave you with sagging loose skin.
After that you can consider a thigh lift.
It should leave you better than you are now but it’s not going to give you great looking legs.
Obesity is probably the biggest contributor and once the skin envelope has been stretched out, it’s not going to shrink back unless somebody is very young and has genetically excellent skin elasticity.Your history has shown you that the skin is not going to retract so it’s going to be there whether you lose weight or have liposuction.
Liposuction on patients who are obese is a bit of a pointless procedure.
In most states Liposuction is limited to 5 Liters (A bit over a gallon) in reality, this is usually only 6 to 8 pounds of fat.if you take 8 pounds of fat removal on a patient who is 240 pounds they’re still going to be 232 pounds after.
8 pounds is a very small amount of fat to remove on someone your size.
8 pounds is a much bigger percentage to remove on somebody who is 140 pounds.
 140 pound patient 5 L of liposuction could remove almost all of their subcutaneous fat.
Weight loss needs to come first, and you should probably figure out why it’s difficult to maintain a certain weight.
There are now medical treatments and other support modalities to help with the struggle of obesity.
You’re not alone and dealing with this condition.
If you want to be healthy and have quality of life than this probably has to be addressed in a healthy long-term manner.
The first step has to be weight loss.
Getting to what medical charts consider a healthy weight is probably not realistic, but you should try.
at 5 foot two you should be able to get down to 140 pounds or 100 pound weight loss which is the definition of morbid obesity.
if you can lose the weight on yourself, you’ll never need liposuction, but only skin surgery.
That should be your ultimate goal.
Your goal should be to never have a liposuction and only have skin surgery as a reward of successful weight loss.
Whether you do it by diet and exercise or you do it with medical management? It doesn’t matter you need to lose the weight.
You can probably find a plastic surgeons who will be happy to do Liposuction for you at your current weight. 
Your problem isn’t fat distribution. It is obesity.
The distribution of fat, skin issues all developed as a result of obesity.
People do not change fat distribution with age in any significant way. 
For now, I recommend you focus on weight loss.
When the time comes and the problem is purely related to skin laxity, then you can consult with providers for skin surgery.
Be careful with surgery treatments that seem too good to be true or offer other than what I have described.
 Unfortunately there is some unethical businesses looking to get rich. 
Different providers may have different opinions.
Best,
Mats Hagstrom MD.

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