Yeah correct that the area of concern is complex and does not always respond the way people had anticipated from fat removal procedures. The main reason for this is that both skin laxity and skin compression contribute substantially to contour in this area. A good assessment should begin by understanding what the primary problem is and that will help determine what the right treatment is and what certain treatment can or cannot achieve. For thE other thigh I like to make a clear distinction between what is a settlebag and what is more of a banana roll or skin fold issue. I begin consultations or auto thigh assessments by creating a line that goes straight down the outer thigh. In medical terms we sometimes called is the mid axillary line but it is all straight line down the most outer part of your outer thigh that would divide the outer thigh into a front and rear half. True saddlebags are usually equally distributed on the author thigh both in front and behind this mid axinary or thigh dividing line. If all of the problems are behind a line or more on the poster your aspect of the outer thigh then results from Liposuction will be somewhat diminished. Any skin laxity due to weight fluctuations or age will lessen the candidacy or potential impact of Liposuction. I always take a weight fluctuation history on all patients as well as do an examination where I lift and pull on the skin to see if this changes the contour significantly. You can do this yourself by either looking in the mirror or have someone else take pictures while you grab the skin above the problem area and lift it up. For the area of concern you would be lifting on the hip and buttocks area or in the love handles. If the contour of the banana roll and outer thigh improve significantly by putting the skin under tension then that shows you exactly how much skin is contributing to contour in that area. Removing the fat will not reduce the amount of skin bulging due to skin laxity combined with gravity. The second variable or reason that this area is challenging is skin redundancy in an upright standing position which is how most people judge the problem and potential results from the procedure. Any joint on the body that has a substantial range of motion has to have skin laxicity to allow for that range of motion. For example, women put develop skin laxicity on the back bra roll area or in their armpit typically have redundancy because of the immense range of motion of the shoulder joint. Another area that may be easier to visualize or understand is the skinfold that forms on the lower abdomen when we sit. Sitting contracts the skin pushing the skin of the abdomen towards the thigh because of hip flexion. At the same time the skin on the back of the thigh in the sitting position is tight when the hips are flexed. In an upright standing position the front and the back skin problems flip or reverse and the abdominal skin is now under tension or stretched while the skin on the back of the thigh is being pushed into the buttocks. This creates a skin bulge in some people called the banana roll. If the outer thigh fullness is more related to the banana roll or on the backside of the mid thigh line then the less of a result Liposuction is going to create in the more complex the procedure becomes. Trying to compensate skin laxity or a skin bulge with fat removal distorts the natural normal fat distribution and can create an abnormal contour in certain body positions. That is not to say but this area cannot be treated or see improvements from Liposuction. They are the other response best to fat removal is the area closest to the mid thigh line in the area the response worse is the area on the back of the thigh just below the buttock experience All of that said, by far the most important variable is finding the most experienced and talented plastic surgeon. With experience and talent surgeons are able to make accurate assessments and clearly differentiate what represents skin, what represents fat, and understanding of how much fat can be removed exactly in what areas and predict with accuracy what the results will look like. To find the most talented provider there’s no substitute to having multiple in person consultations. Stay local and schedule all consultations as in person consultations whenever possible. During each consultation ask each provider to show their entire collection of before and after pictures for outer thigh liposuction. An experience provider should have done difficulty showing you 30 or more sets of before and after pictures for author thigh liposuction results. Ask the provider to show examples of their best outcomes, average outcomes and less than outcomes. Ask them to show before and after pictures of patients with very similar body characteristics to your own in regards to wait, size, shape and skin laxicity. Highly experienced surgeons will have hundreds of before and after pictures to choose from and should have no difficulty coming up with precise examples for you to see. Likewise, talented and experienced surgeons should have no problem showing and discussing a variety of quality outcomes and differentiating average versus best results. I recommend all patients review all various physician review websites and avoid providers with any significant number of justified negative reviews. Justified negative reviews 10 to always be organic and while not everybody is pleased with plastic surgery outcomes providers who are highly competent and practice quality medicine are able to manage the majority of patients to the point of not needing to write defaming justified negative reviews. While positive reviews may be reassuring they are typically not organic and the number of positive reviews among different providers typically has a little relationship to skill or talent. The most talented providers typically do not engage in pain advertising, large social media campaigns or require encouraging patients to promote their practice. Do not discount providers who have less notoriety or smaller Internet presence In the end vetting your plastic surgeon correctly is the most important variable in maximizing quality outcomes with a clear understanding of what can or cannot be achieved with the procedure. Good luck with your decision making and potential upcoming procedure. Mats Hagstrom MD