What are revision options for a skin fold under the butt/banana roll and over-suctioning of inner thighs and knees? (photos)

Question

I had bad liposuction done a couple years ago that caused irregularities to my inner thighs/knees as well as forming a roll below my left butt cheek. I have gotten fat grafting and additional liposuction done with the hope of improving these issues with no improvement. The surgeon I used for the revision even tried kybella on the butt roll without any improvement. What options do I have For fixing the roll under my butt? And can I do anything to improvement the appearance of my knees.

Stephen M. Krant, MD, FACS · Answer

With your photos, it is difficult to visualize the specific
problem. Secondary liposculpture with prolonged tape support may help to
correct the left butt crease. The inner thighs and knees are more problematic
since the tissue is thinner. Start with ultrasound to soften the scars and to
increase circulation. Then, further autologous fat graft may help the problem.
It is NOT an easy problem/cure! Good luck!

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.

Daniel Barrett, MD · Answer

Dear Interestedinsurgery15,
it is hard to tell for sure without an examination. If you are considering a surgery, I would suggest you to consult a board-certified plastic surgeon. Only after a thorough examination you will get more information and recommendations.
Daniel Barrett, MD

Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Kamran Khoobehi, MD · Answer

There are areas of too much liposuction and areas of need for suction. The best is to do liposuction and fat grafting to reverse the over liposuction areas.

John P. Stratis, MD · Answer

First, it would be important to have a face to face in office consultation with an experienced plastic surgeon and have previous before picture available and the operative report available for review. Revisions of all types require as much information as possible in order to understand why the deformity occurred and what can be done to correct it.I personally would be cautions of any physician who thinks their technique or machine is the only way to solve a particular problem, especially if that physician is making their claim just by looking at pictures.I have had and I have seen good results with SAFE lipo techniques, developed by Dr. Simeon Wall in Louisiana. He has extensive experience in revisional liposuction procedures.Be cautious with the next procedure because you certainly don't want to make things worse.

Mats Hagstrom, MD (license on probation) · Answer

Unless your last provider was subpar you already understand the limitations of revising previously poorly done liposuction. This is especially true for those who have been over treated. Treatment options are generally revision Liposuction which is often counter to what the primary problem is, fat transfer or converting the procedure to a skin excision procedure like a fight lift or tummy tuck for abdomens.Since afternoon the primary problem is that too much fat was removed revision Liposuction can definitely make things worse and it’s limited in what it can achieve. In some ways it’s simply throwing gasoline on the fire. Fat transfer is limited because over treated areas no lack post tissue to support the graft leading to fairly high graft loss.When fat transfer is the approach patients generally need to except that this will take multiple rounds.Because this is tedious work with only small increments of improvement With each go around the incentive to move forward with revision surgery often diminishes with patients having almost PTSD symptoms from being disfigured.First and foremost is excepting the inherent limitations and that there is no one single procedure they can fix the problem. Sometimes things can be made a little better and that’s the best that should ever be offered.I would be very apprehensive of anyone claiming to have a fix all technique or the skill to correct the problem. This is especially true for those claiming to have some special magical device such as VASER to “break up scar tissue”.I’ve done the best that can be had is to make things look a little different.The area of concern should probably not have had liposuction in the first place. The banana roll is a skinfold and it’s not related to excess fat.areas that are better for liposuction such as the abdomen or arms have a better shot at correcting deformities because the area responds well to liposuction in the first place.The banana roll is particularly an undesirable area to treat with liposuction and inner thighs is a close second.I wish they would teach these concepts in plastic surgery school but sometimes they don’t.Best, Mats Hagstrom MD

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

High definition VASER liposuction is very efficient at correcting traditional liposuction complications. 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, 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

What are revision options for a skin fold under the butt/banana roll and over-suctioning of inner thighs and knees? (photos)

Answers (7)

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