On occasion, I am asked to perform liposuction on the area known as the "banana roll". The area is fraught with complications and poor outcomes. The reason for this comes down to one of my most basic fundamental beliefs in surgery. First, you need to make the correct diagnosis, and then you apply the correct treatment. The banana roll is a skin-only condition and has nothing to do with fat.Let me try to explain the physiology of the banana roll. At times, I love when patients come in to my office and lean forward and pinch one of their abdominal skin folds and say, "Doctor, look at this. It has to go." In general, this is when patients want liposuction. I then ask them to stand up and show them that the fat goes away when they stand up and that everyone has a roll when they lean forward.The same is true for the upper back of the thigh. When we lean forward gently, there's no fold or roll of excess fat at all. When we stand up straight, the skin gets scrunched together, and the roll forms. It's because the skin is being scrunched together, and, therefore, the problem is not that there is excess fat in the area.Since it's a skin condition and not fat, liposuction is surely not going to be an effective treatment. As you know, a banana roll can even be created by inappropriately performed liposuction. In your case, there is no simple answer since a definitive diagnosis needs to be made first.If someone has a defect after liposuction, there are two generally two, and sometimes three, alternatives. They include doing revision liposuction to make things even, doing fat transfer to restore excessively removed amounts of fat that should not have been removed and, thirdly, doing a skin resection when indicated. In your case, no one will be able to give you an accurate assessment or recommendation based on such limited information. To get an accurate assessment, you need an in-person evaluation. Please consult with a plastic surgeon who specializes in liposuction and fat transfer.Best of luck,Mats Hagstrom, M.D.