Will Treating Upper, Posterior Thigh (Below Butt Crease) with Zeltiq/Coolsculpting Cause Butt Droopage, Like Liposuction?

On the backs of my upper thighs, below the butt crease, I have some minor extra fat that spans across the thighs and is 1.5 - 2 in in height. I guess some people may call this the banana roll - in my case, there is no technical "roll" (more like a slight bulge). I am interested in Zeltiq, but if liposuction in that area is not recommended because it comprises butt structure and cause droopage, is Zeltiq not a good idea in that area as well?It is advertised as being a treatment for the "roll".

Doctor Answers 9

Off label uses for Zeltiq CoolSculpting thighs

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The CoolSculpting device by Zeltiq is FDA cleared for abdominal and love handle areas. Off-label uses by doctors have included the thigh and with the new CoolFit flat applicator, more areas are possible. 

The banana roll area, if treated with liposuction, can cause a drop in the buttock creating a new fold, if the fascial (deep tissue support layer) is weakened by the cannula used to vacuum out the fat. Only freezing the fat occurs with CoolSculpting as it does not involve moving a cannula through the tissue so there should be less theoretical chance of developing a problem in the banana roll area.  However, more study is needed in this area and CoolSculpting on the thigh can not be recommended at this time as a generalization.

The information provided in Dr. Shelton's answer is for educational purposes only and is not intended to constitute medical advice.  The information provided should not be relied upon as a substitute for consultations with a qualified health professional who may be familiar with your individual medical needs.

Manhattan Dermatologic Surgeon
4.9 out of 5 stars 39 reviews

CoolSculpting Not Cleared For Thigh Area

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CoolSculpting is FDA-cleared for the flanks (love handles) and abdomen and is proven to be a safe and effective treatment. At this time it is not approved for the upper thigh area.

Coolsculpting on the posterior thighs

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Coolsculpting on the posterior thighs is an off label non FDA approved treatment area and carries attendant risks that should be explained. Butt drop is not a typical side effect.

Steven Hacker, MD
West Palm Beach Dermatologic Surgeon

Banana Roll Liposuction

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The banana roll or fat below the buttock crease is fibrous and will not fit into the cool sculpting applicators.  A minimal amount of liposuction could be done with more focus on the lateral thigh.  Coolsculpting is a treatment for the rolls of the trunk, bra rolls, love handles, muffin tops, and more.

Sarah A. Mess, MD
Columbia Plastic Surgeon
4.7 out of 5 stars 21 reviews

CoolSculpting by Zeltiq Is Less Likely to Cause Butt Drooping

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Our experience for the banana roll or inner thigh with Coolscultping by Zeltiq has been less risk of butt drooping.  Ligaments lifting the butt like a sling are less likely to be disrupted as compared to liposuction.  Liposuction requires tearing through soft tissue, coolscultping is chilling the tissue.  Similar we are seeing very few side effects in a related area next to the banana fold involving the upper inner thigh.  If a vacuum suction can be maintained on an area of fat then the area can be treated.

Robert A. Weiss, MD
Baltimore Dermatologic Surgeon
5.0 out of 5 stars 13 reviews

Micro liposuction works well.

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I think I see what you are talking about, and micro liposuction works well in this area.  If done well, the buttocks should not drop. We have been disappointed with the CoolSculpting results we have seen.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon

Generally not.

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The area of the back of the thigh right next to the buttock crease is sometimes referred to as the banana roll by the general public.  This area is a great area for fat reduction in general since it makes the thigh as well as the buttock area look better.  Within this area are small ligaments that connect the skin to the underlying muscle fascia.  When liposuction is performed these ligaments can be disrupted especially if the liposuction is performed deep.  Coolsculpting has a much lower chance of disrupting these ligaments since they will generally be stretched but not broken.

All the best,

Dr Remus Repta

Remus Repta, MD
Scottsdale Plastic Surgeon
4.9 out of 5 stars 173 reviews

Coolsculpting for the banana roll

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We have had good luck with treating the banana roll with Coolsculpting/Zeltiq.  Clearly, one could not say with any certainty without seeing you in person if you would or would not be a good candidate for the procedure. If the bulge is small and/or firm, the limiting factor would be if we can get the area to be treated into the treatment chamber sufficiently. 

Good luck~

Dr. Grant Stevens

Grant Stevens, MD
Los Angeles Plastic Surgeon
4.7 out of 5 stars 152 reviews


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Coolsculpting should not cause any "butt droopage".  Coolsculpting is an effective FDA non invasive treatment for excess fat. I have seen some impressive results with a series of 2-3 treatments. However, the results do vary from patient to patient. Remember, cool sculpting requires no surgery and it will generally yield at least 10-20% improvement each treatment. It will take up to 3 month to appreciate your final results after each treatment. However, you must understand that cool sculpting is NOT liposuction. Liposuction is a surgical procedure and will yield more definitive results. Please visit with a board certified PS to learn more about your options.

Dr. Basu
Houston, TX

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.