Sometimes the Best Liposuction Revision Involves Neither Liposuction Nor Fat Grafting
As a surgeon who performs hundreds of liposuction revision cases each year, I am often confronted with patients from all over the world who require different modes of thinking and prioritizing and different methods of correction in accordance with both their wishes and in accordance with what they are willing to sacrifice for those results. Sometimes liposuction hastens the descent of skin and fat grafting to replace the tissue is really a poor solution to the issue. Sometimes the best solution is a solution that was never considered in the first place. I will provide some examples.
I frequently have athletic people who have had previous liposuction of the banana roll or the area under the inferior buttocks. If this is done too aggressively or if the skin continues to sag there is a real problem that presents itself. Although I can occasionally do body tite to improve the skin laxity, much greater skin laxity will not respond to body tite.
So the issue is that the inferior aspect of the buttock and the posterior thigh have essentially too much skin. In many cases some of these patients have had further revision surgery including a lower posterior body lift. They have acquired a scar at the top of the buttocks in an attempt to lift the buttock and improve that area. The problem with this technique is that it frequently does not lift the buttocks effectively and it does not address the posterior thigh laxity.
The best treatment for this laxity is something I call an inferior buttock lift or a posterior thigh lift. The incision is placed within the natural buttock crease, technically called the gluteal fold. Through this incision you can take out several inches of skin from above the fold and from below the fold. Please see my you tube videos of inferior buttock lift. This will tighten the skin, improve the look of cellulite, improve dimpling from previous liposuction and will improve contours of the buttocks and thighs. In fact, the technique I use can be used to create a gluteal fold as I have done for some who do not have any definition of the buttock or no thigh buttock definition.
The incision is very versatile and I have used it many times to remove silicone or other foreign materials from the buttocks. I have used it for fat necrosis removal. Fat necrosis occurs when transferred fat dies due to lack of blood supply. This occurs most commonly after a Brazilian buttlift. This dead fat must be cut out as these are hard calcification bricks of tissue not amenable to liposuction.
The incision can also be used to help camouflage buttock irregularities after removal of fat necrosis or silicone or whatever. The procedure can be used to improve the roundness of the buttock all at the same time. In addition, this works very well for very long buttocks on in patients with residual skin due to massive weight loss.
The other advantage to this technique is that it can create shape to a saggy butt without further flattening the buttocks like the lower posterior body lift inevitably does. The real advantage of the lower posterior body lift in my opinion is that it can address a great deal of laxity along the lateral thigh element. However it does little to help the inferior buttocks without flattening the buttock significantly and it does not address the posterior thigh element like the inferior buttock lift does.
Thus, in some cases of liposuction revision placing fat back into the area where fat has been removed is simply not the best strategy. In these cases that are more difficult, is imperative to seek out a true expert in the field of body contouring who has at his disposal seemingly infinite number of techniques to address whatever particular problems that are confronting the patient a present. You do not want to be pigeonholed into selecting a surgeon and a technique merely because that surgeon is comfortable performing that technique.