After the abdomen, the most popular liposuction procedure is undoubtedly the upper lateral thigh, also known as saddlebags. The flank just below, better known as love handles, also brings its share of dissatisfaction. This is why I treat these two areas as a single anatomical unit, and when the patient comes for her saddlebags, I encourage her, when indicated, to address both at the same time. Why correct only one flaw and leave the other for later, when both can be removed simultaneously at a lower cost, completely resolving the issue?
As we touched on in a previous chapter, the violin deformity combines three anomalies:
a more or less hollow area between these two fat bulges, known as the iliac depression.
However, note that while three anomalies contribute to the violin deformity, its correction must go beyond these three anomalies. Indeed, experience has taught me that to achieve an excellent result, it is necessary to correct the lower buttock and the banana, that is, this banana-shaped fat bulge on the upper posterior part of the thigh.
Indeed, the weight and volume of the fat in these two areas, the buttock and the banana, push the thigh outward, accentuating the saddlebags. I have named these two areas the triangle, because when drawing on the patient, it forms a triangle.
However, note that while three anomalies contribute to the violin deformity, its correction must go beyond these three anomalies. Indeed, experience has taught me that to achieve an excellent result, it is necessary to correct the lower buttock and the banana, that is, this banana-shaped fat bulge on the upper posterior part of the thigh.
Indeed, the weight and volume of the fat in these two areas, the buttock and the banana, push the thigh outward, accentuating the saddlebags. I have named these two areas the triangle, because when drawing on the patient, it forms a triangle.
Fatty flanks or love handles are almost always present, especially since they tend to increase in volume after menopause. Reducing them through liposuction can be a true rejuvenation. It is important to note that love handles are very common in men, and this aspect leads to constant demand for liposuction with excellent results, but it requires a reliable technique since the fat there is very fibrous and harder to remove.
The iliac depression, this hollow area between the two bulges of the violin deformity, is sometimes completely devoid of fat. At that point, we start by harvesting fat from the outer thigh or flank, and at the end of the procedure, we reimplant this freshly “harvested” fat to fill the hollow area. Then, with their thumbs, the surgeon molds this new fat, as if it were modeling clay, to distribute it evenly.
Since the reinjected fat does not fully revive, some can be stored in the freezer to be reimplanted a few months later. At that point, we hope to achieve the line I have named the “Claudia Schiffer line,” which is a harmonious, perfect curve running from the flank to the outer knee, without any breaks or bumps. Returning to the saddlebags, the first of the inseparable duo, let us repeat that it was this area that motivated the invention of liposuction. Indeed, large bellies, especially aprons, were treated by lipectomy, despite unavoidable scarring, but at least with clothing, the disfigurement was no longer visible, except in private.
For saddlebags, the operation was much less suitable, as the fat block to be removed was harder and less well-defined than an apron of fat; also, the procedure caused such scarring that the patient could hardly show her thighs anymore. Then came liposuction…
But what the patient must understand once again is that liposuction only accesses fat. If the muscle is “bulging” in that area or the bone is prominent, some roundness may remain, although the improvement will always be significant. Of course, some patients will not be satisfied, even with excellent results, because they wanted to look like a friend who went to a certain surgeon and was left with no roundness at all. But would that other surgeon have done better? Each patient is different, and trying to remove too much to flatten the area at all costs would lead to skin irregularities, very unsightly, somewhat resembling repoussé leather.
I take advantage of this photo (Fig. 131) to express some reservations about comparisons between different practitioners. Despite my experience of over 5000 procedures, I can never offer a patient an absolute guarantee of the outcome of a liposuction. What I know for sure is that the quality of treatment, the attention paid to patients, and their motivation to improve their appearance for many years guide every professional action I take in the most transparent dialogue possible.
