[Case Review] Thigh and Buttock Liposuction
During thigh liposuction consultations, I often hear things like "My legs are thick, so please just make my thighs slimmer," or "I want to lose weight, but my thighs are the hardest part to slim down." Yet when we stand in front of the mirror together, the concern may start with the thighs alone, but in most cases what actually shapes the rear view and the leg line is how the thighs, buttocks, knees, and calves connect with one another.
Today, through the case of one patient who had 360-degree circumferential thigh liposuction together with the lower buttocks and the area above the knee and the inner knee, I would like to explain why we at Venus Clinic see liposuction not as "surgery that reduces a body part" but as "surgery that reshapes the body contour," and how the results should be viewed.
Liposuction Is Body-Contouring Surgery
The first thing I want to emphasize is that liposuction is not surgery to correct obesity, but surgery to reshape the body contour. Liposuction textbooks also explain that obesity by itself is not an indication for liposuction, and that there is no scientific evidence that liposuction treats obesity [1]. Reducing body weight is the role of diet and exercise; liposuction is surgery that refines the subcutaneous fat in areas that do not respond well to exercise and diet, changing the outline of the body.
We Judge Results by Overall Body Balance, Not by Size
For this reason, we do not judge the results of liposuction only by "how many centimeters the thigh circumference decreased." Even if the thighs become slimmer, it is hard to call it a good result if the buttocks look relatively larger, or if fat remains around the knees so that the thighs and calves connect awkwardly. The goal of liposuction is not simply to reduce the size of the treated area, but to make the overall body shape balanced and attractive. This is why we plan the surgical range by looking at the thighs, buttocks, knees, and calves not as separate parts, but as one continuous line of the legs and the rear view.
When the Fat Layer Becomes Thinner, the Shape of the Bones and Muscles Shows
When the fat layer beneath the skin becomes thinner, the shape of the muscles and bones underneath becomes visible on the surface. Textbooks also explain that when the bulge of the inner thigh is flattened with liposuction, the silhouette comes closer to the outline of the muscles [2]. In other words, the result of liposuction ultimately follows the bone structure and muscle shape the person already has, and we review this together during the preoperative consultation and explain the changes you can expect.
We Treat the Thigh as a 360-Degree Cylinder
The thigh is shaped like a cylinder, with the front, outer, back, and inner sides joined all the way around. If only one or two of these sides are treated, a boundary can form between the treated and untreated areas, and the leg may look different depending on the viewing angle. In this case, the patient had surgery on the entire 360-degree circumference of the thigh.
Textbooks also explain that connected areas such as the inner thigh and the inner knee give smoother results when treated as one continuous area rather than separately, and that treating them separately tends to leave a boundary line at the edge of the treated area [2]. They also note that the outer thigh borders the hip, so it is natural to treat it together with the buttocks [3]. At Venus Clinic, too, when we perform thigh liposuction we often plan it continuously, extending up to the hips and buttocks and down to the knees [6]. We remove the fat that needs to be removed as thoroughly as we can, and we smooth the contour so that it is not lumpy or uneven.
| Treated area | Why it was treated together in this case |
|---|---|
| Thigh, 360 degrees | To refine the front, back, inner, and outer sides in one continuous circle, creating a thigh line that flows without boundaries from any angle |
| Lower buttocks | To reduce the weight and volume of the lower buttocks and improve sagging, and so that the buttocks do not look relatively larger when only the thighs become slimmer |
| Above the knee | To smoothly connect the line running from the front of the thigh past the knee down to the calf |
| Inner knee | To reduce the bulge on the inside of the knee and straighten the line running from the inner knee to the inner calf |
Why We Also Treat the Lower Buttocks
If Only the Thighs Get Slimmer, the Buttocks Look Bigger
Some people who have had liposuction on the thighs alone say after surgery that "my buttocks look bigger and saggier." The buttocks themselves have not changed, but because the thighs have become slimmer, the buttocks look relatively larger [7]. So for someone whose thighs and buttocks are both large, it is important to plan so that the size of the two areas stays in harmony.
How Buttock Sagging Improves
When the buttocks sag, the drooping buttock tissue (skin and fat) covers the original crease line between the buttock and the thigh. The line many people think of as a crease is often actually the lower edge of the sagging buttock. When liposuction of the lower buttocks reduces volume and weight, the skin contracts and the buttocks rise; the buttocks become shorter in length while the thighs look longer [8]. Textbooks also explain that when fat is suctioned from a shallow layer above the buttock crease to lighten the weight of the buttock, the skin contracts slightly [5].
Just Below the Buttock: Shallow and Careful
The bulging area just below the buttock crease, at the upper back of the thigh, is called the banana fold in textbooks. Fibrous tissue that supports the buttock runs through the deep fat layer of this area, and if fat is suctioned deeply, this tissue can be damaged, which may lengthen the crease below the buttock [5] or create a double crease (two crease lines), which is not easy to correct once it forms [4]. That is why at Venus Clinic we carefully refine only the shallow layer in this area [7].
When a Crease Line Appears Below the Buttock After Surgery
As the buttocks rise, the original crease line, which was hidden by the sagging buttock before surgery, may become visible. This crease is not newly created by the surgery; it is the crease line that was already there. Also, depending on skin elasticity, the buttocks may not rise enough and some sagging may remain [8]. Because the crease line is hidden before surgery, it is difficult to know exactly in advance which will happen, and results differ from person to person.
Above the Knee and Inner Knee: The Line Leading to the Calf
The knee area is easy to leave out in thigh liposuction, but in the leg line the knee is the link between the thigh and the calf. If fat remains above the knee, the area above the knee stands out even though the thigh has become slimmer, and the line running from the thigh down to the calf looks broken.
A Bulging Inner Knee and a Hollow Inner Calf
When fat bulges out on the inside of the knee, the inner calf below it looks relatively hollow, and the legs may even look curved, like bow legs. Reducing the bulge on the inside of the knee lets the area from the inner knee to the calf connect in a straight line, tidying the leg line from the thigh down to the calf [6]. Textbooks also explain that reducing fat on the inner knee gives the inner knee a pleasing, balanced contour [2].
Setting Realistic Expectations
What liposuction can address is the fat beneath the skin. The degree of curvature of the leg bones and the size of the muscles themselves do not change with liposuction, so it is not surgery that straightens bow legs caused by the bone structure. It is more accurate to understand it as refining a line that looked curved because of fat. Also, after fat on the inner knee is reduced, the inside of the knee may look slightly concave when the knee is bent at 90 degrees [2].
Liposuction reduces the number of fat cells, so if you gain weight after surgery, the remaining fat cells can enlarge again, and more fat may build up in untreated areas, making the body's balance look awkward. How much the buttocks rise and how the leg line changes also vary from person to person depending on skin elasticity and body type. Continuing to manage your weight after surgery helps maintain the results longer.
Advantages of Treating the Thighs and Buttocks Together
The Balance Between the Thighs and Buttocks Is Maintained
When the size of the buttocks decreases along with the overall size of the thighs, the balance between the thighs and buttocks is maintained. Without the awkward look of slim thighs and relatively large buttocks from behind, the rear view running from the waist through the buttocks to the thighs is tidied into a single line.
The Leg Line Continues Down to the Calf
When the area above the knee and the inner knee are treated together, the line of the whole leg can be refined, not ending at the thigh but continuing past the knee down to the calf. From the front, the line from the inner knee to the calf, and from the side, the line from above the knee down to the calf, connect smoothly, so the entire leg line looks noticeably straighter.
References
- Klein JA. Tumescent Technique: Tumescent Anesthesia & Microcannular Liposuction. Mosby; 2000. Chapter 28.
- Klein JA. Tumescent Technique: Tumescent Anesthesia & Microcannular Liposuction. Mosby; 2000. Chapter 34.
- Klein JA. Tumescent Technique: Tumescent Anesthesia & Microcannular Liposuction. Mosby; 2000. Chapter 32.
- Klein JA. Tumescent Technique: Tumescent Anesthesia & Microcannular Liposuction. Mosby; 2000. Chapter 36.
- Toledo LS. Refinements in Liposculpture of the Buttocks and Thighs. In: Shiffman MA, Di Giuseppe A, eds. Liposuction: Principles and Practice. Springer; 2006. Chapter 20.
- Venus Clinic. Liposuction at Venus Clinic. https://myvenus.co.kr/liposuction/664 (in Korean)
- Hakjun Kim. [Case Review] A Double Crease After Thigh Liposuction. Venus Clinic Doctor's Column; 2026. https://myvenus.co.kr/column/578365 (in Korean)
- Hakjun Kim. How the Buttocks Rise After Liposuction for Buttock Ptosis. Venus Clinic Doctor's Column; 2026. https://myvenus.co.kr/column/578392 (in Korean)
Before-and-After Photos
Below are front, side, and rear photos of one patient who had 360-degree circumferential thigh liposuction together with liposuction of the lower buttocks, above the knee, and the inner knee at Venus Clinic. All after-surgery photos were taken 1 week after surgery. Results vary from person to person depending on body type and skin elasticity.
Thigh and Buttock Case (Front, Side, Rear)
Front — The saddlebags on the outer contour of the thighs have been removed, and fat on the inner thighs has also been removed.
Side — The bulge on the front of the thigh has been removed, and the buttocks appear lifted. Although this photo was taken only 1 week after surgery, only slight bruising is visible from the side, and recovery has been progressing well.
Rear — The line from the inner thigh to the calf has become straight, and with the saddlebags removed, the outline of the buttocks and thighs has become more feminine. The crease at the lower buttocks has also been removed, so the buttocks look more lifted.
This is a case in which the thighs (360 degrees), the lower buttocks, and the area above the knee and inner knee were treated together. The thighs were treated circumferentially, all 360 degrees; the lower buttocks were treated to improve buttock sagging; and the area above the knee and the inner knee were treated at the same time. Not only did the overall size of the thighs decrease, but the size of the buttocks decreased as well, so the body changed into an overall well-balanced shape while the balance between the thighs and buttocks was maintained. In addition, both the line from above the knee to the calf and the line from the inner knee to the calf improved, so the hollow area of the inner calf that had looked like bow legs now connects in a straight line, and the leg line down to the calf has been tidied as well.
| Information on the Posted Liposuction Before-and-After Photos | |||
|---|---|---|---|
| - Same person | Surgery performed at Venus Clinic; same person | - Date taken | Taken around 2025; comparison at 1 week after surgery |
| - Same conditions | Edited to the same posture and size as closely as possible | - Side effects | https://en.myvenus.co.kr/should_know/38861 |
In Closing
The most important thing in thigh liposuction is not the size of the thighs alone, but the balance of the whole body shape that continues through the buttocks, knees, and calves. At Venus Clinic, we view the thigh as a 360-degree cylinder and plan surgery so that the lower buttocks and the knees are connected into one line.
References: Thigh, Buttock, and Knee Liposuction How Buttock Ptosis Liposuction Works Double Crease After Thigh Liposuction
Dr. Hakjun Kim, Director, Venus Clinic
