Thigh Liposuction and Buttock Liposuction: Surgical Areas and Cost

In this article, we divide the surgical areas of thigh liposuction and buttock liposuction one by one with color-coded illustrations, and explain why the cost differs depending on the surgical area and what you should check carefully before surgery.

The colors are translucent so that the outline of the body remains visible. The same number marks the same area in the front, side, and back views.

The location of each area is summarized in the table below.

We divide the buttock into four parts by drawing a vertical line and a horizontal line through the center. The outer upper part is the upper-outer, the inner upper part is the upper-inner, the inner lower part is the lower-inner, and the outer lower part is the lower-outer. In the illustration, ① upper-outer and ② upper-inner together are called the upper buttock, and ③ lower-inner and ④ lower-outer together are called the lower buttock. The hips, on both sides above the buttock, and the saddlebags, just below the lower-outer, are distinguished separately from the buttock.

For this reason, at Venus Clinic, for a figure in which fat is concentrated in the lower body, we suggest treating the lateral, medial, anterior, and posterior thigh as a 360-degree cylinder, together with the knee, buttocks, and hips. We remove the fat that needs to be removed as thoroughly as possible, and smooth the line so that it is not bumpy.

On the day of surgery, we draw the fat thickness on the skin of the area to be suctioned, like the contour lines of a map. At the center of the concentric lines, the fat is thick, and it becomes thinner toward the outside. We review the area to be suctioned together with you using these markings [7]. During surgery, we suction crosswise, changing direction through several incisions, and taper the edges gradually so that no boundary is left with the surrounding area [8].

The lateral thigh is strongly affected by the position used during surgery. When the patient lies on the side and the thighs are bent forward and brought together, the upper end of the thigh bone (the greater trochanter) is pushed outward and lifts the fat and skin above it, creating a "pseudobulge" that looks fuller than it really is. If this fullness is suctioned as it appears, the spot will look sunken when the patient stands up [2][7]. So the thigh is kept in a straight line with the body, and suctioning is done with the same contour as when standing.

Caution is needed when operating in the "frog-leg position," in which the patient lies on the back with the knees bent and the thighs rotated outward and spread apart, for example when treating the inner thigh. In this position, the thigh rotates and the fat on the inner thigh is stretched and twisted; if it is suctioned in that shape, the fat may be removed unnaturally once the patient stands with the legs straight, and unevenness is likely. This stretching, compression, or twisting of subcutaneous fat when the body moves away from the correct posture is called lipowarp (fat warping) [1][7]. Lipowarp occurs not only in the frog-leg position but also when operating with the thigh rotated [7]. For the outer thigh as well, when the hip joint is bent forward, the fat at the back is stretched and the fat at the front is compressed, so it is easy to suction too much at the back and too little at the front [2]. Therefore, when operating in the frog-leg position, we take care with the amount and direction of suctioning, keeping in mind that the fat is in a warped shape, and we support the thigh as close as possible to its standing shape during surgery.

For the same reason, surgery should not be performed with the thigh rotated inward (internal rotation) or outward (external rotation). When the thigh rotates, the shape and proportions of the fat layer change, so even if the suctioning looks even on the operating table, once the patient stands, one side may have too much removed and the other too little [2][7].

In particular, when the thigh is drawn inward (adduction), outward (abduction), or rotated, the position of the greater trochanter, the bony prominence at the upper outer femur, moves as well. The spots that look prominent or hollow on the operating table then swap places compared with standing. If a lot is removed from an area that looks prominent in this position, that area can sink and leave a depression once the patient stands upright.

Also, if liposuction is done while the fat layer is twisted by adduction or abduction, the cannula tracks may look straight on the operating table, but once the leg returns to the normal position they are no longer straight — they become twisted like a snake. Because the fat has been removed along twisted paths, the surface becomes uneven. That is why at Venus Clinic we perform suction with the thigh kept close to its natural standing position.

In the thigh and buttock, there are five places where the shallow fat layer just under the skin is firmly attached to the membrane covering the muscle and there is hardly any deep fat layer. They are the lateral gluteal depression, the gluteal crease, the distal posterior thigh, the middle medial thigh, and the inferolateral iliotibial tract. These "zones of adherence" are said to be attachment bands that firmly anchor the skin to the muscle so the skin does not sag. For this reason, they are areas where excessive liposuction should be avoided. Suctioning too much here makes the area prone to sinking and unevenness, and the fat gathering between these zones instead looks more prominent [9]. At the pre-surgical design, we mark these five places first.

In the banana-shaped fold area where the lower buttock meets the back of the thigh, removing a lot of fat carries a high risk of creating a double crease [2]. So this area is suctioned conservatively, the cannula is inserted at an angle of about 45 degrees to the gluteal crease, and suctioning is not done across the back of the thigh [4]. If too much fat just below the gluteal crease is removed, the area where the sitting bone presses when sitting may become painful, and it has been reported that a problem that arises this way is difficult to reverse [4].

Even with the same phrase "thigh liposuction," the areas included may differ from one consultation to another. That is why you should check the surgical areas carefully before having surgery. At the consultation, please check the items below together.

The same applies when you choose a liposuction clinic, receive consultations at several places, and compare liposuction prices. At the consultation, confirm which surgical areas are included, and compare prices only for the same areas. This is because, even when the surgery has the same name, costs cannot be compared directly if the included areas differ.

Please be sure to tell us at the consultation about any medication you are taking. Some medications, such as steroids, can slow wound healing. When the thigh is treated as a 360-degree cylinder, recovery takes longer than for other areas, and if the calf and ankle are also treated as a cylinder at the same time, swelling in the leg can become very severe, so we do not do them at the same time. In the lower two-thirds of the thigh, the skin may not adhere well in some people, so we also look at skin elasticity before surgery.

After thigh and buttock surgery, you wear a thigh compression garment that covers from the lower abdomen to the ankle. This is because a garment made for the torso does not press on the thighs [5]. Generally, it is worn 24 hours a day for the first 2 weeks after surgery, then only during the day once it feels comfortable, and because the skin continues to adhere during this process, we advise wearing it for at least 1 month. For the inner thigh in particular, the garment must be pulled up fully to the groin line so that no bulge remains there. On the other hand, compression that is too tight can block lymph flow and actually increase swelling [6], so it is important to wear a garment that fits your body.

Even while wearing the compression garment, sitting hunched for a long time can cause the surgical area to contract while folded. Sit with your back straight, and walking a little from the day of surgery helps with swelling and preventing blood clots. Please avoid showering for the first 3 days and soaking in a bath for 3 weeks, and increase active exercise such as jogging or aerobics gradually after 3 to 4 weeks following surgery.

This is a "Thigh Premium Liposuction" case in which the 360-degree thigh, above the knee, medial knee, buttocks, and hips were treated together, and all of the after-surgery photos were taken about 7 weeks after surgery. Swelling may still remain at this stage, so this is not the final result.

This is a case in which the 360-degree thigh, above the knee, medial knee, buttocks, and hips were treated together. All photos taken from the front, back, and side in several postures are included. Please compare the outer line running from the hips to the thigh, the inner thigh and inner knee lines, and the lower buttock line together. Although a large amount of fat was removed, with a pure fat volume of 3,300ml, you can also see in the after-surgery photos that the thighs and buttocks do not look saggy. This is because the surgery was performed to smooth the fat layer evenly while respecting the zones of adherence, and so that the skin would tighten to fit the reduced volume.

Below is a photo of the fat suctioned in this case. After excluding the red liquid layer at the bottom of the canister, the pure fat volume was 3,300ml.

The contents collected in the canister separate into two layers. The yellow layer on top is called supernatant fat, and the red liquid layer at the bottom is called infranatant fluid. The lower layer is mostly the tumescent anesthetic solution infused during surgery, and the upper layer is the fat that was actually removed. As in the photo, an upper layer of clear yellow and a thin lower layer indicate that the yellow fat was suctioned cleanly with little bleeding. In this case, there was hardly any bruising even around 1 week after surgery. At Venus Clinic, we use handmade micro cannulas and have experience with this surgery, and we suction while working to reduce tissue damage and bleeding. However, the degree of bruising and swelling can differ from person to person.

Thigh liposuction and buttock liposuction have short names, but many surgical areas are included within them. Depending on which areas are treated together, both the balance of the result and the surgical cost change, so before surgery, please point out your areas of concern by the numbers in the illustrations, check carefully how far the surgery extends, and then decide. When you look for a liposuction clinic and compare liposuction cost and liposuction price, please also compare only the same surgical areas.

References: Cylindrical Thighs, Hips, Buttocks, and Knees Liposuction of the Hips, Buttocks, and Thighs The Apple Line of the Thighs and Pelvis Recovery Schedule After Liposuction Precautions by Surgical Area