Outer Thigh Bulges

by James J. Romano, M.D.

“Dr. Romano, I am at my perfect weight, eat healthy, and exercise regularly yet I have these bulges on my outer thighs like saddlebags that I just can’t get rid of”

THE TYPICAL PATIENT WITH OUTER THIGH BULGING

The above quote is by far the most common statement I hear from patients. In this situation, there is a desire for a more youthful and contoured appearance, silhouette, and size of the outer thighs. There is the desire to fit better in clothing, wear smaller clothes, tuck in shirts, and look better in swimsuits. Many patients focus on localized fatty deposits in the outer thighs because it can be hard to change the appearance this particular area with diet and exercise. Features of excess fatty accumulation may also be present in the face, neck, chest, abdomen, hips, back, flanks, inner thighs, outer thighs, knees, legs, or ankles. Dieting and/or exercise do not always address these the problem of excess fatty deposits, but certainly complement the result achieved by liposuction.

THE POPULARITY OF LIPOSUCTION

Our societal near-obsession with body image and shape, combined with the limitations of diet and exercise, has helped to create a tremendous public demand for liposuction. This procedure is the single most often performed and requested cosmetic surgical operation in the United States today. Its popularity is fueled by the fact that in most trained hands it is relatively safe, the results provide immediate gratification for the patient, and there often is only mild discomfort with a rapid recovery. Many physicians—not just plastic surgeons—are learning, marketing and offering this procedure, so be aware of your physician’s credentials.

THE PHYSIOLOGY AND BIOLOGY OF FAT

Fat, or adipose tissue, is composed of fat cells (adipocytes), which store fat (mainly triglycerides), and a loose supportive connective tissue structure containing blood vessels and nerves. Fat cells play numerous metabolic roles in the body including that of an energy source and storage place, interacting with insulin and hormone synthesis, to name a few. Studies suggest that adult fat cells are incapable of multiplication, therefore there are a fixed number distributed in a genetically predetermined fashion throughout the body.

Regardless of the function, as a person gains weight these cells expand, and as weight is lost they contract, but the number and distribution remain essentially unchanged. This accounts for why so many normal weight people complain of localized fatty deposits unresponsive to diet and exercise, and why liposuction is perfect for such individuals. This also explains why dieting does not interfere or conflict with liposuction. Dieting reduces a patient’s weight and overall size, and may show some improvement in specific areas, but liposuction affects shape and contour. In other words, liposuction removes fat cells so that this reduced overall number imparts a “protective effect” on the treated area and weight gain or loss won’t be noticed as much as in the non-treated areas.

THE TECHNIQUE

Liposuction is performed by first determining the areas of fat excess to be treated and injecting these areas with anesthetic solution. In this example, the outer thighs or saddlebags. When looking front view into the mirror these are the bulges just below the waistline at the outer thighs. It usually extends around the back in a roll just below the buttock crease. Markings are placed around the targeted areas.

Next, tumescent anesthesia is used. This method of anesthesia is one of the greatest advances in liposuction and is so popular it is now used by most physicians. It employs a dilute local anesthetic solution that is generously injected into specific areas. This procedure reduces bleeding, bruising, discomfort and pain, and contributes to more rapid recovery and often, a more predictable result. Local anesthetic can be the sole anesthetic, or, it can be combined with intravenous sedation or general anesthesia. This advanced anesthetic technique virtually eliminates any pain during the procedure, post-operative pain, or bruising.

After the anesthesia is in effect, tiny little incisions about ¼ inch in length are placed in several inconspicuous locations. The fat is removed with thin tubes connected to suction. The small diameter tubular instrument used to remove the fat is called a cannula. These instruments come in various shapes and sizes depending on the amount and location of the fat. They have highly polished surfaces to slip through the fatty tissues with minimum friction or damage. They are blunt-tipped to prevent cutting and bleeding, and essentially “push aside” and protect the blood vessels and nerves. The cannula suctions out the fat through one or several strategically placed holes at the tip. The end result is assessed by how smooth and natural the contour is. There should be no dents or bulges. No drains are used. A foam pad then a tight garment is placed over the area.

Liposuction can be performed by one of two techniques. The conventional technique (described above) relies on the mechanical disruption of fat cells by the movement of the cannula and the vacuum of the suction pump. The second technique is called ultrasonic liposuction, or ultrasonic assisted liposuction. It is a new technology that has generated substantial interest. Ultrasonic sound waves, much like shock waves, are transmitted into the fatty tissues from the tip of the cannula probe. The fat cells are disrupted and the fat is removed by low-pressure vacuum. Either technique provides an excellent, safe, and predictable result. Which one is best for you depends on the quality of fat, amount of fat to be removed, the distribution of the fat, and other factors.

THE RECOVERY

You can go home after several hours or can stay overnight in the surgical center. You can shower the next day. There is only minimal pain that is mostly gone by the next day and easily controlled by medications. Swelling is mild to moderate and peaks in two to three days, then disappears rapidly over the next three weeks. Minimal or no bruising is usual. Some grogginess is present which can persist for about a week. You can resume many activities within the first week, and most including exercise, in at least three weeks. There are no stitches to remove. Expect to be off of work for only one to seven days. Some patients return to work the next day!

THE RESULT

You can expect a beautiful, balanced and proportioned contour that is immediately seen and only gets better in time. If you gain weight, you do not gain much in the liposuction areas. The liposuctioned areas appear natural and presentable in the first week that just gets better over the next three to six months. You are more confident and comfortable with your appearance.