It is necessary to describe these body sections as a complete unit rather than as separate areas. Women in particular tend to have subcutaneous fat deposits on the high hip and lateral thigh, often resulting in a disproportionate size problem when buying clothing. Many patients will report that they have to buy clothing of one size to fit their chest and a larger size to fit their hips and thighs. Some patients appear complaining that their problem is their buttocks, their “saddlebags” or possibly their “thunder thighs.” It will be the cosmetic surgeon’s responsibility to create the curves and decrease the volume of the appropriate areas, which may not be the patient’s perception. The cosmetic surgeon who is performing liposuction on this area must evaluate the woman from the waistline to the knee.
The optimum result will only occur if the cosmetic surgeon can conceptually perceive the postoperative shape. To help delineate the desired contour one needs to know the maximum concavity in the convex curve that makes up the hip and lateral thigh. This area is the maximum gluteal depression. An easy way to evaluate that depression is to have the patient laterally abduct the leg in the standing upright position. As a part of my marking technique I mark this depression. This depression is the distal extent of the high hip and the proximal extent of the lateral thigh. As one performs the liposculpturing surgical procedure one must realize that the convex curve and round feminine derriere one is attempting to accomplish requires reduction of the subcutaneous fat in both the lateral thigh and the high hip area until they are confluent with the original concavity between the two areas. To achieve the best results, the hip and the lateral femoral area need to be treated during the same operative procedure. Women tend to gain weight around the hips with age and pregnancy. Many feel this is the beginning of the aging process and are anxious to have this area reduced. It should be noted to remove the fat in the high hip especially in the deeper planes the cosmetic surgeon needs to note that the fat is oriented in a more superior plane than the fat of the lateral thigh.
This area is one of the more forgiving areas of the body and superficial liposuction is usually not required. Deep liposuction will usually give excellent results in this area. Most of the time the skin in this area is quite thick and it contracts nicely. For patients who have flaccid skin and excessive fat in this area, superficial liposuction might be required, with the results always being controlled by constantly evaluating irregularities with the free hand. One needs to develop a concavity in this area that blends into a convex curve at the hip.
There is no area of the body where the surgical markings are more important than in the gluteal trochanteric lateral thigh area. The disproportionate areas of fat deposits are altered when the patient is placed on the surgical table. The patient has to be marked in the standing position and the markings need to be followed when the patient is lying on the surgical table. To obtain optimal results, the cosmetic surgeon will need to conceptualize the perceived postoperative result. I use a topographic type of marking with more circles in areas that will need more suction. As mentioned earlier, the delineation of the high hip requires the knowledge that the deeper fat lies slightly superior and medial to the horizontal. The superior margins blend up and into the back, whereas the inferior margin stops at the maximum gluteal depression. Once this area has been marked, the lateral thigh and posterior thigh to be included in the resection should be marked.
Obviously the body is not symmetric and the markings will be slightly different on the two sides of the body. A technique described by Gasparotti whereby using the palms of the hands and pushing inward achieves the desired contour. This maneuver will better help to visualize the end result. Areas of depression that may require lipoaugmentation are marked in a different manner (I will often place an “F” for fill inside these circles). It is important to evaluate the amount of fat that will be removed and note it. This will help during the procedure when the tumescent fluid may have altered the contour slightly. I then begin to draw a line starting at the waistline making the appropriate concave and convex curves to simulate the new figure. While still standing the patient is then marked on the anterior surface of the waist, hips and thigh.
This is important because when the patient is lying down it is easy to remove too much fat from the anterior lateral thigh and leave an unsightly depression. Posteriorly one of the most important landmarks has been described as the Gasparotti or G point. This is the area of the junction of the buttock with the lateral thigh. It begins at the thigh–gluteus junction superiorly and phases out as the subcutaneous fat of the lateral thigh inferiorly tends to blend closer to the underlying fascia. To achieve the appearance of a longer leg as one sculptures, a slight depression is created in this area. This will give roundness to the buttocks and visually lengthen the leg.
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