Answer:
There are seven types of hip, thigh, and buttock deformity:

(From McCarthy)

Type I – medial thigh excess
Type II – trochanteric excess (saddlebag deformity)
Type III – gluteal depression
Type IV – violin deformity: combination of saddlebag and upper hip fullness with gluteal depression
Type V – obesity
Type VI – asymmetry secondary to traumatic or iatrogenic causes
Type VII – aging, atrophy, or weight loss after morbid obesity

Any given patient may fall into one type or represent a combination of them.  Types II, III, and V can be managed with liposuction alone while Types IV and VI may require some skin reduction with or without liposuction.  Type VII may require only skin reduction via gluteal lift and/or belt lipectomy.

Liposuction:


(from McCarthy)

Liposuction is usually performed via an incision in the infragluteal fold with an addition higher incision closer to the anus to access the upper hip areas if necessary.  Unless the patient or the deformity is very large, a small caliber cannula (3.7 mm) is usually preferred to eliminate the need for pretunneling.

Gluteal lift:



Figure caption: Deformities that require skin reduction: A to C, Three such deformities. A and B will require skin reduction as well as suctioning. C, Skin reduction alone may be all that is necessary.  D to H, The technique for reducing the skin envelope and leaving the island to diminish the gluteal recess.  I, Additional suctioning for final contour improvement. (From McCarthy)

Gluteal lift or skin reduction is performed via an elliptical incision on the inferior buttocks with the inferior edge of the ellipse coinciding with the infragluteal fold.  After de-epithelialization, superior and inferior wedges of fat are excised to leave an “island” of fat in between.  This minimizes postoperative depression in the area.  Further liposuctioning may be performed prior to skin closure.
 

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