Thigh Lift Research Articles

A journey through liposuction and liposculture: Review.

IntroductionNowadays, liposuction is the most frequently performed aesthetic surgery procedure in Western Countries. This technique has had rapid development since the 1970s, when it was experimented for the first time by A. and G. Fischer. It is currently widely used in clinical practice for many different situations in aesthetic, reconstructive and functional fields.Materials and methodsThis review aims to describe the historical evolution of liposuction by analyzing the transformation of the method in function of the introduction of innovative ideas or instruments. We have also focused on reporting the major clinical applications of this surgical technique, applicable to almost the entire body surface. We finally analyzed the complications, both major and minor, associated with this surgical technique.ResultsLiposuction is mainly used to correct deep and superficial fat accumulations and remodel the body contour. It has become an essential complementary technique to enhance the aesthetic result of many other aesthetic procedures such as reduction mammoplasty, abdominoplasty, brachioplasty, thigh lift and post bariatric body contouring. However, it can be largely used for the treatment of innumerable pathologies in reconstructive surgery such as lipomas, lipedema, lipodystrophies, pneudogynecomastia and gynecomastia, macromastia e gigantomastia, lymphedema and many others. The complication rate is very low, especially when compared with conventional excisional surgery and the major, complications are generally associated with improper performance of the technique and poor patient management before and after surgery.ConclusionLiposuction is a safe, simple and effective method of body contouring. It has enormous potential for its application in ablative and reconstructive surgery, far from the most common aesthetic processes with a very low complication rate.

Impact of Patient Subtype and Surgical Variables on Abdominoplasty Outcomes: A 12-Year Massachusetts General Hospital Experience.

The traditional abdominoplasty is one of the most common surgical procedures performed. This study evaluates the impact of different surgical techniques and clinical patient factors on abdominoplasty outcomes. A retrospective review of consecutive patients undergoing abdominoplasty was performed. Seven hundred seventy-nine patients with a mean age of 43.7 years and a body mass index of 27 kg/m underwent abdominoplasty. The majority were women (92.9 percent), and massive weight loss was present in 34.8 percent. Abdominoplasty techniques included traditional (59.4 percent), belt lipectomy (17.9 percent), fleur-de-lis (16.4 percent), umbilical float (9.2 percent), and mini-abdominoplasty (2.8 percent). Half of the study population [n = 384 (49.3 percent)] had concurrent surgical procedures. Total complications (23.0 percent) consisted primarily of wound- and scar-related complications (15.3 percent). Approximately 60 percent of patients received heparin chemoprophylaxis, with overall thromboembolic and hematoma rates less than 1 percent. Univariate analysis revealed that massive weight loss (p = 0.04), fleur-de-lis (p = 0.03) or belt lipectomy (p = 0.05) techniques, and concurrent medial thigh lift (p < 0.001) all significantly increased complications. Previous scars, amount of weight loss, operative time, liposuction, and other concurrent procedures did not affect total complications. Male sex (OR, 1.96; p = 0.04), fleur-de-lis technique (OR, 1.71; p = 0.04), and medial thigh lift (OR, 3.3; p < 0.001) were independent risk factors for total postoperative complications. This study demonstrates that abdominoplasty alone or in combination with liposuction and aesthetic breast surgery can be performed safely, with an acceptable complication profile. Risk, III.

Thighplasty: improving aesthetics through revival of the medial, horizontal procedure: A safe and scar-saving option

Thighplasty is a common bodycontouring procedure, but also associated with a high complication rate. The purpose of this study was to access the outcome of the medial horizontal thigh lift as it is a common surgical technique regarding thigh deformity correction performed at the authors' department. Surgical keysteps, clinical applications, advantages and disadvantages of the procedure are shown. Postoperative evaluation took place with special focus on individual patient satisfaction. Retrospective analysis of 25 bilateral thigh lifts with single medial horizontal incision line was performed. Evaluated data include patient age, sex, body mass index, combined procedures, additional liposuction, weight loss, former bariatric surgery, comorbidities, smoking status and surgical complications. Follow-up was performed with a standardized protocol and the scar was accessed according to the Vancouver-Scare-Scale. Additionally the patients were asked to complete a questionnaire divided into the sections 'scars', 'postoperative result' and 'sexuality'. Average patient-age was 43 years. Average follow-up was 2 years and 8 months. Average weight loss before surgery was 57 kg. 36% of all patients additionally received a liposuction of the medial thigh. In six cases (24%), we observed complications, which were designated as 'minor complications' in five times (conservative management without problems) and 'major complication' in one time (surgical revision). Postoperative patient-satisfaction was high. Compared to the horizontal and vertical combined thigh lift with the classic T-shaped incision lines we observed fewer complications and a reduction of postoperative morbidity. Additionally patient satisfaction was very high. We estimate that the main reason therefore is the avoidance of the vertical scar and its associated short- and longterm problems. The evaluated data confirm the medial horizontal thighplasty as a good and valuablesurgical option for the management of thigh deformities with moderate skin and tissue excess, localized in the upper part of the thigh.

Oblique Thigh Lift after MassiveWeight Loss

Oblique Thigh Lift after MassiveWeight Loss

Reply: Concomitant Liposuction Reduces Complications of Vertical Medial Thigh Lift in Massive Weight Loss Patients

Background:Medial thigh lift procedures in the massive weight loss population have been associated with significant complication rates. Liposuction-assisted medial thighplasty has recently been introduced as a technical advancement to improve outcomes. To date, no study is available directly compari

Necrotizing Fasciitis in Aesthetic Surgery: A Review of the Literature

Necrotizing fasciitis (NF) is a rare, potentially fatal, infective complication that can occur after surgery. Diagnosis is still difficult and mainly based on clinical data. Only a prompt pharmacological and surgical therapy can avoid dramatic consequences. There are few reports regarding NF as a complication after aesthetic surgical procedures, and a systematic review still lacks. We have performed a systematic review of English literature on PubMed, covering a period of 30years. Keywords used were "necrotising fasciitis" matched with "aesthetic surgery complications", "breast surgery", "mammoplasty", "blepharoplasty", "liposuction", "facelift", "rhinoplasty fasciitis", "arm lift", "thigh lift", "otoplasty" and "abdominoplasty fasciitis". No additional search and temporal limitation were set. Among 3782 papers concerning NF, only 18 were related to NF after an aesthetic surgical procedure. Liposuction was the most affected procedure, with buttocks and lower extremity the most involved anatomical regions. The majority of the infections were monomicrobial, promoted by Streptococcus pyogenes. In most cases, NF occurred within the third post-operative day with non-specific signs and symptoms. In 14 cases, a single or multiple surgical interventions were performed and survival was achieved in 11 patients. In case of infection after aesthetic surgery, we should always bear in mind NF. Clinical hallmarks still guide NF management. Because early signs and symptoms are usually non-specific, a strict clinical control is highly suggested. Once clinical suspicion is raised, prompt antibacterial therapy should be administered, followed by surgical debridement in case of ineffective response. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Aquacel Surgical Dressing after Thigh Lift: A Case–Control Study

Background:The postoperative dressing in patients undergoing thigh lift is often difficult, not very resistant to movement, and uncomfortable for the patient, and often exposes surgical site to infection, maceration, or delay in wound healing.Methods:We included 40 patients in a case–control crossover study with no period effects, who were treated both by Aquacel Surgical and a traditional wound dressing. Surveys with a 10-point scale evaluation were used to assess nontraumatic removal level, ease of application, adhesion, and strength of the 2 treatments. We reported the number of days necessary for wound healing, the number of infection cases, and wound-related complications. Costs of the 2 medications were also considered. Ten days after surgery, patients answered a questionnaire with 6 multiple-choice questions to assess comfort, pain at dressing change, pruritus, strength, and number of dressing changes.Results:Compared with controls, surveys revealed Aquacel Surgical to be less traumatic to remove, easier to apply, and to be more adherent and stronger. Significant acceleration of the wound healing was also evident with Aquacel Surgical compared with the traditional dressing. Nonsignificant differences were reported about the risk of infection and wound-related complications between the 2 treatments. A statistical analysis of costs revealed that Aquacel Surgical is significantly more expensive than the traditional medication.Conclusion:We recommend the use of Aquacel Surgical in all the surgery procedures where the risk of wound dehiscence and maceration is high.

The versatility of the medial thigh lift for defect coverage in the genito-perineal region.

Soft tissue defects in the genito-perineal region are predominantly because of trauma, infections, neoplasms or iatrogenic causes. As a result of the region's urological, reproductive and gastrointestinal function, defects in this area may cause devastating physical and psychological consequences as well as diminished sexual functioning. The purpose of this study was to examine the efficacy of implementing a medial thigh lift for defect coverage in the perineal region. A retrospective analysis of all medial thigh lift procedures for defect coverage in the genito-perineal region between November 2010 and March 2015 was conducted at three institutions. Ten consecutive patients underwent a medial thigh lift for defect coverage in the genito-perineal region. Nine patients were male, and one was female. The causative factors were Fournier's gangrene in eight patients, one patient had a straddle injury, and one suffered from extramammary Paget's disease. The mean follow-up time was 19·8 months. The average total defect size was 11·1 × 11 cm (length × width). The medial thigh lift procedure is a safe, technically easy and reliable technique with discrete scars. Outstanding aesthetic and functional outcomes result in a high rate of patient satisfaction. Through immediate wound closure, a reduction of recovery time can be achieved.

Concomitant Liposuction Reduces Complications of Vertical Medial Thigh Lift in Massive Weight Loss Patients.

Medial thigh lift procedures in the massive weight loss population have been associated with significant complication rates. Liposuction-assisted medial thighplasty has recently been introduced as a technical advancement to improve outcomes. To date, no study is available directly comparing the traditional approach and this new technique. Here, the authors evaluate outcomes and complications of both techniques in a retrospective cohort study. Outcomes of 59 patients undergoing vertical medial thighplasty at the authors' institution between 2008 and 2014 were assessed retrospectively. Evaluated parameters include age, sex, body mass indices, method of weight loss, comorbidities, and complications (e.g., seroma, infection, wound dehiscence, hematoma, and surgical revision). Appropriate statistical analysis was performed. There were 29 patients in the excision-only group and 30 patients in the liposuction-assisted group (all women; average age, 41.5 years). The overall complication rate was significantly reduced in the liposuction-assisted group (13 percent versus 59 percent; p < 0.001). The incidence of individual complications such as seroma formation (zero patients versus 10 patients; p < 0.001) and wound infection (one patient versus eight patients; p = 0.01) was significantly less in the liposuction-assisted group. In addition, we observed a significantly shorter hospital stay (6.0 days versus 7.8 days), reduced number of follow-up visits (2.0 versus 4.4), and reduced time to drain removal (1.8 days versus 4.1 days; p < 0.001) in the liposuction-assisted group. Liposuction-assisted medial thighplasty led to a significant reduction of complications and faster recovery in the massive weight loss patient population. As a consequence, the excision-only vertical thigh lift has been completely abandoned in the authors' clinical practice. Therapeutic, III.

Medial thigh lift in post-bariatric patients: Our encouraging experience

Background: A high rate of postoperative complications following inner thigh lift is reported in the medical literature. The authors present the results of a study on the validity of inner thigh contouring, with liposuction and concomitant skin excision, in postbariatric patients.Methods: This study examined the charts of 46 postbariatric female patients, who underwent medial thigh lift with a ‘T’ scar technique and concomitant liposuction, between February 2010 and February 2013. Complications were recorded. A questionnaire was administered to the patients at the 1-year follow-up visit. Preoperative and 1-year postoperative photographs were compared, superimposed, and analysed.Results: This study did not observe major systemic complications, haematoma, seroma, infection, skin necrosis, lymphoceles, or lymphoedema. Minor complications were three cases of wound dehiscence and two cases of deepithelialisation. At the 1-year follow-up visit, caudal scar migration, genital distortion, recurrent ptosis, or deformity of the inner thigh contour were not observed. Questionnaires and a comparison of pre- and 1-year postoperative pictures showed encouraging results.Conclusions: The medial thigh lift technique described and assessed in this article is a straightforward surgical procedure, with considerable functional and aesthetic results. Liposuction, early mobilisation, and appropriate postoperative management are pivotal to reduce postoperative downtime and complications.

Management of the Postbariatric Medial Thigh Deformity.

Thigh contour deformities-in particular, those of the medial thighs-are a common concern for many individuals seeking body contouring. Despite the frequency of this concern, some plastic surgeons have often been reluctant to embrace the medial thigh-lift procedure because of the risk for significant complications and relatively poor results. The authors' approach to medial thigh contouring is to address the variables outside of the medial thighs affecting the medial thighs before considering a medial thigh-lift procedure with a vertical component. In this article, the authors review the senior author's (J.F.C.) experience of 350 vertical medial thigh lifts in the weight-loss patient. The charts of 350 consecutive individuals who had undergone vertical medial thigh lifts were reviewed for complications and other variables. The procedures were all performed by the senior author between February of 2000 and February of 2014. The preoperative markings, current surgical technique, and postoperative care are described. There were 326 women and 24 men in the study, with an average age of 43 years. The overall complication rate was 45.14 percent. Skin dehiscence and seroma formation were the most frequent complications, at 31.14 percent and 18.18 percent, respectively. The vast majority of patients were pleased with the aesthetic and functional results of their surgery. The medial thigh deformities of the weight-loss patient are effectively addressed by a vertical medial thigh lift when the variables adjacent to the medial thighs are first treated by a body lift. Therapeutic, IV.

The Influence of Two Stretching Techniques on Standing Hip Range of Motion.

The purpose of this study was to describe the effects of two stretching techniques on standing hip range of motion (ROM) in female dancers. The participants were 18 university students. They were randomly assigned to one of three groups: active stretch group (Bartenieff Fundamentals(TM) thigh lift), passive stretch group (contract-release-contract form of PNF), or a control group. The participants assigned to the stretching groups completed 12 sessions of their randomly assigned stretch technique over a 3-week period. A repeated measures ANOVA (group x day) was used to analyze statistically the data gathered on the pre- and post-standing hip ROM tests. Both of the stretching groups had statistically significant increases in standing hip flexion angles during the standing hip flexion test. The passive stretch group had greater increases than the active stretch group [F(4, 86) = 7.03, p < 0.01]. The results of this study provide evidence that the effects of supine stretching transfer to standing hip flexion.

Prevalence and factors associated with persistent pain following body contouring surgery

Persistent postsurgical pain (PPP) has been reported by patients following various surgeries. Body contouring procedures are being performed more frequently, but no data are available regarding the effects of these procedures. Long-term disability occurring after performing "functional" procedures on healthy subjects is a particular concern. The aim of this study was to describe the risk factors, prevalence, characteristics, and effects of persistent pain after body contouring procedures. Patients who underwent body contouring surgery (e.g., abdominoplasty, lower body lift, medial thigh lift, brachioplasty, and abdominal liposuction) between January 1 2009 and December 31 2013 were included in this retrospective, monocentric cohort study. Pain evaluation was performed using a visual analog pain scale (VAS) and the Douleur Neuropathique 4 (DN4) questionnaire. Major risk factors previously identified in the literature were evaluated. The study included 199 patients. Pain was reported by 42 patients (21%). Seventy-one percent (n=30) of these 42 patients presented with neuropathic pain. Risk factors that were significantly associated with PPP were acute postoperative pain (p=0.0003), medical history of bariatric surgery (p=0.002), longer period of hospitalization (p=0.04), depressive status during the operative period (p=0.03), substantial stress before surgery (p=0.03), and major complications after surgery (p=0.03). Persistent chronic pain is frequent after body contouring procedures. Preemptive approaches and early postoperative diagnosis are important measures that can be used to limit the effects of this complication on the patient's quality of life.

Medial thighplasty: Current concepts and practices

Medial thighplasty, also known as medial thigh lift, is a procedure that has been carried out for five decades. The original "Lewis" technique has undergone many changes, and thereby been rendered widely available to plastic surgeons. Given the increasingly high number of surgical reconstructions after massive weight loss, this technique is now an integral part of a surgeon's therapeutic arsenal as he strives to meet the evolving demands of patients. The objective of this article, which is based on a comprehensive review of the literature, is to summarize current knowledge on medial thighplasty and thereby allow plastic surgeons to adopt the operating technique best suited to the deformations presented by their patients and to the overall context. The different techniques, outcomes and complications are successively discussed.

An Integrative Therapeutic Concept for Surgical Treatment of Severe Cases of Lymphedema of the Lower Extremity.

Lymphedema results from insufficient lymphatic drainage and typically affects the extremities. Recent studies revealed obesity as another cause of extremity lymphedema. Conservative treatment of patients with elephantiastic lymphedema of the lower extremity is limited and often inadequate. Resecting surgery plays an important role in these cases. Here, we investigated the effects of an integrated therapy concept on outcome and complication rates. We retrospectively analyzed the clinical outcome of 26 patients with elephantiastic lymphedema of the lower limb who underwent a complex decongestive physical therapy (CDP) perioperatively and reduction surgery in our clinic between 1998 and 2011. We subsequently compared these patients (group A) with a control group of 30 patients (group B) who received medial thigh lift due to post-bariatric or aesthetic issues between 2011 and 2013. The incidence of complications, reoperations, blood transfusion, and duration of hospital stay was analyzed. All patients in group A received CDP perioperatively in a specialized lymphological clinic. Both groups are comparable in terms of age and sex. Patients significantly differ in terms of BMI (p < 0.001). Thirty-six reductive procedures were performed in group A and 30 in group B. We did not see any significant difference in the incidence of complications (p = 1.000) and the rate of postoperative blood transfusions (p = 0.116). We were able to show that an integrative concept including surgery is a good additional option for the treatment of severe cases of lymphedema in appropriate candidates. Furthermore, an adequate perioperative conservative setting helps to minimize possible complications.

Body-contouring surgery following bariatric surgery: do we need to provide this service?

Bariatric surgery is well established as a treatment for obese patients with hypertension and type 2 diabetes. Over one-third of the adults in New Zealand population are overweight and one-fourth are obese.1 Following massive weight loss, patients are often left with hanging and excessive soft tissue. Anecdotally, we know that patients often request removal of this tissue and the most common procedures they seek are abdominoplasty, brachioplasty and medial thigh lift. Given the incidence of obesity and the increasing number of bariatric procedures, it is important to better characterize the number of patients who may benefit from body-contouring surgery and to identify what those benefits are. At our regional service based at Middlemore Hospital, the General Surgery Department has been providing government-funded bariatric surgery since 2007. We have a large cohort of patients who are now over 2 years post-bariatric surgery and from whom we can ask their experience with excess soft tissue and the effect on their lives. We sent questionnaires out to 200 patients who were 2 years post-bariatric surgery and 50 matched controls who had laparoscopic cholecystectomies over the same time period. The response rate was just over 50% for the bariatric surgery patients and only 4% for the control group. Using a Likert scale to assess degrees of concern, we asked about excess abdominal skin, arm skin and thigh skin and how these areas affected the ability to do activities of daily living, social interactions and soft-tissue infections. Of the responses, 97% strongly/agree they had excess skin over the abdomen with 83 and 86% for upper legs and arms, respectively. We also found that 55% had weekly infections from oversized pannus and 21% had yearly infections. The excess skin also caused 42% to agree that abdominal skin limits their ability to exercise, similarly in 61% in those with upper leg and 64% with upper arm excess. The information from this study suggested that there are significant quality-of-life issues related to having this excess soft tissue both psychosocial and physical for patients at a stable weight post-massive weight loss. There is evidence to demonstrate the improvement in quality of life provided by body-contouring surgery following massive weight loss.2, 3 Klassen et al. interviewed 43 patients and found the main concerns precontouring were physical, cosmetic, psychological, sexual and social.4 Overall cosmesis improved but some concerns were raised over scarring. Most reported an improvement in sexual life and a ‘huge difference’ in psychological health. van der Beek et al. also completed quality-of-life questionnaires and showed an improvement,5 as did Araco et al.6 There is additional evidence that weight loss is not only maintained post-body contouring surgery but there is increased weight loss over and above the weight of the tissue removed at the time of surgery.7 The financial cost of body-contouring surgery is significant with a straight forward abdominoplasty requiring 3 h or longer of surgery time with a two-night hospital stay. In our publicly funded institution, the calculated value for this treatment is between NZ$15 000 and $25 000. Post-operative complications may increase this cost. Our impression is that there would be significant demand for body-contouring surgery following bariatric surgery if there was funding available for these procedures. In our department, we currently perform some body-contouring procedures but these are on a case-by-case basis and need to be approved by a group of clinicians who prioritize these ‘restricted procedures’. We believe there is clear evidence for clinicians to demonstrate to the funders of surgery that the benefits from body-contouring surgery are significant enough to warrant allocation of resource to these patients for these procedures.

Venous Thromboembolism in the Cosmetic Patient

PURPOSE: Venous thromboembolism (VTE) is one of the most feared post-operative complications in cosmetic surgery. The true rate of VTE in this patient population remains largely unknown and current ASPS recommendations for prophylaxis are partially extrapolated from Orthopedic and General Surgery literature. Furthermore, although there are provider surveys suggesting a high incidence of deep venous thromboses in certain plastic surgeon communities in the United States, there still is a dearth of data establishing the number of these complications on a population level and quantifying concrete risk factors. This study analyzed the risk factors for VTE in cosmetic surgical procedures, alone and in combined procedures. METHODS/MATERIALS: All patients who had a clinically significant VTE complication in cosmetic surgery procedures between May 2008 and May 2013 were identified from the CosmetAssure database. CosmetAssure is an insurance program that provides coverage for treatment of significant complications following aesthetic surgery. Univariate and multivariate analysis was performed on identified risk factors for venous thromboembolism, including age, smoking, BMI, gender, diabetes, type of facility where performed, and if the procedure was combined or alone. RESULTS: A total of 129,007 patients were identified from 183,914 procedures in the database. An overall complication rate of 1.9% was established. A total of 116 confirmed VTE complications were encountered (0.09% incidence). Combined procedures had a significantly higher overall rate of VTE compared to solitary procedures (0.20% vs. 0.04%, p<0.01). On multivariate logistic regression significant risk factors (p<0.05) included body procedures (RR 12.9), combined procedures (RR 2.3), BMI ≥ 25 (RR 2.0) and age ≥ 40 (RR 1.8). Diabetes, smoking, gender and the facility in which the procedure was performed were not found to be significant risk factors (Table 1). Face procedures (0.01%) and breast procedures (0.01%) had the lowest VTE rates, followed by combined face/body (0.16%), body procedures (0.21%), and combined body/breast procedures (0.28%). The most common single procedures reporting confirmed VTE were thigh lift (0.25%), lower body lift (0.23%), abdominoplasty (0.20%), brachioplasty (0.13%), liposuction (0.06%), breast reduction (0.03%), and rhinoplasty (0.03%).Table 1: Risk Factor multivariate logistic regression.BMI, body mass index. ASC, accredited surgical center. OBSS, office-based surgical suites. CONCLUSION: The complication rate for VTE in cosmetic procedures is relatively low. However, the risk increases with combined procedures as well as with particular body areas, most notably body. Equally, significant patient risk factors exist including BMI and age.

Desire for Body Contouring Surgery After Laparoscopic Sleeve Gastrectomy.

Laparoscopic sleeve gastrectomy (LSG) is an effective approach for the treatment of morbid obesity. Surgically induced massive weight loss provokes skin deformities that can be addressed with plastic surgery. However, there is a paucity of data regarding the esthetic outcome of patients after LSG. The aim of the study was to assess the postoperative appearance and the request for body contouring surgery after LSG. All the patients who underwent LSG between August 2006 and September 2014 with a minimum follow-up of 1 year were interviewed using the Post-Bariatric Surgery Appearance Questionnaire. Postoperative satisfaction with their appearance, and the desire and frequency for body contouring surgery were assessed. A total of 175 patients were interviewed. Overall, 75% of the patients rated that they felt attractive with their appearance. More specifically, 84% of men and 72% of women were satisfied with their appearance. Females were most dissatisfied with waist/abdomen, chest/breasts, and upper arms, in descending order. Males were dissatisfied with chest/breasts, upper arms, and waist/abdomen, respectively. The most desired procedures were abdominoplasty, chest/breast lift, and upper arm lift in females and abdominoplasty, thigh lift and upper arm lift in males. Only 3.6% of patients underwent body contouring surgery postoperatively. LSG patients rated their overall appearance from slightly to moderately attractive. There was a strong desire for abdominoplasty; breast lift and upper arm lift in females, although only a small proportion of patients proceeded to plastic surgery. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to Table of Contents or the online Instructions to Authors www.springer.com/00266.

L-Shaped Lipothighplasty

In addition to the already-known postoperative complications in patients formerly obese, for medial thigh lift, there are many more problematic issues. The main ones are represented as follows: by the frequent downward displacement of the scars that become, in this way, extremely visible; by the distortion of the vulva or scrotal region; by serious and disabling disorders of the lymphatic system; and by the early recurrence of ptosis in this anatomical site. From 2004 to 2010, 16 patients with moderate to severe laxity of the medial area of the thighs were treated by an L-shaped medial thigh lift after selective liposuction. Ten have been previously treated with biliopancreatic diversion and 6 have been previously treated with gastric bypass. Mean (standard deviation [SD]) height before bariatric surgery was 1.62 (0.08) m, mean (SD) weight was 141.53 (23.12) kg, and mean (SD) body mass index was 57.13 (8.21) kg/m. After the intervention, mean (SD) weight decreased to 81.12 (16.43) kg, whereas mean (SD) body mass index decreased to 31.83 (8.51) kg/m. After L-shaped lipothighplasty, 13 patients (81%) had no complications in the postoperative period. No skin necrosis, hematoma, seroma, or thromboembolic events were reported. Two patients experienced hypertophic scarring and 1 patient had a wound infection because of poor hygienic care. The medial lifting technique defined as L-shaped lipothighplasty is a valid, fast, and safe technique and can reduce early and late postoperative complications in a critical and troublesome area for the surgeon who is going to correct the deformity.

Removal of excess skin after massive weight loss: challenges and solutions

Removal of excess skin after massive weight loss: challenges and solutions Salvatore Giordano Department of Plastic and General Surgery, Turku University Hospital, Turku, Finland Abstract: The advent of bariatric surgery has led to a subspecialty in plastic surgery for skin and fat contouring which remain after massive weight loss. The author discusses the preoperative assessment, surgical treatment plan, postoperative management, possible complications, and benefits of postbariatric surgery. Preoperative planning includes medical history and patient assessment. Surgical procedures for brachioplasty, upper back lift, breast reshaping, abdominoplasty, panniculectomy, lower back lift, and thigh lift are discussed. Indications, postoperative complications, and benefits are also discussed. The best candidates for postbariatric plastic surgery are those who have achieved weight loss stability with a BMI of 32 or less and who have adequate nutrition in order to heal the surgical excisions. Abdominal and truncal deformity are the most common presenting complaints in massive weight loss patients, and the procedure of choice to address this region is a body lift. Postoperative care focuses on patient safety, prioritizing in deep venous thrombosis (DVT) prophylaxis and seroma prevention. Postbariatric body contouring aims to correct the deformity due to the excess of skin after massive weight loss and to restore a sense of normalcy. Keywords: morbid obesity, bariatric surgery, weight loss, massive weight loss, body contouring, panniculectomy