Thigh Lift Research Articles

Two cases of lower body contouring with a spiral and vertical medial thigh lift.

Massive weight loss results in skin excess, leading to an unsatisfying body contour. Various thigh lift procedures can correct flabby skin in the lower leg. We present a lower body contouring technique with a report on two patients. The procedure is determined by the body contour of the patient. As the skin excess in the thigh area tended to appear mostly on the medial side, a vertical medial thigh lift was considered. Moreover, for patients with a pear/guitar-shaped body contour, we added the spiral thigh lift for skin excess in the buttocks and the lateral thigh area. The extent of tissue to excise was determined by pinching the patient in a standing position. The inferior skin flap was fixed to non-movable tissue, which was helpful for lifting the tissue and preventing the widening of the scar. After the operation, a drain was kept for 3 to 4 days. A compressive garment was used after removing the drain. There were no complications. The patients were discharged 6 to 8 days after the operation. In conclusion, skin excess, especially in the lower body, can be corrected by a thigh lift combining several procedures, varying from person to person.

Medial thighplasty: Horizontal and vertical procedures after massive weight loss

Background:The ‘medial thigh lift’ was first described by Lewis in 1957, but did not receive the widespread acceptance because of the various postoperative complications, such as scar migration with vulvar deformities and early recurrence of ptosis. For this reason, Lockwood developed a technique of anchoring the dermis to the Colles’ fascia, to make the surgical outcome more stable over time and to prevent scar migration. In this article, we describe our approaches to the medial thigh lift in post-bariatric surgery patients.Materials and Methods:A total of 45 females underwent medial thigh reduction. In 15 patients with Grade 2 on Pittsburgh Scale (PS), we performed a thigh lift with a horizontal scar; in 15 patients with Grade 2 on PS, we used a technique with a vertical scar; in 15 patients with Grade 3 on PS, the above-mentioned two procedures were combined. When it was really necessary, we also did the liposuction of the medial thigh. The patients were observed every 6 months with a 60-month median follow-up (range: 12–108 months).Results:In six patients was observed scar enlargement due to poor wound healing (one patient with a horizontal scar, three patients with a vertical scar and two with the combined procedure). In two patients with a horizontal scar, minimal scar migration was observed. In three patients, the recurrence of ptosis was evident (one patient with a horizontal scar and two patients with the combined procedure). No skin necrosis was observed.Conclusion:The medial thigh lift surgery is remarkably simple and free of major complications, if the basic anatomy of this region is understood, in order to preserve important structures such as the great saphenous vein and femoral vessels. The only complication is the presence of extensive and visible scars along the thigh, in the case of vertical procedure, and along the inguinal canal, with a possible distortion of the labia major, in the case of horizontal procedure.

Complications in Postbariatric Body Contouring Based on Different Weight Loss Methods

Sir:FigureIt was with great interest that we read the article “Complications in Postbariatric Body Contouring: Postoperative Management and Treatment” by Dr. Michaels and colleagues.1 We congratulate the authors for their carefully described general and specific strategies with which to prevent several complications that could develop in post–bariatric surgery body contouring cases. We completely agree with them that more attention should be given to the postoperative management of these patients. In addition to their large database incidence rates, we want to contribute our 7-year experience in this field of quick growth in plastic surgery. Furthermore, to complete this essay, it can be useful to classify complications according to the type of bariatric procedure previously performed as done by Dr. Gusenoff et al. in 2009.2 In this regard, analyzing our 158 cases retrospectively, we observed a significant difference in postoperative complication rates between patients who lost weight by diet and/or exercise [n = 18 (11 percent)], those who received predominantly restrictive procedures such as gastric banding [n = 21 (13 percent)] or sleeve gastrectomy [n = 23 (15 percent)], and those who received mixed procedures such as gastric bypass surgery [n = 96 (61 percent)]. Body contouring procedures performed were, in order, abdominoplasty, thigh lift, brachioplasty, and male or female breast contouring. Average weight loss was 161 lb. The overall rate of complications was 38 percent, including postoperative anemia (defined as a decrease in the hemoglobin value of at least 3 points), which was the most common one. We observed increased incidence rates not only between patients after bariatric surgical procedures and those who received nonsurgical treatment, but also within surgical techniques themselves. Patients who underwent mixed procedures appeared to have an overall incidence rate of complications after body contouring of 55 percent versus 30 percent following restrictive surgery and 15 percent of patients who lost weight by diet or exercise. Complications mentioned by Dr. Michaels and other authors are comparable to those we came up against3,4: hematoma (2 percent), seroma (6 percent), wound problems (9 percent), anemia (14 percent), skin necrosis (1 percent), scar revision (2 percent), and infection (4 percent). The infection rate was more frequent among surgical patients too, regardless of what Dr. Gusenoff found about infection rates in patients who had body contouring after massive weight loss. No cases of venous thromboembolism or lymphedema were found. According to the authors' conclusions, complications may always occur. Therefore, a correct plan of action, beginning with the most suitable bariatric procedures for each patient, the immediate identification and discussion of complications that could follow the surgical treatment, the proper post–bariatric surgery management, and the prevention of complications, should always be pursued. Paolo Persichetti, M.D., Ph.D. Campus Bio-Medico University of Rome Pierluigi Gigliofiorito, M.D. Campus Bio-Medico of Rome University Beniamino Brunetti, M.D. Tiziano Pallara, M.S. Campus Bio-Medico University of Rome Giovanni Francesco Marangi, M.D. Campus Bio-Medico University of Rome, Rome, Italy

Post-bariatric surgery body contouring in the NHS: A survey of UK bariatric surgeons

Following massive weight loss, patients are left with folds of redundant skin that may cause physical and psychological problems. These problems can be addressed through body contouring procedures such as abdominoplasty and the thigh lift. Despite an exponential rise in the number of bariatric surgery procedures performed in the United Kingdom, there are no national guidelines on the provision of body contouring procedures after massive weight loss. We conducted a survey of UK Bariatric Surgeons to determine the pre-operative counselling that patients receive on this issue, their opinions towards post-bariatric surgery body contouring and current referral patterns to Plastic Surgery. By exploring the relationship between Bariatric and Plastic Surgery, we aimed to identify how the comprehensive treatment of patients undergoing bariatric surgery could be improved. A questionnaire was sent to 86 surgeon members of the British Obesity and Metabolic Surgery Society. Questionnaires were analysed from the 61/86 respondents (71% response rate). 92% of the responding surgeons feel that patients face functional problems relating to skin redundancy after massive weight loss, and a high percentage of patients complain about this problem. However, only 66% of surgeons routinely counsel patients about these problems before they undergo bariatric surgery. 96% of respondents feel that body contouring for these patients should be funded on the NHS in selected cases. However, it is difficult for patients to access consultation with a Plastic Surgeon and there are no explicit guidelines on the criteria that patients must fulfil to undergo body contouring surgery on the NHS. At present, these criteria are locally determined and represent a postcode lottery. The NICE guidelines on obesity recommend that patients undergoing bariatric surgery should have information on, or access to plastic surgery where appropriate, but this standard is not being achieved. National guidelines on post-bariatric body contouring surgery are needed to improve the comprehensive treatment of these patients. The clinical and cost effectiveness of bariatric surgery has been well established. Further studies focussing on the outcome of body contouring after massive weight loss could support this becoming and integral part of the bariatric surgery pathway.

Donor-Site Morbidity of the Transverse Musculocutaneous Gracilis Flap in Autologous Breast Reconstruction

The authors have used the transverse musculocutaneous gracilis flap technique for autologous breast reconstruction after skin-sparing mastectomy since August of 2002. The donor site is closed in the manner of a medial thigh lift. The authors examined the short-term and long-term results of donor-site morbidity in their first 22 patients. Nineteen patients underwent unilateral and three patients received bilateral breast reconstruction with a transverse musculocutaneous gracilis flap after skin-sparing mastectomy. Using a questionnaire, patients were asked about complaints resulting from elevation of the gracilis muscle and their satisfaction with the result, general condition, and sexuality. Cosmetic evaluations of the thigh donor site were performed independently by two plastic surgeons. To evaluate short-term results, mean follow-up of the 22 patients was 10 months. All patients were satisfied with the scar in the inguinal region. Concerning thigh symmetry, 42 percent of patients showed excellent results, 40 percent had good results, and 18 percent had fair results. With regard to the scars, 24 percent of patients had excellent results, 46 percent had good results, and 30 percent had fair results. Thigh shape was evaluated as excellent by 26 percent, good by 52 percent, and fair by 22 percent. Patients who had a unilateral gracilis donor site had a difference in maximal thigh circumference of 2.368 cm. Four years postoperatively, all patients would choose this kind of operation again. The medial thigh region allows the removal of a moderate amount of tissue, even in thin patients, with a very inconspicuous scar. The transverse musculocutaneous gracilis flap is safe for immediate reconstruction of small and medium-sized breasts, with minimal functional donor-site morbidity. Therapeutic, IV.

The Deep Anchored Inner Thigh Lift

The medial thigh area remains a troublesome region for body contouring in patients with lipodystrophy and/or skin flaccidity. Liposuction has proven effective in patients who have excess fat deposits but do not have a significant degree of skin laxity. The skin in this area of the body is often thin and inelastic, and in most circumstances where skin laxity is present, liposuction alone fails to remodel and tighten the inner thigh. Thus, it is necessary to combine liposuction with skin excision to achieve acceptable cosmetic results. The purpose of this article is to present the authors' technique of inner thigh lift using a novel dermoadipose flap design, which allows an effective anchoring of the inferior flap of the inner thigh to the adductor major tendon at the pubic bone insertion site. This novel approach creates a strong and stable anchoring site for the inferior inner thigh flap. In the authors' experience this technique has proved safe and effective, has a decreased morbidity, and achieves excellent cosmetic results.

The Deep Anchored Inner Thigh Lift

The Deep Anchored Inner Thigh Lift

The Scarpa Lift—A Novel Technique for Minimal Invasive Medial Thigh Lifts

Abdominoplasty and lower body lift procedures are the most common and sufficient procedures to correct abdominal tissue redundancy. Frequently, patients who undergo these procedures have lost a relevant amount of weight and additionally present tissue redundancy in the area of the medial thighs. Patients with mild to moderate skin surplus in the medial thigh region often refuse an additional scar in this specific region. For these cases, the medial thigh region can be indirectly treated by the vertical scarpa lift, sparing the medial thigh approach and consequent complications such as scar descent or vulvar distortion. Additionally, the lymphatic vessels below the scarpa fascia can be preserved, reducing the postoperative abdominal seroma rate.

The Circumferential Thigh Lift and Vertical Extension Circumferential Thigh Lift

Excess skin and soft tissue of the thighs after massive weight loss (MWL) can present with varying degrees of severity. The classic medial thigh lift has considerable limitations in the postbariatric population, inspiring the quest for safer and more effective technical solutions. In this study, the circumferential thigh lift (CTL), and CTL with vertical extension, predicated on a theoretical and technical approach that improves safety and aesthetics in thighplasty after MWL, is described and evaluated. Nine patients were treated; all patients experienced MWL and all had previously undergone first-stage contouring with circumferential abdominal dermolipectomy. Patients were treated with a prone-to-supine approach with concomitant suction-assisted lipectomy (SAL). Lumbar and lateral thigh and infragluteal skin and fat were excised to the midaxillary lines and medial thigh meridians. Direct excision of anterolateral thigh skin was carried in a superficial plane into the medial thigh to confluence with the posterior excision. No direct undermining of any skin margin was performed. When soft-tissue excess is limited to the proximal third of the thigh, a horizontal excision pattern is used; with middle and lower one-third thigh excess, a vertical extension is employed. The medial superficial fascial system is anchored to the superficial perineal fascia. Data were reviewed retrospectively. In the 9 procedures performed, 3 achieved MWL by nonsurgical means, and 6 underwent bariatric surgery (bypass or band). Three patients were treated with CTL, and 6 with CTL with vertical extension. There were 3 seromas (33%) treated with percutaneous aspiration. There was 1 case of cellulitis (11%) treated successfully with in-office incision and drainage, and oral antibiotics. There were no hematomas, skin loss, wound dehiscences, lymphedema, or vulvar distortions. The circumferential excision of thigh excess without direct undermining allows for the maintenance of a rich blood supply to skin margins, and concomitant SAL improves thigh contour while providing discontinuous thigh undermining. Anchoring of the superficial fascial system to superficial perineal fascia reinforces the medial lift and prevents scar migration. CTL with or without vertical extension can be combined with SAL to maximize safety and aesthetic results after MWL.

Commentary on “Deepithelized fasciocutaneous flap for labia majora augmentation during thigh lift. A case report” by AAH El Danaf

Commentary on “Deepithelized fasciocutaneous flap for labia majora augmentation during thigh lift. A case report” by AAH El Danaf

Spiral Thigh Lift for the Massive Weight Loss Patient

Plastic and Reconstructive Surgery 126():p 76, October 2010. | DOI: 10.1097/01.prs.0000388798.77242.5a

Integration of the Vertical Medial Thigh Lift and Monsplasty: The Double-Triangle Technique

Integration of the Vertical Medial Thigh Lift and Monsplasty: The Double-Triangle Technique

Deepithelized fasciocutaneous flap for labia majora augmentation during thigh lift

Labioplasty currently entails, other than labia minora reduction, labia majora skin excisional contouring and fat grafting. To restore fullness in a postbariatric patient, a technique was developed for labia majora augmentation using an anteriorly based adipofascial flap raised from the dispensable inner thigh lift crescent. The labiocrural crease delineated the flap medial border while the extent of the thigh redundancy determined its lateral border. A pocket in the labium was created and the flap was inserted. The procedure succeeded on one side and failed on the other, due to postoperative squeezing evacuation of a hematoma retracted the unattached flap. This labium was refilled later with fat grafting. Both for flap-insertion and fat-grafted labia showed almost symmetrical volumes after 1 year. Anatomical studies are necessary to accurately identify the flap blood supply. A large series is required to support the procedure as being safe and reliable.

Multiple Procedures and Staging in the Massive Weight Loss Population

Unlike traditional plastic surgery patients who present with a specific anatomical complaint, massive weight loss patients often have multiple regions of concern. No single procedure can address the whole-body deformities associated with massive weight loss. The authors sought to quantify their clinical experience to provide evidence-based analysis of procedural combination in body contouring. Patients were enrolled in an institutional review board-approved prospective clinical database over a 5-year period. Procedure categories included breast, medial thigh lift, buttock and lateral thigh lift, upper back lift, brachioplasty, and abdomen. Analysis of variance was used to analyze differences between procedure combinations. Six hundred nine massive weight loss patients underwent 661 cases involving 1070 procedures. Length of hospital stay increased with the number of procedures performed (p < 0.001). Second-stage cases (n = 60) had similar complication rates and length of hospital stay. Seroma and dehiscence were strongly correlated with the number of procedures (p < 0.001), as were tissue necrosis and infection (p = 0.02), whereas hematoma was unrelated (p = 0.25). Major complications did not increase in multiple-procedure cases. In a large experience at a high-volume center, concomitant procedures were performed safely in carefully selected patients with low major complication rates. Although aggregate minor complication rates were predictably higher than in single-procedure cases, there was no significant increase on a per-procedure basis. Multiple procedures can be combined safely in the body contouring patient, with surgical staging offering a viable alternative for patients who are unable to undergo combined procedures.

Lower thigh-knee lift

Lower thigh laxity is a difficult area to be completely corrected. Although, some techniques may achieve some tightness in this region, skin laxity and ptosis recurs within few months. Thighplasty was performed in 10 patients with skin redundancy and adiposity. Circumferential liposuction was done first. The incision was placed at the posteromedial aspect of the thigh. The medial tissue was pulled upward, posterior and lateral. A posteriorly rotated excision pattern was done. The whole thigh was taut. Skin redundancy at the lower thigh and knee regions was completely eliminated. Follow up ranged between 9-12 months. The described technique is effective in lower thigh lift as well as the whole thigh

A New Technique for Gluteal Lifting Using Deepithelialized Dermal Flaps

In this article, Handschin et al. [1] promote several modifications to the inferior buttock lift techniques previously described by Gonzalez [2] and Huemer et al. [3]. The main modifications include the division of the deepithelialized infragluteal crescent into upper and lower segments. The other adjustment is the subsequent anchoring of the deepithelialized flaps into the gluteal fascia instead of the ischial periosteum in order to recreate the inferior gluteal fold and provide the buttock lift. The authors describe the procedure in a series of eight patients with very good aesthetic results by postoperative analysis and patient satisfaction report and no recorded complications after a 2month follow-up. The inferior gluteal lift is a very powerful and effective tool in the appropriate candidate. It improves the inferior gluteal fold and the skin and subcutaneous tissue of the superior posterior thigh. The procedure is indicated in patients with mild buttock ptosis with excess skin and subcutaneous tissue in the inferior gluteal fold or ‘‘banana fold.’’ It can also be used to improve a double infragluteal fold, to correct infragluteal fold asymmetry, or to shorten a long buttock when combining it with an upper buttock lift. It is indicated when the maximum point of buttock fullness is at the mid to upper portion of the buttocks, which should coincide with the level of the pubic symphysis [4]. If the maximum point of fullness falls below this line, then a superior approach and/or augmentation should be contemplated [5]. Furthermore, the inferior gluteal lift technique is contraindicated when the excess skin and subcutaneous tissue extends laterally toward the trochanteric area because this would force the incision to extend laterally, resulting in a long infragluteal fold. It has been widely accepted that one of the features of aesthetically pleasing buttocks is a short infragluteal fold that does not extend past the union of the semitendinous muscle with the biceps femoris, which is medial to the midaxial line of the thigh [4]. The postoperative results depicted in the article demonstrate a successful creation of an inferior gluteal fold and improvement in the contour of the inferior buttock and posterior thigh skin. Yet, the resulting inferior gluteal fold is long and extends into the trochanteric area. Unfortunately, only one patient was depicted in the postoperative images. We agree that avoidance of anchoring the dermal flaps to the periosteum of the ischial tuberosity would result in less postoperative pain as described by the authors. We routinely extend horizontal medial thigh lifts posteriorly into the inferior gluteal crease to create an improved infragluteal fold and lift the skin and subcutaneous tissue of the medial posterior thigh. In our experience with inferior gluteal lifts and horizontal thigh lifts, we have avoided scar migration and recurrence of ptosis by anchoring the superficial fascial system of the lower skin flap to the ischial periosteum with satisfactory long-term results [6]. We are concerned with the ability of the gluteal fascia to withstand the gravitational and muscle pull over a period of time. In their study, the patients were followed postoperatively for 2 months. It would be interesting to know whether the authors have experienced sustained long-term results without scar migration or ptosis recurrence. S. O. Sozer (&) F. J. Agullo Department of General Surgey, Texas Tech University Health Sciences Center, 4800 Alberta Avenue, El Paso, TX 79905, USA e-mail: doctor@elpasoplasticsurgery.com

Sciatic neuropathy after body contouring surgery in massive weight loss patients

To date, obesity affects a substantial population in industrialised countries. Due to the increased awareness of obesity-related morbidity, efficient dietary regimens and the recent successes with bariatric surgery, there is now a high demand for body contouring surgery to correct skin abundancies after massive weight loss. The known risks for this type of surgery are mainly wound-healing complications, and, more rarely, thromboembolic or respiratory complications. We present two female patients (23 and 39 years of age) who, in spite of standard positioning and precautions, developed sciatic neuropathy after combined body contouring procedures, including abdominoplasty and inner thigh lift. Complete functional loss of the sciatic nerve was found by clinical and electroneurographic examination on the left side in patient one and bilaterally in patient two. Full nerve conductance recovery was obtained after 6 months in both patients. Although the occurrence of spontaneous neuropathies after heavy weight loss is well documented, this is the first report describing the appearance of such a phenomenon following body contouring surgery. One theoretical explanation may be the compression of the nerve during the semirecumbent positioning combined with hip flexion and abduction, which was required for abdominal closure and simultaneous access to the inner thighs. We advise to avoid this positioning and to include the risk of sciatic neuropathy in the routine preoperative information of patients scheduled for body contouring surgery after heavy weight loss.

Lethal Pulmonary Embolisms Are Avoidable

Sir: We read with great interest the article “Temporal and Demographic Factors Influencing the Desire for Plastic Surgery after Gastric Bypass Surgery” by Dr. Gusenoff and colleagues published in an earlier issue of this Journal.1 The authors conducted a survey-based study of 2501 patients. They found a statistically significant association between young age, divorced status, female gender, history of laparoscopic gastric bypass, and desire to undergo body contouring after massive weight loss. Similarly, we conducted a study of our “bariplastic surgery” patients to further understand their unique needs and characteristics. After obtaining institutional review board approval, a survey was sent to 1991 patients who had undergone bariatric surgery between June of 2001 and June of 2006 at our institution. Two hundred forty-eight surveys (12.5 percent) were returned, 179 of which met inclusion criteria. Study variables included age, preoperative weight, maximum weight loss, nadir attained weight, preoperative body mass index, current body mass index, lowest body mass index, and information regarding insurance coverage and patient satisfaction with plastic surgery procedures. Statistical analysis with paired t testing revealed no statistically significant difference between patients who underwent plastic surgery procedures and those who did not. Contrary to the article referenced above, our study suggests that there are no objective patient- or weight-specific characteristics that make a patient more likely to seek body contouring after massive weight loss. We also found that the bariplastic patient is more likely to pursue face/neck lifting, thigh lifting, and arm shaping operations compared with the general population. Lastly, insurance coverage of plastic surgery was noted to be an important determinant of participation in body contouring procedures.2,3 Marcelo M. Ghersi, M.D. Kimberly A. Swartz Martin I. Newman, M.D. Michel Samson, M.D. Department of Plastic and Reconstructive Surgery Cleveland Clinic Florida Weston, Fla.

Hidradenitis suppurativa of the groin treated by radical excision and defect closure by medial thigh lift: Aesthetic surgery meets reconstructive surgery

Hidradenitis suppurativa of the groin is a chronic, relapsing inflammatory disease of the skin and subcutaneous tissues. Radical surgical excision is the treatment of choice. Often split-skin grafting or wound healing by secondary intention are used for defect closure, sometimes with disfiguring results. We describe our experience with radical excision of localised inguinal hidradenitis suppurativa and immediate defect closure with a medial thigh lift. Our hospital database was searched for all patients presenting to our institution for surgical treatment of hidradenitis suppurativa between 2001 and 2006. Only patients with hidradenitis confined to the groin were included. Exclusion criteria were simple abscess incisions, recurrence after previous grafting or flap surgery and extension of the disease outside the groin and presence of clinical signs of infection at the time of surgery. We documented patient demographics, sizes of defects, complications, time of follow-up, recurrences and patient satisfaction. A total of 8 patients with localised inguinal hidradenitis suppurativa were identified and 15 thigh lifts were performed. Defect size assessed on pathologic examination of the excised specimens averaged 15.9 cm x 4.3 cm x 1.3 cm (length x width x depth). All wounds but one healed primarily. Functional and aesthetic results were satisfactory. No major complications and no irritations of the genital area were observed. No recurrences were observed either. We propose the medial thigh lift to be considered for immediate defect closure after radical excision of localised inguinal hidradenitis suppurativa provided that no perifocal signs of infection are present after debridement.

Limb Contouring after Massive Weight Loss: Functional Rather than Aesthetic Improvement

After massive weight loss, both upper and lower limbs show a similar deformity which consists of redundancy and ptosis of the cutaneous mantle. Many disturbances are associated with this abnormality, which can be treated surgically. A retrospective review of limb-contouring procedures after massive weight loss is presented. Thigh lift and arm lift procedures are described. All surgeries of upper and lower limbs contouring performed between 2003 and 2006 are reviewed with regard to quantity of tissue removed, comorbidities, complications and patients' satisfaction, which was surveyed through a questionnaire exploring functional and esthetic results (maximum score 3). Among 48 bilateral limb-contouring procedures, medial thigh lifts were 35 (73%) and brachioplasties were 13 (27%). Mean age was 46 and average body mass index variation was 20 kg/m(2). The most frequent comorbidity was gallstones (28%). In 46% of the whole group of patients, there was no complication to mention. The most frequent complication was acute anaemia in both procedures (43% in thigh lift and 54% in arm lift). Mean quantity of adipose-dermoid tissue removed was 766 g in thigh lift and 463 g in arm lift. In case of surgery combined with liposuction, the average aspirated volume was 1,933 ml (thighs) and 1,117 ml (arms). Patients' satisfaction was 2.7 for thighs and 2.6 for arms, as average. The rate of complications in limb contouring after weight loss is higher than the analogue esthetic procedures. Nevertheless, due to the rehabilitative significance of limb surgery after weight loss, this step is to be included as fundamental in obese patients' surgical therapy.