Thigh contour deformities, and those of the medial thighs, are a frequent concern for individuals seeking body contouring. The deformity is usually secondary to weight loss and is often associated with prior pregnancy and, in many instances, liposuction of the thighs.
Despite the frequency of this concern, plastic surgeons have often been reluctant to use the medial thigh lift procedure because of the risk of significant complications and poor results and the potential for readily visible scars.
Until recently, all medial thigh lift techniques described in the literature attempted to address medial thigh deformity by removing soft tissue excess in a vertical vector alone. An exception was Lewis’s first description of a medial thigh lift in 1957. He advocated both a horizontal and vertical component to the procedure.
Lockwood, a proponent of vertical vector excision alone, described minimizing complications such as labial spreading and scar migration and improving outcomes by securing the medial thigh flap to Colles fascia. Although the concept seemed to be a logical approach to address problems associated with medial thigh lifts, it added little to existing procedures.
In recent years, primarily in response to the increase in numbers of individuals with post-bariatric body contour concerns, plastic surgeons have again advocated the excision of soft excess in both a vertical and horizontal vector to address medial thigh deformities.
Body contouring operations such as thigh lifts are being performed in higher numbers, mirroring the increase in bariatric surgery over the last decade. According to the American Society for Aesthetic Plastic Surgery, thigh lift was among the top 20 most-performed operations over the last several years.
In addition, the significance of addressing the vertical soft tissue excess of the lower abdomen, hips, thighs, and buttocks before performing an effective medial thigh lift has become more generally accepted.
Massive weight loss patients are divided into two groups: deflated and non-deflated. Deflated patients are present with skin flaccidity without residual fat deposits. In deflated fat, tissue thickness is lower, so a combination of surgeries is possible because the surgical time and bleeding are minor. These patients are treated using an extended vertical medial skin excision, with or without liposuction.
Non-deflated patients present with both skin laxity and fat collection. For these patients, liposuction is performed at the first stage, combined with a lower body lift, followed by an extended vertical medial skin excision 4 to 6 months later. In the non-deflated, the association of procedures simultaneously is not recommended because the thicker adipose tissue is related to a higher incidence of postoperative complications.
Patients with aging thighs usually present with fat collection with varying degrees of skin laxity. Their thigh deformity is confined to the upper thigh and offered liposuction and horizontal medial skin excision at the level of the inguinal fold. The progression of skin flaccidity from the upper to the entire thigh can be associated with vertical skin excision.
PATIENT SELECTION AND SCREENING
As with all surgical candidates, individuals seeking surgical correction of their medial thigh deformities should undergo a thorough history and physical examination. Information relevant to medial thigh lift surgery includes a weight history through lifestyle changes.
Prior body contouring procedures should be noted, including liposuction, because it may affect the surgical plan and outcome.
I should also document the history of lymphedema or peripheral vascular disease.
As part of the initial interview, patients’ expectations for medial thigh lift surgery and their tolerance for scars should be established.
Physical examination should focus on a careful assessment of the medial thigh deformity and the variables outside the medial thighs potentially contributing to the deformity: soft tissue excess along the lower abdomen, mons pubis, hips, lateral thighs, and buttocks.
Patients should be asked to stand in front of a full-length mirror and apply solid traction upward to the soft tissues of their lower abdomens with their two hands. At the same time, the surgeon or examiner should then apply upward traction to the patient’s lateral thighs and buttocks.
This technique for examination helps eliminate the variables outside the medial thighs contributing to the medial thigh deformity. It also shows patients the function of circumferential body lifting procedures. Patients usually are not aware of the significance of these variables.
A second maneuver that should also be considered is to have patients abduct one of their thighs. Grasping the soft tissue of the medial thigh with the patient standing and stigmata of lymphedema should be documented, as should the presence of arterial or vascular insufficiency.
Scars from previous surgery along the lower body and extremities should be documented, as should contour irregularities secondary to liposuction. The quality of existing scars is essential to note. Medial thigh lifting surgery may result in more perceptible scars than other more traditional procedures.
What Can’t Thigh Lift Surgery Make Out?
Thigh lifts are not meant to remove extra fat. Liposuction alone can remove excess fat deposits where the skin has good elasticity and can naturally conform to new body contours. In examples where skin elasticity is reduced, a thigh lift and Liposuction may be commended.
Who is the Right Candidate for Thigh Lift Surgery?
In general, candidates for a thigh lift are:
- People whose weight is stable
- People with the extra soft tissue on the inside (medial) thigh area and the outer (lateral) thigh
- Healthy individuals who do not have medical conditions that impair healing or increase the danger of the surgical operation
- People with a positive outlook and realistic goals for what thigh lift surgical procedure can achieve
- People devoted to directing a healthy lifestyle, including proper nutrition and fitness
TREATMENT GOALS AND PLANNED OUTCOMES
A clear understanding of the variables contributing to a patient’s medial thigh deformity is critical to optimizing outcomes following medial thigh lift surgery.
Their dependent position complicates the analysis of the medial thighs. Unlike many other body areas commonly treated by plastic surgeons, the medial thigh contour is strongly affected by the status of the soft tissues immediately cephalad to it, particularly in patients after weight loss.
A failure to address deformities along the mons pubis, hips, thighs, buttocks, or the lower body produces suboptimal results. Circumferential lower body lift procedures effectively address these concerns. Equally important is the recognition of soft tissue excess in the horizontal vector.
What Should I Expect During a Consultation for Thigh Lift Surgery?
- During your thigh lift surgery consultation, be ready to talk about:
- Your surgical goals
- Medical conditions, drug allergies, and medical discourses
- Current medications, vitamins, herbal supplements, alcohol, tobacco, and drug usage
- Previous surgeries
Your Cosmetic Surgeon will Discuss This with You:
- Evaluate your general health status and any pre-existing health conditions or risk factors
- Analyze and measure your physical structure, including detailed measurements
- Need photographs for your medical records
- Discuss options with your doctor
- Discuss your options and recommend a course of treatment
- Discuss outcomes of thigh lift surgery and any risks or potential complications
The success and safety of your procedure depend on your complete candidness during your consultation. It’s vital to understand all aspects of your thigh lift procedure. It’s natural to sense some anxiety, whether excitement for your anticipated fresh look or a bit of preoperative stress. Don’t be timid about talking about these feelings with your plastic surgeon.
PREOPERATIVE PLANNING AND \PREPARATION
The critical point for successful intervention is the preoperative evaluation for surgical planning. The surgeon should clarify the limitations of the procedure, discuss complications, and emphasize the presence of extensive scarring, especially in patients for whom a vertical medial incision will be needed.
We evaluate the skin quality (MWL patients have depleted collagen fibers), degree of elasticity, laxity, identification of lipodystrophy areas, and presence of previous scars. We also evaluate the pinch test and traction’s vertical and horizontal skin excess. You must sign a consent form.
The patient must undergo a psychological evaluation to check their expectations about the outcome. A nutritional screening must be performed, especially in MWL patients. Nutritional deficiencies such as iron, albumin, and vitamin depletion can predict complications.
Before surgery, antimycotic treatment should be performed in patients with fungal infections. Moreover, patients should stop smoking; the prevention of venous thromboembolism is crucial and should be adopted.
Marking and Surgical Technique
Most skin excision techniques involve skin markings at the proximal and medial thigh using the pinch test to predict the amount of skin to be removed, which is adjusted perioperatively to achieve closure without tension. The patient is marked in the standing position, anterior and posterior, with the knees apart. The femoral triangle is marked to avoid dissection into the lymph vessels. The location of fat deposits for liposuction is also marked.
The degree of thigh laxity determines the location of the incisions and the need to add a vertical component. Usually, when skin laxity is located only at the upper third of the thigh, a horizontal incision at the level of the inguinal fold is enough.
However, if skin laxity reaches the entire thigh L–a shaped incision or a T-shaped incision may be needed, according to the amount of skin to be resected. An attempt is made to hide the resultant scar less visible in an anatomic position in these cases.
Intended Outcomes of a Thigh Lift Surgery
- Although it involves several months for your body to recover fully, the results of your thigh lift operation will be apparent at once.
- Quiet, well-contoured thighs will replace the excess skin and fat.
- There will be some visible scars.
How Should I Prepare for Thigh Lift Surgery?
In preparing for thigh lift surgery, I may need you to:
- Get lab testing or a medical evaluation
- Take certain medications or adjust your current medicines
- Stop smoking
- Avoid taking aspirin, anti-inflammatory drugs, herbal supplements, or other drugs that may increase bleeding.
Thigh lift surgery may be performed in MSI surgical facility, licensed ambulatory surgical center, or hospital. If your thigh lift is performed on an outpatient basis, arrange for someone to drive you to and from surgery and stay with you for at least the first night following surgery.
What are the Steps of Thigh Lift Surgery?
A thigh lift procedure includes the following steps: Anesthesia Medications are administered for your comfort during the surgical procedures. The options include intravenous sedation and general anesthesia. Your doctor will recommend the best option for you.
Inner thigh lift incision: One technique used for a thigh lift places incision in the groin, extending down and wrapping around the back of the thigh. Another method removes excess skin from the crotch down to the knee using an incision along the incision. The incision patterns vary based on the treatment area, degree of correction, and patient and surgeon preference.
You may also qualify for a minimal incision inner thigh lift that involves an incision only in the groin area. Your plastic surgeon will find what’s right. Outer thigh lift incision: Improving the contours of the outer thigh may require an incision extending from the groin around the hip and across the back. Advanced techniques usually allow incisions to be placed in strategic locations where most clothing and swimsuits can hide them. However, incisions may be extensive.
Closing the incisions: Deep sutures within underlying tissues help form and support the newly shaped contours. I may use sutures, skin adhesive tapes, or clips to close the skin incisions.
What Should I Expect During Thigh Lift Surgery Recovery?
The smoother, tighter contouring from a thigh lift is apparent almost immediately, although initially obscured by swelling and bruising. During your recovery from thigh lift surgery, dressings/bandages may be applied to your incisions after the procedure. Small, thin tubes may be temporarily placed under the skin to drain excess fluid or blood that may collect.
You will be given specific instructions that may include:
- How to care for the surgical site(s)
- Medications to apply or take orally to aid healing
- Specific concerns to look for at the surgical site or in your general health
When to Follow Up with Your Cosmetic Surgeon?
- Be sure to ask your thigh lift surgeon specific questions about what you can expect during your recovery period:
- Where will I be taken after my surgery is complete?
- What medication will I be given or prescribed after surgery?
- Will I have dressings/bandages after surgery? When will they be removed?
- Are stitches removed? When?
- When can I resume regular activity and exercise?
- When do I return for follow-up care?
Thigh lift Surgery Recovery at Home
If you experience any shortness of breath, chest pains, or unusual heartbeats, seek medical attention at once. You may need hospitalization and added treatment if any of these complications occur.
- You must follow your cosmetic surgeon’s instructions carefully.
- Your incisions will be bandaged, and any drains will be placed temporarily.
- After the first swelling and bruising subside, the results will be ready for the vise.
- It can take up to 8 months for 100% of the edema to completely subside.
- Surgical incision scars tend to improve for a little over a year.
What Results Should I Expect After Thigh Lift Surgery?
- The results of a thigh lift are visible at once. However, the latest results may take several months to develop fully.
- Following a thigh lift, skin quality improves both appearance and feel.
- Some visible scars will remain, but the overall results are long-lasting if you keep up a stable weight and general fitness.
- As your body ages, it is natural to lose some firmness. However, most of your first improvements should remain.
- Although satisfactory results are expected from your procedure, there is no guarantee. It may not be possible to do the best results with a single surgical procedure, and another surgery may be necessary for some situations.
Adequate pain management should be carried out because the medial thigh is an area with great sensibility. Urinary catheterization is indicated during hospitalization to reduce dirt and local humidity and promote comfort for the patient due to vulvar edema.
Patients are advised that they may ambulate immediately after surgery as tolerated. Dressings and elastic wraps are removed 48 hours after surgery when showering is permissible.
Compressive garments can be used from early postoperative days to 3 to 6 weeks after surgery. Still, You can start their use only 15 days after surgery because they initially lead to the retention of local moisture, which increases the risk of dehiscence.
After that, patients are not advised to wear any supportive garments unless swelling of the legs or feet becomes evident. In these cases, supportive stockings are suggested.
Any exercise or activity that may lead to significant perspiration is discouraged for two weeks. In addition, patients are advised to avoid abducting their thighs beyond forty-five_ to avoid excessive tension and the thigh perineal closure.
Vigorous upper body activities are permitted after two weeks, and lower body activities after six weeks. Patients are not advised to apply or consume any products or perform any therapy to improve scar quality.
What are the Risks of Thigh Lift Surgery?
The decision to have plastic surgery is highly personal. You’ll have to decide if the benefits will make your goals and if thigh lift surgery’s risks and potential complications are acceptable. Your plastic surgeon and staff will explain the risks associated with surgery. You will be asked to sign consent forms to make sure that you fully understand the procedure and any risks and potential complications.
Thigh lift surgery risks include:
- Anesthesia risks
- Poor wound healing
- Fluid accumulation (seroma)
- Major wound separation
- Deep vein thrombosis, cardiac and pulmonary complications
- Fatty tissue under the skin might die (fat necrosis)
- Persistent pain
- Skin discoloration and swelling
- Skin loss
- Sutures may spontaneously surface through the skin, become visible or produce irritation that needs removal.
- Unfavorable scarring
- Numbness or other changes in skin sensation
- Recurrent looseness of skin
- Possibility of revisionary surgery
I will thoroughly discuss these risks and others before your consent. It would be best to address all your questions directly with your plastic surgeon.
I can determine the specific risks and the suitability of this procedure for a given individual only at the time of consultation. All surgical procedures have some degree of risk. Minor complications that do not affect the outcome occur occasionally. Significant complications are rare. One should realize that a thigh lift can be an extensive operating room and may take an extended time to recuperate.