Medial thigh lift

[Trochanteric under gluteus lift or bodylift, technique for massive trochanteric lipodystrophy: About 11 cases]

INTRODUCTION

There is a growing demand for weight loss sequelae. Some women have a particular morphology with a major trochanteric excess that warrants specific treatment.

MATERIALS AND METHODS

On the basis of the technique published in 1964 by Pitanguy, the authors suggest a lift of the external face of the thigh with the scar redrawing the lower part of the buttock, from the gluteal fold to the inguinal region by crossing the trochanteric region. Eleven cases of major trochanteric excess after slimming are presented. In 4 cases, the trochanteric excess is solely treated by trochanteric under gluteus lift. In 7 cases, it is associated with abdominoplasty to perform a trochanteric under gluteus bodylifting.

RESULTS

Complications and results are presented. The trochanterian excess is reduced, the buttock is harmonious and the patients satisfied.

DISCUSSION

Modifications are made to the much criticized technique of Pitanguy. The lipectomy replaces the monobloc resection, the scar is verticalized on the trochanter to join the abdominoplasty scar. This technique is an alternative to the vertical trochanteric resection associated with classic bodylift.

CONCLUSION

The trochanteric under gluteus lift is an elegant solution for treating large trochanteric excess. It is adaptable. It can become bodylifting TSF in the cases of great slimming.

An improved dual approach to post bariatric contouring - Staged liposuction and modified medial thigh lift: A case series

Objective:

Following massive weight loss (MWL) medial contouring of the thigh is frequently requested to improve appearance and function. Thigh lifting can be associated with significant complications. We present a case series of post bariatric patients undergoing thigh lift using staged the liposuction, a modified T incision and a buried de-epithelialised dermal flap.

Materials and Methods:

From January to December 2012, 21 consecutive patients underwent a modified medial thigh lift. A retrospective review of the case notes was performed to assess complications that occurred.

Results:

There were no major post-operative complications in terms of reoperation, hematoma, thromboembolism and no seromas. Seven patients, all of which were smokers had minor superficial wound healing complications. Aesthetic outcomes were satisfactory for all patients at a minimum follow-up of 6 months.

Conclusions:

The modified ‘T’ incision with staged liposuction is described. We have found the technique to be useful for a variety of different thighs. It is a reproducible method for contouring the medial thigh in MWL patients. In this series, our overall complications were low, and no seromas occurred.

Medial thighplasty after massive weight loss: are there any risk factors for postoperative complications?

BACKGROUND

With the increasing incidence of obesity in Western societies, an increasing number of patients undergo bariatric surgery that leads to functional and aesthetic sequelae related to a rapid and massive weight loss, namely, skin and fat excess. The goal of surgical management after massive weight loss is to optimize the functional results obtained from bariatric surgery or diet by removal of the redundant skin folds. The authors report their experience with medial thighplasty after massive weight loss and identify factors predictive of postoperative complications.

METHODS

This retrospective study investigated 53 patients who underwent surgery for medial thighplasty after massive weight loss. Data were collected through chart review and submitted to statistical analysis.

RESULTS

The average weight loss before thighplasty was 43.5 ± 14.9 kg, and 39.6 % of the patients experienced at least one complication. The complications were seroma (9.4 %), wound dehiscence (20.8 %), scar migration (17 %), wound infection (5.7 %), and partial skin necrosis (1.9 %). The body mass index (BMI) before massive weight loss and the BMI before medial thighplasty were found to be risk factors for the development of a postoperative complication.

CONCLUSION

Few guidelines exist for the optimization of care and safety in this complex patient population. The information from this retrospective study complements the current data from the literature and can help surgeons select patients eligible for medial thighplasty. This report shows that the BMI before medial thighplasty should be taken into consideration for patients willing to undergo a body-contouring procedure.

LEVEL OF EVIDENCE IV

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 .

Liposuction-assisted medial thigh lift in obese and non obese patients

INTRODUCTION

The abdomen, thighs and buttocks are often the areas of greatest concern to patients following massive weight loss due to bariatric surgery. The typical appearance of the patient who has lost a massive amount of weight derives from a combination of factors, including gender-dependent body morphology and a change in body mass index, which lead to skin and soft-tissue excess and poor skin tone. Thigh laxity and redundancy represents a great challenge to both patients and surgeons. Not only because of the difficulty to satisfy the patients, but also due to the higher incidence of complications especially, with those obese patients who have not undergone bariatric surgery before. The problems with such patients are due to the heavy thighs that require both debulking and tight anchorage to prevent scar migration or labial distortion.

AIM OF THE WORK

The aim of the present study is to improve the aesthetic outcome and avoid the complications of medial thigh lifting with simultaneous liposuction in obese and non-obese.

PATIENTS AND METHODS

A total of 25 female patients presented during the period from January 2007 to July 2011 complaining of moderate to severe thigh laxity with or without lipodystrophy. In 20 patients medial transverse thigh lift was performed, to treat medial thigh friction and laxity particularly in the upper half. Whereas, in the other five patients were suffering from upper and lower medial thigh bulkiness, vertical thigh lift was performed.

RESULTS

All patients recovered well in 2 weeks and showed improvement of thigh contour. Scar downward displacement in one patient. No skin necrosis or seroma. No labial distortion or separation encountered.

CONCLUSION

Simultaneous liposuction and thigh lift gave good results provided proper patients selection, appropriate technique to each patient, meticulous, cautious liposuction and handling of the tissues and most importantly is the deep tight anchorage sutures to guard against the effect of heavy skin flaps.

Spiral lift: medial and lateral thigh lift with buttock lift and augmentation

BACKGROUND

Patients with a pear- or guitar-shaped body contour deformity are not frequently encountered, but represent a surgical challenge. Traditionally, these patients have been treated with belt lipectomies, lower body lifts, medial thigh lifts, and liposculpture because liposuction alone often is insufficient. This article describes an alternative method for performing a medial, anterior, and lateral thigh lift with a buttock lift and autoprosthesis augmentation through a single spiral incision easily concealed by underwear.

METHODS

A retrospective study of patients treated for body contour deformities from January 2004 to June 2006 was conducted. The inclusion criteria for spiral lift were lipodystrophy and excess skin and subcutaneous tissue of the thighs, flanks, and buttocks without contour deformities of the abdomen. The incision extends from the inferior crease of the buttocks along the inguinal crease and continues just inferior to the anterior iliac spine, spiraling above the buttocks and meeting the contralateral incision at the sacrum. A dermal fat flap is rotated to function as an autologous buttock implant. Pre- and postoperative views, patient satisfaction, complications, and operative details are analyzed and described.

RESULTS

Of the 253 consecutive patients treated for body contour deformities, 5 met the inclusion criteria for the spiral lift. All the patients were women ranging in age from 30 to 43 years. Comparison of pre- and postoperative views demonstrated improved contour and firmness of the thighs and gluteal region with easily concealed scars. The inferior gluteal sulcus became less evident, and the buttock mass was elevated and augmented with maximum projection at midlevel. Patient and surgeon satisfaction was high. One patient experienced delayed wound healing. Stability in the body contour repair was demonstrated at the 1-year follow-up assessment.

CONCLUSIONS

A reliable, versatile, and effective technique is described. Applicability and experience with the procedure are limited due to infrequent presentation of patients seeking correction for such a body contour deformity.

Use of the pitanguy large flap demarcator in thigh dermolipectomy with a medioanterior scar extension

BACKGROUND

Thigh dermolipectomy is one the most challenging procedures for the treatment of postobesity deformities. Excessive tissue on the medial portion of the thigh is associated with the poor results of the classic approach. Recently, different techniques have been proposed with the goal of improving the results. The current study presents an alternative technique for thigh dermolipectomy using the Pitanguy flap demarcator with a medioanterior scar extension.

METHODS

From January 2002 to July 2005, the authors prospectively followed up patients undergoing thigh dermolipectomy using the Pitanguy flap demarcator for marking resection areas and the medioanterior scar extension.

RESULTS

Eight patients ranging in age from 30 to 54 years and with a weight loss of 30 to 59 kg were submitted to the medioanterior extension thigh dermolipectomy. All the patients displayed important soft tissue laxity and redundancy at the lower limbs. The postoperative follow-up period ranged from 5 to 40 months. The results attained were considered satisfactory, and few complications were observed.

CONCLUSIONS

The poor results of previous procedures were disappointing to many patients and discouraged many others from undergoing thigh dermolipectomy. Using the Pitanguy flap demarcator for markings and the medioanterior scar extension, satisfactory results were increasingly common, and a growing number of patients may be encouraged to undergo thigh dermolipectomy procedures.

Surgical solutions to the problem of massive weight loss

In response to the global rise in obesity, bariatric surgery has become increasingly more popular and successful. As a result, the demand for body contouring following massive weight loss is rapidly growing. Although bariatric procedures may produce impressive weight loss, people who achieve massive weight loss are often unhappy with the hanging folds of skin and subcutaneous tissue that remain. This review examines the nature of the post-bariatric deformity in each body region and briefly reviews common approaches to their treatment.

Fascio-fascial suspension technique in medial thigh lifts

Redundant thigh tissue can be corrected by the thigh lift. However, this is a seldomly used procedure because of postoperative problems such as inferiorly displaced and wide scars, vulvar distortion, and early recurrence of ptosis. In order to limit these complications, we developed a deep anchoring technique based on the overlap of the adductor longus and gracilis fasciae. A group of 18 patients underwent a medial thigh lift using this technique and were followed for at least 12 months after surgery. The fascio-fascial suspension gives strong vertical support with minimal tension on the skin, thereby reducing the complications traditionally associated with this procedure.

Medial thighplasty, prevention of scar migration, and labial flattening

As more people seek body contour surgery spurred on by the media's great interest in suction lipectomy and the seemingly increasing numbers of satisfied patients, we should re-examine an area where results of body contour surgery have been less satisfying, the inner thigh. In those patients whose problem remains skin flabbiness rather than excessive fat, either alone or after successful or partially successful suction lipectomy, an inner-thigh procedure is indicated.