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Dr. Barry Eppley

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Archive for the ‘knee lift’ Category

Case Study – Knee Lifts for Excessive Skin Rolls

Sunday, December 24th, 2017


Background: The descent of gravity affects many face and body structures. The lower extremities are no exception. One of the leg places that tissue falls to is the knee. The knee acts like a stop for tissue descent due to the rigid attachments of the knee joint. It tends to ‘pile up’ above the patella also known as the kneecap. The broader upper surface of the kneecap and its attachments acts is where lower thigh tissues come to rest when the leg is extended.

Problematic knee rolls can not really be improved without direct excision. Any form of a thigh provides a tissue pull that is too distant. Even it were effective many patients with knees rolls do not need or want a thigh lift. The most common treatment approach for knee rolls is liposuction. Besides being ineffective it often, however, makes the knee rolls worse with the tissue deflation. Such knee skin does not have the ability to contract and become less with subcutaneous fat removal.

The knee lift is an uncommon procedure even though it is very effective at removing the knee rolls. The cancer with its use is the obvious visible scar concern. Since the knee must bend such a scar raises the additional concern that it will widen and become an equal aesthetic distraction as the knee rolls themselves.

Case Study: This middle-aged female was bothered by the multiple skin rolls above her knees. Three to four rolls of skin encroached and hung over the top half of her patella with the leg in extension.

Preoperative markings for knee lifts must be done in both leg extension and flexion. Flexion will expand the crescent-shaped skin markings from that done in extension. This shows how much much more tension would be placed on any tissue excision done with the leg extended. The skin marking must then be reduced from what was marked in extension. Usually it will be about 2/3s for what was originally marked in extension to avoid the risk of postoperative wound separation when the knee is bent.

Under general anesthesia the crescent-shape tissue excision is done, removing the upper two-thirds of the preoperative markings. This ensures that the final closure line rests above the patella as well as avoids over resection. The tissue excision only goes down the subcutaneous fat level and stops short of the fascia. A two-layer closure is done with subcuticular skin suturing.

Knee lifts can be a successful treatment for  excessive skin rolls with very acceptable scarring. The key is proper scar line placement and avoiding over resection of tissue. this is dependent on preoperative markings with the knee in both extension and flexion and making the necessary adjustments.


1) Saggy knees develop a roll(s) of skin above the patella.

2) No form of a thigh lift can improve the distant knee location.

3) Knee lifts remove skin and subcutaneous fat above the knee which must be marked carefully to avoid over resection of tissue.

Dr. Barry Eppley

Indianapolis, Indiana

Techniques in Knee Lifts

Tuesday, October 31st, 2017


Many parts of the body suffer sagging or loose skin from the effects of aging and gravity. The tissues above moveable extremity joints (knees and elbows), however, has the added influence of motion across the joint with flexion to an arc of up to 120 degrees. As a result the stretching of the soft tissue over the bony joint contributes to loose skin and wrinkles when the extremity is extended.

Such an effect caused by gravity, aging and joint flexion affects the knee. Above the knee cap (patella) a crescent-shaped tissue redundancy can appear. This can be aesthetically disturbing in some women as the knee is very visible in shorts and many skirt styles. This suprapatellar mound of tissue have been treated by a variety of different modalities with very limited success. While liposuction can reduce its fullness this often only results in a deflated appearance and further tissue wrinkling/folds. In some patient it even makes its appearance worse. Non-surgical skin tightening devices and fat reduction methods offer limited to no visible improvement.

The knee lift is the only true effective procedure because it removes the excessive sagging tissues that abut up against the knee cap. The key to the procedure is carefully marking of the zone of excision and keeping the scar length and location as limited as possible. The suprapatellar excision must be marked both standing as well as sitting with the knees flexed at 90 degrees.This will ensure that an over resection is not done by a pinch test in flexion to determine the amount of potential tension on the wound closure.

The knee lift excision is taken down to the fascia in a wedge-like fashion leaving a layer of subcutaneous fat under the closure line. If this is not done the scar line can end up looking inverted in extension and even potentially in flexion. A layered subcuticular closure is done to avoid any external stitch marks.

While very effective the issue with the knee lift is the resultant scar and how well it heals. Most heal with a very fine line and an acceptable scar as the aesthetic tradeoff. But the risk of adverse scarring remains and the potential secondary need for a scar revision procedure.

Dr. Barry Eppley

Indianapolis, Indiana

The Knee Lift for Unsightly Skin Folds of the Knee

Sunday, November 10th, 2013


Plastic surgery has many nip and tuck procedures from the face down to the thighs. All of these are about removing loose tissues from aging and stretching forces and pulling them tighter closer to their original position. When tissues are pulled upwards they are known as ‘lifts’. (e.g., facelift, breast lift, thigh lift) When tissues are pulled downwards they are known as ‘tucks’. (e.g., tummy tuck)

One of the less well known of the lifting procedures is the knee lift. This almost unheard of extremity lift achieved temporary celebrity status when actress Demi Moore purportedly had it done in 2006. At the time pictures showed her knees before and after although I would question, for reasons explained later, as to whether she had a true knee lift procedure.

Like all body areas, the knees do show the signs of aging. The constant flexion and extension of the knee eventually causes loose skin to appear in folds or rolls above the kneecap. These suprapatellar skin folds can also be exaggerated by the downward descent of the thigh skin which pushes down against the fixed skin on the kneecap. Like rings on a tree trunk, the knees inevitably show the telltale signs of one’s true age.

While there are numerous non-surgical devices that use various forms of energy for skin tightening, and they may be used on the knee area, they do not constitute a true knee lift. Non-surgical treatments can not tighten enough to effectively remove folds of skin. For those with significant knee skin folds , who hasn’t pulled up on their thigh to create a knee lifting effect.

Unfortunately the lifting effect for the knees can not come from any distant area like the groin creases…that is simply too far away to have any effect. A true knee lift involves the direct excision of these folds of knee skin and creates a suprapatellar scar to do so. The creation of this scar in a visible area is the primary reason why it is infrequently performed and rarely heard of…even in plastic surgery circles.

The knee lift is a very successful procedure because it does remove the excess suprapatellar folds of skin. This is done through a crescent-shaped excisional pattern and it will leave a scar. But the key to having a more favorable scar is precise placement of the excision location and to not remove too much tissue. Since the width and appearance of scars is highly influenced by the tension they are under. too much skin removal across a joint that repeatedly flexes is a setup for eventually creating a wide scar.

The markings for a knee lift are initially done with the patient standing. The lower skin crease that hangs down onto the knee cap is marked first in a curved shape. All the folds of excess skin are then pinched and the upper limit is then marked and a superior curved line created. The patient is then sat down and with the knees bent at 90 degrees the size of the crescent evaluated which will appear strikingly large. By using a pinch technique the upper limit of the superior excision line is re-evaluated and redrawn more inferiorly, reflecting the amount of skin that can be removed without undue tightness on the projected closure. It will usually be at least 1 to 1.5cm less than what was marked standing up.

The knee lift is done under local or IV sedation anesthesia. The intervening skin and subcutaneous tissue is removed between the marks but not all the way down to the fascia to prevent unsightly skin adhesions and scar tightness. A three layer wound closure is needed with a barbed suture for a subcuticular skin closure. Long-term suture support is needed to resist the stretching of knee flexion and to help keep the scar as narrow as possible. The knee incision are taped and ace wraps applied. Patients only need to avoid bending their knees greater than 90 degrees for a month after surgery.

While the knee lift is a simple outpatient procedure to perform and has a fairly easy recovery, it is not for every woman that does not like her aging knees. One has to be bothered enough about their extra knee folds that they consider a fineline scar as a good aesthetic trade-off.

Dr. Barry Eppley

Dr. Cristiane Ueno

Indianapolis, Indiana

Dr. Barry EppleyDr. Barry Eppley

Dr. Barry Eppley is an extensively trained plastic and cosmetic surgeon with more than 20 years of surgical experience. He is both a licensed physician and dentist as well as double board-certified in both Plastic and Reconstructive Surgery and Oral and Maxillofacial Surgery. This training allows him to perform the most complex surgical procedures from cosmetic changes to the face and body to craniofacial surgery. Dr. Eppley has made extensive contributions to plastic surgery starting with the development of several advanced surgical techniques. He is a revered author, lecturer and educator in the field of plastic and cosmetic surgery.

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