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Archive for the ‘thigh lifts’ Category

Case Study – Vertical Inner Thigh Lifts

Saturday, January 28th, 2017


Background: Large amounts of weight loss, whether from bariatric surgery or through non-surgical diet and exercise, has an overall body deflation effect. This is manifest as loose skin which can be seen from the neck down to below the knees. All of this loose skin has created a whole spectrum of new body contouring procedures which are really extensions or expanded forms of traditional body lifting techniques.

The thighs are a well known area for the development of loose skin which is largely seen in the inner thigh area. The traditional horizontal groin crease thigh lift is not remotely adequate for most weight loss patients. Extended inner thigh lifts are what is usually needed and are done by either a T-shaped or inverted L-shaped skin excision pattern. While effective, the horizontal skin closure often poses problems of postoperative wound dehiscence, wide scarring and scar drift downward from the groin crease line.

A vertical inner thigh lift concept avoids the use of a groin crease excision/closure line. It is done by creating a larger vertically-oriented elliptical excision of skin from the inner thighs. Its use is reserved for those patients who on a preoperative pinch test produces little to no bunching at the upper end of the planned incision at the groin crease.

Case Study: This 28 year-old female had lost over 60 lbs and had previously been through breast augmentation and a tummy tuck to improve the loose skin in these area. She had loose skin on the inner thighs but it was largely along the inner thighs along a vertical line from the groin creaser to above the knees..

Right Vertical Inner Thigh Lift result Dr Barry Eppley IndianapolisVertical Inner Thigh Lifts immediate results both legs Dr Barry Eppley Indianapolis plastic surgeonUnder general anesthesia and in the frog-legged supine position, a large vertical ellipse of skin was marked out on the inner thighs. The widest margin of skin excision was central as determined by a preoperative pinch test and measured 14 cms. The skin was excised preserving the saphenous vein and closed in a single fine vertical line. No drains were used.

vertical inner thigh lift gap result Dr Barry Eppley IndianapolisThe vertical inner thigh lift will not work for every weight loss patient and depends on how much loose skin one has on their inner thighs. But when possible its uses avoids the potentially problematic horizontal groin crease incision and an intersecting horizontal and vertical skin closure.


1) Loose skin after large amounts of weight loss affects the body from neck to knees

2) Inner thigh lifts usually require a 3D removal of skin in both vertical and horizontal dimensions to be effective.

3) Vertical inner thigh lifts involve a 2D removal of skin and avoids horizontal groin crease scars.

Dr. Barry Eppley

Indianapolis, Indiana

L-Shaped Inner Thigh Lift

Thursday, August 27th, 2015


One of the common body contouring procedures for the bariatric or extreme weight loss patient is the need for thigh lifts. While not usually part of the first stage body contouring efforts, it often is part of a second or third stage makeover effort. The problem with the thigh lift is that the traditional medial or inner thigh lift as a fairly high rate of complications.

The inner thigh lift scar frequently drifts downward due to gravity and the pull of the thigh tissues on it. This frequently exposes the scar below the inner thigh crease making it fairly visible. If the thigh lift scar is placed too high or under too much tension the downward drift of the scar can cause distortions of the vulva or scrotum. Extensive undermining of the thigh tissues also runs the risk of disrupting the groin lymphatics resulting in chronic lymphedema of the leg.

In the September 2015 issue of the Annals of Plastic Surgery an article was published entitled ‘L-Shaped Lipothighplasty’. Over a six year period the authors treated 16 bariatric surgery patients with inner thigh laxity. The majority of them (80%) healed.Two patients developed hypertrophic scarring and 1 patient had a wound infection. There results showed that he medial lifting technique defined as L-shaped lipothighplasty is a safe and effective technique and can reduce early and late postoperative complications in what is a known troublesome area in body contouring.

This paper provides additional documentation as to the validity of a liposuction-assisted medial thighplasty. As has been published in previous papers this is a procedure that is done using four basic steps. First an L-shaped medial thigh lift pattern is marked out. Secondly the area is infiltrated with a tumescent solution. Thirdly the thigh area is treated power-assisted liposuction. Lastly the skin and fat inside the marks are excised with care to preserve the underlying lymphatics and the saphenous vein.

Like all operations the inner thigh lift is different for certain types of patients. It is not one operation done the same way for everyone. The mini- or limited inner thigh lift uses just a horizontal incision in the groin crease with a horizontal ellipse of tissue. This limited form of an inner thigh lift works best for those people who have only loose tissue at the upper thigh area. The L-shaped or short scar inner thighplasty uses an L-shaped excision pattern close to the groin crease for more moderate excesses of inner thigh skin. The full vertical inner thighplasty uses a vertical ellipse of tissue down the center of the inner thigh to remove tissue along its entire length from the groin to the knee.

In most cases, however, the L-shaped inner thigh lift offers a good outcome with a low rate of complications. The L-shaped tissue excision pattern avoids the temptation to take too much tissue horizontally, The liposuction helps reduce the tension on the wound closure through debulking  and provides tissue mobilization with the skin undermining.

Dr. Barry Eppley

Indianapolis, Indiana

Complication Rates of Inner Thigh Lifts

Thursday, January 8th, 2015


There are may women who are not happy with the appearance of their inner thighs. But when significant weight loss has occurred after dieting or bariatric surgery, the inner thigh can develop considerable loose skin which is maximally unaesthetic in its appearance. This is the most common patient in which an inner thigh lift (medial thighplasty) is done.

The inner thigh lift can treat varying amounts of loose tissue and there are a variety of patterns of skin and fat excisions that can be done. These patterns include horizontal, short vertical and long vertical inner thigh lifts. The pattern of excision chosen is based on the location and extent of the loose tissues and how much of the length of the inner thigh is involved. Despite inner thighs being now more than ever before, it is the one body contouring procedure which is probably written about and critiques the least.

Thigh Lift Scars Dr Barry Eppley IndianapolisIn the January 2015 issue of the journal Plastic and Reconstructive Surgery, an article was published entitled ‘Medial Thigh Lift in the Massive Weight Loss Population: Outcomes and Complications’. In this paper, 106 patients (90 women, 16 men) over a nine year period who had various types of inner thigh lifts performed were assessed. Horizontal thigh lifts had a 43% complication rate, short scar inner thigh lifts had a 67% complication rate, full length vertical inner thigh lifts had a 74% complication rate. Complications included wound dehiscence (50%), seroma (25%), infection (16%)  and hematoma. (6%) Chronic leg edema occurred in 25% of the patients which in a few patients took up to one year to resolve. Liposuction outside the scope of the excision was associated with increased complication rates.

For those plastic surgeons that have performed more than just a few inner thigh lifts, this study really rings true. Inner thigh lifts are associated with a high rate of complications and some degree of suture line dehiscence is the norm and not the exception. It is only a question of how big the separation will be and how long it will take to heal. To no surprise, the more extensive the inner thigh lift is (the longer the scar) the higher the rate of potential complications. It is a bit surprising that liposuction also increases the rate of wound dehiscences. But probably not surprising when thought about biologically since it traumatizes the skin flaps and disrupts lymphatic outflow.

Why do thigh lifts have such a rate of wound problems compared to other body contouring procedures? It simply is the location of the incisions are in an area of the body that is exposed to a lot of stress and shearing on the wound closure. It is also over an area of a density of lymph nodes (inguinal lymph node basin) which make sit prone to seroma formation.

Fortunately most of the wound complications associated with inner thigh lifts are not major and do go on to heal on their own without significant scarring complications. But what this study suggests is that over aggressive inner thigh lifts are doomed for problems and a more conservative inner thigh lift, while falling somewhat short of patient expectations in some cases, will more likely have a smoother and shorter recovery period.

Dr. Barry Eppley

Indianapolis, Indiana

The Inner Thigh Gap – Can It Be Created?

Monday, March 11th, 2013


The shape of the thighs has long been an aesthetic interest/concern for some women. The most common thigh deformity are saddle bags, those outward protrusions that violate a straight or gently convex curve from the hip down to the knee. But the inner thigh is also an area of thigh insecurity as well with bulges and sagging skin that obscures a smooth line upward into the genital area.

An often requested inner thigh goal is to have a space created between the inner thighs. Sometimes this is to get rid of rubbing or a chronic irritation from continuous tissue contact. Others seek a more ambitious aesthetic goal where one can see right through the inner thighs like a model going down the runway. Recent reports act as if this is a new cosmetic request (the thigh gap trend) but the reality is that it has been a long-standing concern for as long as plastic surgeons can remember.

While the goal of inner thigh separation is long-standing, the methods to try and achieve it are both old and new. Liposuction and inner thighs lifts are historic treatment strategies that are likely to make the most difference. New treatments such as Smartlipo and non-surgical approaches like Exilis and other energy-based treatments hope to achieve inner thigh reduction through fat cell shrinking and/or removal. It should not be expected that these energy-based treatments will be as effective at inner thigh slimming as surgery.

The reality of inner thigh surgical and non-surgical treatments is that they can be effective but rarely, if ever, can create an open inner thigh space. Unless one is thin enough that they naturally have a gap or are predisposed to one, it is very difficult to create it. One should expect inner thigh shape improvements with various treatments but the creation of a gap is not realistic for most patients.

Dr. Barry Eppley

Indianapolis, Indiana

Postoperative Instructions: Inner Thigh Lifts

Tuesday, March 5th, 2013


Inner thigh lifts are done to recontour the bulging or full area between the inside of the upper legs. In some cases, it is done to correct sagging inner thigh skin after a large amount of weight loss. Through a crecent removal of skin of varying widths with the upper end in the groin crease, the sagging thigh is lifted and tightened. Liposuction of the fat in the thigh skin below the excision is often done to debulk the inner thigh area as well. The location of the incisional closure/scar is hidden as much as possible in the groin crease.

The postoperative instructions for inner thigh lifts are as follows:

1.  Thigh lifts usually have a minimal amount of postoperative discomfort but they will feel very tight. There will be some swelling of the thighs and groins after this kind of surgery. This will go away within a few weeks.

2.  There are no dressings or garments to cover the incisions but they will be heavily taped. The tapes are to be left in place to serve both as a dressing and reinforcement of the incisions.

3.  After 48 hours, take a shower and do not worry about getting the tapes wet.  Do not take a bath or submerge the incisions under water for three weeks after surgery.

4.   The tapes on your incisions will be removed by Dr. Eppley at your first follow-up visit. Most of the sutures will be dissolvable and underneath the skin. There may be several support sutures on the outside which will be removed two weeks after surgery.

5.   Numbness of the skin around the groin and inner thigh is normal after this kind of surgery. Normal feeling will return but it may take up to three months after surgery for that to occur.

6.   Avoid exercise of any kind for four weeks after surgery so breakdown (opening) of the incisions can be prevented. Too much activity too soon is the main reason why problems with healing of the incisions occurs.

7. Squatting places the greatest stress on the inner thigh incisions and should be avoided as much as possible until the incisions are well healed.

8. You may drive when you feel comfortable and can react normally and are off pain medication.

9. The inner thigh scars will initially be red and ropey feeling. This will take months to settle down.

10.   If any redness, tenderness, or drainage develops after the first week of surgery, call Dr. Eppley and have your pharmacy number ready.

Consent for Plastic Surgery: Inner Thigh Lifts

Monday, March 4th, 2013


Every plastic surgery procedure has numerous issues that every patient who is undergoing a procedure should know. These explanations are always on a consent form that you should read in detail before surgery. This consent form, while many perceive as strictly a legal protection for the doctor, is actually more intended to improve the understanding of the inner thigh lift procedure. The following is what Dr. Eppley discusses with his patients for this procedure. This list includes many, but not all,of the different outcomes from surgery. It should generate both a better understanding of the procedure and should answer any remaining questions that one would have.


The alternatives to thigh lift surgery are liposuction which can remove some inner thigh fat but has little effect on skin tightening or lifting.


The goal of thigh lift surgery is to slim and lift the inner thighs and reduce any prominent inner thigh bulging. Creating an space or gap between the inner thighs is not a realistic goal for most patients.


The limitations of an inner thigh lift is in how much reduction and tightening can be achieved. There is a limit as to how much skin can be removed without risking wound healing problems and noticeable scar widening afterwards.


Expected outcomes include the following: temporary swelling and bruising of the inner thighs, a temporary feeling of tightness and numbness of the inner thighs that is felt most with leg extension and squatting and up to 3 months after surgery until the inner thighs feel completely normal again.


Significant complications from inner thigh lifts have not occurred. More common risks include infection,  wound separation, scar widening, a persistent tight feeling and discomfort on leg extension, and inner thigh irregularities and asymmetries and limited improvement in the profile of the inner thighs. Any of these risks may require revisional surgery for improvement.


Should additional surgery be required for inner thigh revision or any complications, this will generate additional costs.

Thighplasty (Thigh Lifts) after Extreme Weight Loss

Wednesday, December 31st, 2008

The thighs suffer loose and hanging skin after extreme weight loss and often look like ‘wax melting on a candle’.  Thigh lifts or thighplasty is the plastic surgery procedure that can address some of these issues.  Thigh liftsconsist of a variety of procedures that differ based on the location and extent of the procedure.  There are inner and outer thigh lifts and vertical and  extended vertical thigh lifts, all based on the nature of the excess skin on your thighs.

The outer thigh lift is done as either part of the circumferential body lift or as an isolated procedure. When the circumferential skin cutout of the body lift crosses the outer waistline (actually lower so it is an upper or outer thigh lift), the saddlebag area of the thighs is lifted. The final scar will cross or be just above the hip bone so this area can be quite tight when closed at the time of surgery. Some plastic surgeons choose to anchor the underside of the thigh skin to the tough lining of the hip bone (iliac crest) and this maneuver can be a good one to prevent scar widening later. In the extreme weight loss patient, the extended nature of the sagging ski n around the waistline makes the body lift a logical choice to get a tummy tuck, outer thigh lift, and buttock lift all in one procedure. Isolated outer thighs in extreme weight loss patients is unusual because if one has sagging thighs there will be other areas that sag as well.

Inner thighs lifts consist of two basic types, simplistically those that are oriented horizontally and those that are more oriented vertically. In either type of thigh lift, I don’t recommend doing them until after the tummy tuck or body lift is first completed. This is because these procedures will provide a mild thigh lift effect which may change the amount of thigh skin removed or the incision (cutout) pattern. Either inner thigh lift approach is a compromise. A horizontal inner thigh lift removes a crescent of skin and fat along the groin crease and this is where the final scar will be. A groin crease scar can be long, extending back into the buttock crease, but it is placed in a natural skin crease that is not that visible. A vertical thigh lift usually includes a horizontal excision of skin along the groin crease but also has a long vertical cut out, a T excision pattern. This is a very effective thigh reshaping procedure but results in a long visible scar down the inner thigh. Most extreme weight patients are usually better off with the combined horizontal/vertical inner thigh lift, if the scar is acceptable.

Dr. Barry Eppley

Indianapolis, Indiana

The Thigh Lift in the Bariatric Surgery Patient

Tuesday, April 29th, 2008

For many massive weight loss patients (> 100 lbs), the thigh is often the last stage of body contouring that is done. It is always a good idea to see how much result you can get in the thighs after the abdominoplasty/panniculectomy/circumferential body is completed first. While these procedures won’t make a dramatic difference in the thighs, they do have some lifting effect in the upper portions of the inner and anterior thigh areas. I never do thigh lifts in conjunction with an abdominal/body lift procedure as this creates an enormous of swelling with lengthy operative times. Plus I don’t like the thought of a narrow strip of skin between the abdominal and thigh incisions from a blood supply/survival standpoint.
Thigh lifts in the massive weight loss patient are very different from the typical thigh lift procedure. First and foremost, the amount skin in all dimensions is simply greater. Therefore, the typical cutout pattern with a resultant scar isolated to the groin crease is not going to be sufficient. A good amount of improvement can not be done this way despite the fact that the scar is fairly well hidden. Second, the excessive thigh skin exists in three-dimensions, meaning both horizontal and vertical skin cutouts must be done to make a true size reduction. This results in an extra scar running down the inside of the leg to at least the knee and sometimes past it. Third, as the scar burden has increased so the the ‘typical’ postoperative problems which can occur including wound separation at the T (junction of horizontal and vertical scars), fluid build-up after drain removal, and some degree of scar thickening.
Like many bariatric plastic surgery procedures, thigh lifts result in a lot of scar but they are tremendously effective. They are not painful to go through other than some discomfort from being tight in the groin area. Recovery from a thigh lift really relates to the need to limit the amount of walking that you do in the first few weeks after surgery so as not to put too much stress on the incision sites.
Dr Barry Eppley

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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