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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

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