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