Maximizing Aesthetics and Safety in Lower Extremity Contouring: The Circumferential Thigh Lift and Vertical Extension Circumferential Thigh Lift
Adam R. Kolker, George D. Xipoleas.
Mount Sinai School of Medicine, New York, NY, USA.
Background: Excess skin and soft tissue of the thighs following massive weight loss (MWL) can present with varying degrees of severity. The classical medial thigh lift has considerable limitations in the post-bariatric population, inspiring the quest for safer and more effective technical solutions. In this study, the circumferential thigh lift (CTL), and CTL with vertical extension, predicated on a theoretical and technical approach that improves safety and aesthetics in thighplasty after MWL, is described and evaluated.
Methods: Nine patients were treated with follow up ranging from 11 to 24 months (mean follow up 14 months). All patients experienced MWL through bariatric surgery or lifestyle modification; all had previously undergone first stage contouring with circumferential abdominal dermolipectomy. All were treated with a prone-to-supine approach (Figure 1), and all with concomitant suction assisted lipectomy (SAL). Dorsally (prone position), liberal SAL is performed after the instillation of lidocaine-free wetting solution. Lumbar and lateral thigh and infra-gluteal skin and fat are excised separately to the mid-axillary lines and medial thigh meridians, respectively. Ventrally (supine position), liberal SAL is performed. Direct excision of anterolateral thigh skin is carried through in a superficial plane into the medial thigh to confluence with the posterior excision. No direct undermining of any skin margin is performed. When soft tissue excess is limited to the proximal thigh, the medial superficial-fascial system (SFS) is then anchored to Colle’s fascia and pubic periosteum. With middle and lower 1/3 thigh excess, a vertical extension is employed. Incising the anterior limb first, only skin and fat to be removed are undermined and excised. SFS-to-Colle’s fascial anchoring is carried out. Closed suction drains are inserted in all patients. Data were reviewed retrospectively.
Results: In the 9 procedures performed, 3 achieved MWL by non-surgical means, and 6 underwent bariatric surgery (bypass or band). All patients were female. Three patients were treated with CTL (Figure 2), and six with CTL with vertical extension(Figure 3). There were three seromas (33%) treated with percutaneous aspiration. There was one case of cellulitis (11%) treated successfully with in-office incision and drainage and oral antibiotics. There were no hematomas, skin loss, wound dehiscences, lymphedema, or vulvar distortions.
Conclusions: The circumferential excision of thigh excess without direct undermining allows for the maintenance of a rich blood supply to skin margins, and concomitant SAL improves thigh contour while providing discontinuous thigh undermining. Anchoring of the SFS to deep fascia and periosteum reinforces the medial lift and prevents scar migration. Circumferential thigh lift with or without vertical extension can be combined with SAL to maximize safety and aesthetic results after MWL.
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