Thursday April 24 , 2014

Thigh Lift and Thighplasty

Ideal Looking Thighs

An ideal looking thigh has particular features that define what it means to have a healthy figure. Part of this definition includes thighs being proportionate to the calves, buttocks and abdomen. The front of the thighs have a subtle convexity that conform to the large muscle, as opposed to the back of the thighs, which are flatter. An ideal thigh has an inner thigh that is firm and flat. The trunk of the body and the outer thigh are part of the hourglass figure, where the waist is ideally concave and the outer thigh convex.

Viewing the body from the front, the thighs are separated from the abdominal and groin area by the groin crease that goes around the back to form the V-shaped demarcation of the buttocks and the lower back. Viewing the body from the back, the upper thigh is separated from the buttocks by a well defined crease called the infra-gluteal fold.

A thigh lift is beneficial for both men and women who experience loose thigh skin and tissue, since the skin is typically flabby, saggy and/or dimpled, and strictly liposuction does not rectify the situation.

What is the Effect of Weight Loss on the Thighs?

Most weight loss patients present with thigh laxity and distortion. This can happen in varying degrees, depending on gender, genetic predisposition, amount of weight lost, and current weight. The appearance of thigh distortion presents as inner thigh rolls that extend backwards under the buttocks, an outer thigh bulge, which is commonly known as saddlebags, loss of a concave waist, numerous dimpling of the thigh fronts, as well as excess tissue around the knees. Like other areas, the thigh tissue laxity presents itself in a vertical or horizontal manner in most weight loss patients. According to our studies in 100 weight loss patients, published in ....................., all weight loss patients experience vertical laxity of their thighs. This can be mild, moderate or severe and affects the outer, inner, front and back of the thighs. In addition to the vertical laxity, about 35 percent of the patients will also have horizontal (circumferential) laxity and excess of their thighs; especially noted in the inner aspect of the thighs. In these patients, the excess thigh tissue makes cascading rolls that extend toward the knees, in conjunction with the changes previously mentioned. The tissue laxity often extends below the inner knees into upper calf areas.

These changes are more notable in women than men, since women typically have more fatty tissue and less muscular mass. In addition to the changes that happen with the thighs, distortion of the lower back and buttocks area happen as well. It is important to appreciate all the different changes that can occur in order to successfully treat the entire body to achieve a uniform look.

What is Thighplasty?

Thighplasty, or thigh lift surgery, is a challenging procedure in post-bariatric individuals because the deformity in the thigh is highly variable. The contour of the thigh is heavily influenced by adjacent areas such as the abdomen, waist and buttocks. The tissues of the thigh are heavy and subject to movement. The incisions for thighplasty are located on the thigh near the groin area, which make them more susceptible to contamination.

Thighplasty is a surgical operation that refers to multiple thigh procedures. These procedures involve removing excess thigh skin and fat tissue. Successful thighplasty reduces the excess thigh tissue as well as the thigh descent. The new contour should follow the appealing aesthetics of the thigh. The scars should be inconspicuous and the creases meticulously reconstructed. Thighplasty describes the thigh's circumferential, or horizontal, reduction, whereas thigh lift describes the vertical elevation of the thigh.

Thighplasty Procedures

  1. Medial inner thigh lift - This procedure corrects the looseness of the inner thigh. This thigh lift technique is used for non-bariatric patients. However, inner thigh lift does not elevate either the back or the front of the thigh.
  2. Outer thigh lift - For weight loss patients, this is best performed as part of the lower body lift procedure.
  3. Vertical thighplasty - This procedure is best used for those weight loss patients who need to reduce the excess circumferential/ horizontal laxity of the thighs.
  4. Spiral thigh lift - Pioneered by Drs. Agha and Hurwitz, this thigh lift procedure was developed for weight loss patients who require a powerful lift of the back, inner, and front of the thighs.

The vertical thighplasty procedure is predominantly used by many plastic surgeons for individuals with massive weight loss to decrease the degree of thigh laxity, or looseness. This is usually done because of the limitations surrounding the current method of inner thigh lift for correcting vertical thigh laxity. The new breakthrough thigh lift procedure, the "Spiral Thigh Lift," corrects vertical laxity of the thigh in the back, front and inner surface. The spiral thigh lift accomplishes circumferential thigh lift when used in conjunction with a lower body lift.

The New Spiral Thigh Lift

The spiral thigh lift is a signature thigh lift procedure designed for individuals who have significant vertical laxity of their thighs. The spiral thigh lift improves the laxity that presents in the front, back and inner surface of the thigh. For many individuals who lose a significant amount of weight, the infra-gluteal crease can become loose. When this happens, the junction between the lower buttocks and upper thigh is lost. Thus, the buttocks and the thighs blend together, altering and blurring the shape of both the buttocks and thighs.

The spiral thigh lift surgery begins with an incision below the infra-gluteal crease, or buttocks fold. Excess tissue on the back of the upper thigh is removed through this incision and then the remaining thigh tissue is lifted to a higher position. Once the thigh has been lifted, it is secured to the underlying tissues. Finally, the infra-gluteal crease is reconstructed, enhancing the shape of the buttocks and thigh. The incision is continued over the groin crease and made parallel to the upper thigh to correct the front and inner thigh laxity. Fat and a wedge of excess skin are removed, the inner thigh is lifted and then secured in an elevated position. The groin crease is reconstructed and the scar is inconspicuous underneath clothing. This procedure results in a contour of the thigh that is tighter and smoother, enhancing skin flow.

The spiral thigh lift offers significant improvement of the thigh laxity without the more disfiguring scar that can be seen with a vertical thighplasty. The choice of procedure, however, depends on the expectations and desires of each individual.

Vertical Thighplasty

Vertical thighplasty, which is a thigh reduction procedure, is often the surgery opted for by many plastic surgeons, instead of a thigh lift procedure. It is the recommended treatment for loose thigh skin that occurs in a horizontal (circumferential) dimension. Vertical thighplasty involves removing a large elliptical section of skin and tissue from the inner thigh. This is done through a vertical incision that reaches from the groin crease all the way to the inner knees or below the inner knees if needed. In our practice, a vertical thighplasty is the recommended procedure for about one third of people who need a thigh reduction. Following the vertical thighplasty, many patients elect to have an outer thigh lift together with the spiral thigh lift in order to achieve complete circumferential lift of their reduced thighs. The scar resulting from the vertical thighplasty is visible on the inner thighs, whereas the spiral thigh lift scar is typically covered by most undergarments.

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