Undesirable skin laxity and adipose excess of the anterior and medial thighs which is correctable by a medial thigh lift (MTL).
The patient is cognitively and psychologically cleared for the treatment. Inappropriate behavior prompts psychological screening and referral as indicated.
The patient understands the aesthetic goals, basic technique, and placement and unpredictability of the scars, as well as the common risks of a MTL. Then the patient signs written consent form.
Chronic skin diseases, swelling, lymphatic, venous or arterial insufficiency are investigated and if not resolved will probably contraindicate surgery.
General medical condition, nutrition, and anemia are noted and improved as needed or the patient is rejected. Massive weight loss patients receive special supplements. History and physical examination and selected laboratory studies identify general or selected malnutrition that should be corrected for optimal wound healing. Obesity is treated by weight loss and if the patient is unable then patient is offered a highly regimented 42-day, 500-calorie-a-day diet plan with HCG (human choriogonadotrophic hormone) single-syringe injections. The daily management is by the physician assistant.
Whenever possible, our aestheticians institute a special package of twice-weekly Lipomassage (Endermologie, LPG, Paris, France) 45-minute sessions for 3 weeks prior to surgery. The mechanico-stimulation activates supportive collagen synthesis, softens adiposity and improves blood flow. Subsequent liposuction appears less traumatic and hemorrhagic. The patient has been prepared for her routine postoperative Lipomassage. If the patient expresses unrealistic expectations during this preparation, then thigh lift is reconsidered.
Medial thigh lift (MTL) encompasses a wide range of operations and procedure combinations dictated by the extent of thigh and lower torso deformity and the patient’s expectations. MTL is essentially an excision of medial thigh skin, followed by closure with superior suspension, resulting in tighter and lifted thigh skin. The most limited MTL is a horizontal crescent excision from the mons pubis to the ischial tuberosity inferior to the labia majora. The advanced medial thigh flap is anchored to Colles fascia to avoid inferior drift of the scar.1The horizontal excision may be extended posteriorly beyond the tuberosity along the infragluteal fold to the lateral trochanter to lift the posterior thigh and define the inferior border of the buttocks. The excision may also be extended anteriorly to beyond the mons pubis to the groin as part of an abdominoplasty. With both posterior and anterior extensions, the horizontal excision takes a spiral turn from posterior across medial to the groins; hence the term spiral thighplasty.2Regardless of the extensions, the superior horizontal excision lifts roughly only the upper third of the thigh. A mid-medial vertical excision will remove laxity along the mid- to distal medial thigh. The excision is taken as far distally as necessary to tighten loose thigh skin.
This chapter’s vertical MTL description reflects a recent clinical case that also included a lower body lift (LBL). The patient was a 42-year-old woman, with a body mass index (BMI) of 24.7, who lost 100 pounds through a gastric bypass 3 years prior to requesting surgery to improve her lower torso and thighs. She had a prior abdominoplasty and bilateral brachioplasty. This operation started supine with the upper oblique and horizontal portions at the same time as the vertical portion of the thighplasty (Figures 27.1–27.5). She was then turned prone for completion of the operation (Figures 27.6–27.9). Table 27.1 lists the special equipment for the procedure.
Table 27.1 Special equipment
Ultrasonic-assisted lipoplasty equipment (LySonix or Vaser)
Rapid saline infusion and aspirating liposuction system with 4-mm cannulas
#1 or #2 PDO Quill suture
3-0 Monoderm Quill suture
Indermil® (Henkel, Dusseldorf, Germany) or Dermabond® (Ethicon) skin glue
Large Marena (Marena Group, Lawrenceville, GA) long-leg tights