Introduction to Thigh lift

Following weight loss, and sometimes ageing, men and women can get sagging and rippling of of the skin of their thighs that can extend from the upper thighs to the knees. Often, women complain that they are unable to wear swimsuits and that the loose skin rubs together between their thighs and that it looks very "crepey". In addition the presence of extensive stretch marks makes the thighs unattractive. Also the wrinkled loose skin around the knees keeps many women from being able to wear skirts. Many times in my practice I see women who come for an examination, grab hold of the front and back of their thighs and pull the entire thigh skin area up tightening the whole thigh area and say "that's how I want it to look!".  Unfortunately it is never as simple as that!

What is a Thigh lift?

A Thigh Lift is indeed a procedure which lifts and tightens the loose skin of thighs -  however it does so mostly on the skin of the inner thigh region and therefore does not lift the front or back of the thigh. Sagging of the outer thighs and buttock regions is usually treated by way of a Body lift which is a much larger operation, and usually is associated with a scar right around the entire circumference of your body at the level of your waist. Unlike liposuction which only reduces the unwanted fat, a thigh lift will also remove the skin and therefore tighten the inner aspect of the thighs.

What types of Thigh lifts are there?

Two different types of thigh lifts can be performed depending on the extent of skin laxity. If the skin laxity and rippling is mostly limited to the upper inner thighs, and skin excess does not extend to the lower half of the thigh, a Medial Thigh Lift can be performed. In this procedure the excess skin and fat is removed in the upper inner thigh region. The scar is located along the groin crease and extends down behind and into the buttock crease. This scar is usually well hidden.

In cases where people have lost a significant amount of weight and are left with extensive laxity and rippling of the skin along the entire inner aspect of the thigh all the way down to the knees then an Extended Thigh Lift is usually performed. In addition to the scar of the groin crease, there is also a long vertical scar that extends along the inner thigh(similar to the inseam of a pair of trousers) sometimes right down to the inner knee region. As you can imagine therefore this can be quite a long and obvious scar. This vertical scar enables us to remove the lax excessive skin of the entire thigh just as the inner seam of a pair of trousers determines the width of a trouser leg. As a result of the extensive skin involvement, this procedure is usually more involved than the medial thigh lift. However when extensive skin laxity and fat excess is present then this is usually the only option.

Can Thigh Lifts be Combined with Liposuction?

Yes. Both the  Medial  and Extended Thigh Lift can often be combined with limited Liposuction in order to better contour the legs and also to reduce the size of the "saddle bags" or love handles or other areas.

Is Liposuction alone an Option?

Liposuction removes fat cells and does not affect the skin. Therefore if your problem is due to loose skin, performing any form of liposuction will lead to an exacerbation of your problem and make the area look worse with excess loose skin developing.  The only time liposuction is a better choice is when there is a lot of fat and the skin is tight. When the skin is loose, a thigh lift is usually the best choice.

What does the operation involve?

In both the Medial and Extended thigh lift the basic premise involves removing excess skin and associated fat from the region and then suturing the ends together. In principle it is a very straightforward surgical procedure. However due to the large area and length of wound that requires suturing it is somewhat time consuming and can take up to 2 hours to complete the procedure. The incision line is sutured with dissolving stitches and surgical tapes are then applied to the surface of the skin. A bandage is then applied around the thighs in order to apply some compression and reduce any swelling and bleeding.

Am I a suitable candidate?

This will be decided at your consultation. During your consultation Mr. Karidis will ask you about your general medical

If you are a smoker you will be asked to stop smoking well in advance of surgery. Smoking seriously constricts blood vessels and therefore decreases blood flow to a given area resulting in poor healing. Aspirin and certain anti-inflammatory drugs and other medications (discussed in DO'& DON'TS section) can cause increased bleeding, so you must avoid these.

A physical examination will determine if you are a candidate for a Thigh lift procedure. A thigh lift should not be performed to correct obesity. Heavier patients will be disappointed with the overall result even if surgical measures or altering existing techniques such as extending the incision and liposuction are performed. This is because being significantly overweight will still leave you with substantial and significant fullness in these areas. To avoid this disappointment and to minimise the need for a secondary procedure, the best candidates are men and women who are within several pounds (i.e. 10%) of their ideal weight. If you are significantly more than this then you will be asked to reduce some weight before going ahead with any surgery.

In certain borderline situations however a thigh lift can be performed in individuals who are perhaps slightly more than within their 10% of ideal weight (i.e. 15%). This can be technically performed with some success, but with the understanding of a couple of provisos. First is that, the result will not be as ideal as it would be by getting you to within your 10% of ideal weight, and that secondly further secondary procedures, i.e. liposuction may be required, or that further weight reduction will be necessary to further improve the result. A thigh lift in these situations is usually performed to basically remove the obviously loose, hanging skin, which has arisen as a result of some weight loss, and which will not go with even the most diligent of exercises and diet, and that the hope is that this will act as an incentive or motivation for you to pursue further weight reduction.

What type of anaesthetic  is used and how long does the procedure take?

A general anaesthetic is normally used for a thigh lift which means you are asleep. The operation usually takes about 2 hours to perform.

How long do I stay in hospital?

An overnight stay is usually indicated for  a thigh lift. You are discharged the following morning usually.

What happens after the surgery?

Once you've recovered, you will notice that you will be wearing a compression garment which will help control the swelling and subsequent bruising. Mr. Karidis prefers to mobilize his patient early and so once you feel reasonably comfortable you will be instructed to get up and around. The dressings will need to be reexamined and changed in about 5 days. You may notice some bloody soiling on the inner aspect of the thigh. This is normal. If it is excessive, one of the nursing staff will pad it for you.

Is it painful?

Pain and discomfort are subjective Any pain is probably more noticeable when standing or and walking in the first few days following surgery and usually involves mainly a pulling or tightening sensation in the inner aspect of the thighs. Thus for the first week or so you will need to take regular painkillers in order to minimise this.

What kind of after effects should I expect?

Following surgery you will experience considerable swelling and some bruising of the thigh region This will be even more noticeable if the thigh lift was accompanied by liposuction. The compression garment you will be wearing will reduce the swelling. The bruising however usually lasts about 3 weeks. While most of the obvious swelling will have dissipated by this time, subtle swelling will still be present for up to 6 months.

In addition you will notice that some areas of the thighs will feel firm or hard  to touch, particularly along the edges of the incision site. This will be as a result of the normal healing process laying down elements of scar tissue to facilitate healing. When this occurs, massage as instructed by Mr. Karidis will speed up the recovery. It gradually resolves in time but may take a few months to complete. You should expect the sensation to the skin over the  inner parts of the thigh to be reduced after surgery. This is as a result of surgical trauma to the nerves in the region. This usually recovers in a few months

What are the scars like?

As already explained in the case of the extended thigh lift the scar length can be substantial extending the vertical length of the inner thigh. The medial thigh lift scar is more limited and usually is tucked into the inner groin region. Although all surgeons try to suture the incision as neatly as possible, it is ultimately impossible to predict a scars' eventual appearance. In fact very rarely can thigh lift scars be described as hairline. You must understand that due to the normal healing response these always appear red, raised and lumpy in the first few months after surgery, but do tend to settle with time in most people. A silicone gel sheet will be provided for you and which will help the appearance of the scars. However it may take up to 18 or 24 months to do so. Stretching and prominence of all or parts of the scar however can occur and may be permanent. If necessary, and when deemed appropriate, it may be necessary to revise a scar to try to improve its appearance. This will be discussed at the follow up consultations.

What could go wrong?

Whilst it is true that when a Thighlift is performed by a qualified plastic surgeon the risks are small, nonetheless, specific complications with this procedure can and do occur.

As in any procedure the risk of significant infection is always possible. This is minimised by careful surgical technique and the preventative administration of antibiotics both at the time of surgery and after. However despite these measures mild infection is relatively common and can occur around the incision site, but usually subsides over a period of about 2 weeks.

Risks such as blood clots are rare. You will be asked to wear special stockings (TED) just prior to coming to theatre, to reduce this likelihood. Furthermore during your operation special pump devices (Flowtron) are wrapped around your calves to stimulate continued blood flow to this region and avoid any stagnation of blood which can lead to blood clots. Early mobilisation by moving around as soon after the surgery as possible also reduces this considerably.

As mentioned earlier, swelling should be expected after this operation. When mild or moderate swelling is present, the body rapidly reabsorbs this. Very rarely, increased bleeding can lead to more significant swelling and the development of a haematoma (a collection of blood under the skin). If this were to happen, surgical drainage to evacuate this would be required. Ultimately however this should not affect the final outcome.

Another possible complication is the formation of a collection of fluid called a "seroma". This fluid is clear and yellow in colour. It is seen as a swelling in the lower abdominal region, and many times patients report that they can feel this fluid moving under the skin. It is usually noticed at about 10 days after surgery. The treatment will depend on the amount of fluid present. If this is deemed to be small and is not causing any discomfort, then only a pressure garment is applied and the body reabsorbs this, usually by about a month's time.  If however the amount of seroma is significant and causes pain or discomfort, then the initial treatment is to draw out this fluid with a needle (called aspiration). Following aspiration the swelling rapidly disappears. If necessary this procedure may be repeated in a week's time.

During the first 2 -3 weeks after surgery, some patients may experience a minor loss of wound adhesion at any point of the incision site. This is a temporary complication, which will require regular dressing changes initially. Eventually the wound contracts and shrinks  so that scab develops over this, which subsequently separates after 3-4 weeks. However some distortion of the skin around the scar may ensue particularly if this has occurred over the hip region. Further revision surgery may be required if necessary.

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