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The most common thigh complaints are excess fat or loose skin, which are often incorrectable with diet and exercise. Localized medial or lateral thigh excess, such as “saddlebags,” can usually be corrected with thigh liposuction. The medial thigh occasionally requires excisional techniques, usually limited to a scar in the inguinal crease, but down the leg in severe cases. Both excisions and liposuction in the medial thigh should be performed by trained plastic surgeons as there are important vascular, neural, and lympathic structures at risk in this area and the thin, loose skin may not contour well after liposuction. Circumferential adiposity is more difficult to correct. It is possible to liposuction circumferentially but the risks are increased and conservative, serial treatments may be necessary to remove the desired amount of fat in a safe manner.
Excisional procedures are needed when significant excess skin is present with thigh fat. Both a thigh plasty and a thigh dermal lipectomy will remove fat and improve contour, but not without significant scarring, either directly at the site of excess, in the groin, over the hip, vertically down the medial or lateral thigh, or circumferentially in a bikini line distribution. After preoperative marking, the excess tissue is removed and the thigh is lifted with deep fascial suspension and multilayered closure. The more extensive procedures require a 2 to 6 hour surgery with deep sedation, general anesthesia, or epidural block and overnight observation. Postoperative drains, pain control, and assistance with protected early mobilization are vital. Swelling is significant and blunts the improvement for several months. Activities should be limited for 2 to 3 weeks and slowly advanced over 4 to 6 weeks.
All of the descriptions for the various procedures are condensed from the text of the upcoming textbook written by Dr. Christopher Park and Dr. Malcolm Marks and are copyrighted, "The Artistry of Plastic Surgery: Exploring the Experience” . |
