Overview of Thighplasty
Thighplasty is a type of surgery where extra fat and skin is removed from the inner thigh. The goal of thighplasty is to create a more normal look and enhance the functioning of the upper leg, thereby improving overall life quality. With weight loss procedures becoming more popular, it’s not unusual to find people dealing with issues related to excess skin after losing significant weight.
In the past, thighplasty was seen as a purely cosmetic procedure, but now it is also used to help people suffering from amputation, obesity, or who have lost a lot of weight. The surgery can help increase the person’s ability to move, promote better hygiene, and treat ongoing skin irritations and infections. Over the years, the techniques used in thighplasty have become better, reducing the risks involved and making the outcomes look more natural.
One area of focus in thighplasty is the medial (inner) part of the thigh. While surgery here can lead to less visible scars, post-surgery healing can be affected by infections or injury caused by rubbing. The process requires precise removal of tissue; doctors have to be careful not to remove too much or too little to avoid complications and ensure symmetric and aesthetically pleasing results. Thighplasty involves considering the patient’s individual case and designing the best surgical approach, dealing with any hurdles that come up, and providing proper care to patients after the procedure.
Anatomy and Physiology of Thighplasty
Thighplasty, also known as a thigh lift, was first introduced in the 1950s, but was not initially popular due to high rates of complications. Early problems like unusual scarring and changes in the shape of the genitals were due to a lack of understanding about the structure of the thigh. Over time, as our understanding of the thigh’s anatomy has grown, we’ve improved thigh lifts to get better results and fewer complications.
In both men and women, the inside of the thigh has skin and fat that is not tightly attached to the layer below, called the fascia. The skin here is also thinner. This structure makes the inside of the thigh more prone to be floppy and sag, which can even extend to the knee in severe cases. That’s why thigh lifts often focus on the inside of the thigh rather than the outside or back.
The femoral triangle is a key feature to note during this procedure. This is an area near the crease of your groin that marks the transition from your pelvis to your leg. Important structures like the femoral artery, vein, and nerve, along with a protective sheath, pass through this triangle. Because this region also houses lymphatic vessels, which are part of your immune system, disturbing them during surgery could lead to complications. Therefore, during a thigh lift, surgeons aim to remove the excess skin and fat without disturbing these crucial structures.
Another important vein, the great saphenous vein, runs along the inside of the thigh. It’s important to avoid damaging this vein during surgery to prevent leg vein problems after surgery. Yet, in cases where patients already have vein problems before surgery, doctors may actually treat these problems during the thigh lift.
It’s also crucial to consider the superficial lymphatics, which are small vessels that help your immune system work. These vessels are mainly located in the interior of the thigh and can be damaged during surgery, causing problems like lymphocele (a buildup of lymph fluid) or swelling due to lymphedema (blockage in the lymphatic system). Staying close to the surface while performing a thigh lift has led to successful outcomes with less risk of these problems.
In the past, thigh lifts often led to undesirable scar migration (movement of the scar over time). A method was introduced to anchor the tissue to a deeper layer called the Colles fascia to deal with this issue. However, recent studies have shown variable outcomes due to the varying thickness of the Colles fascia, leading to inconsistent long-term results and associated problems.
Why do People Need Thighplasty
Thighplasty, often seen as a cosmetic procedure, has been increasing in popularity alongside weight loss surgery. This surgery can greatly benefit those who have lost a lot of weight and suffer from lipodystrophy, a disorder that affects the way the body uses and stores fat. When people have lipodystrophy in their thighs, it can cause their skin to sag or hang, causing numerous problems such as skin irritation, infections, restricted mobility, pain, discomfort with appearance, and difficulty finding comfortable clothes.
To figure out the best approach to treat these thigh abnormalities, doctors use a tool called the Pittsburgh Rating Scale (PRS). This system helps categorize skin abnormalities by severity and area targeted for treatment. The scale goes from 0, signifying normal, to 3, indicating severe deformity. The PRS is useful before the surgery to predict outcomes and decide on the best approach. Less severe issues may be improved by minimal invasive treatments, like liposuction, while more severe deformities might need a more intensive surgery involving cutting, lifting, and repositioning the tissue.
Thighplasty has also showed promising results for those who have had a lower limb amputation. By reshaping the remaining portion of the limb, the procedure allows a prosthetic piece to fit better. Compared to repeatedly adjusting the prosthetic, thighplasty is a cost-effective and practical option especially for people with obesity who have had a transfemoral (above the knee) amputation.
Thighplasty can also be used in special situations to treat wounds in the genital and pelvic areas caused by infections, injuries, or tumors. For instance, hidradenitis suppurativa, a chronic disease causing inflammation and often affecting areas like the armpits and groin, may sometimes be treated with a radical removal of the affected area. In these serious cases, combining thighplasty with tissue transfer – using tissue from elsewhere in the body to replace the removed area – can help promote better healing. Therefore, the benefits of thighplasty can extend beyond just cosmetics; it can also significantly enhance functionality.
When a Person Should Avoid Thighplasty
There are some situations that might make a thigh lift surgery (thighplasty) more risky, although there are no situations where it’s absolutely not allowed. However, there are some health conditions that should be managed better before the surgery to make it as safe as possible. These include diseases like diabetes, heart disease, kidney problems, and anemia, as well as conditions affecting the lungs.
Before the surgery, the doctor will have to carefully check for any signs of blood vessel or lymphatic diseases (conditions that affect the vessels that carry blood and fluid in your body, respectively). This is because these diseases could lead to complications during or after the surgery.
Speaking of lymphatic diseases, there’s one called lymphedema that’s particularly important. This is a long-lasting condition where fluid collects in the tissue, causing swelling and other symptoms such as a heavy feeling, easily-caused dents in the skin, and repeated infections. Unfortunately, there’s no cure for it, and the best approach is to try to keep it under check. This condition can often get mixed up with simple excess fat tissue, and might need a particular scan (called lymphoscintigraphy) to accurately diagnose it. If a person with poor lymphatic drainage due to the disease was to get a thighplasty, it could suddenly make the disease much worse, with more complications following suit. Therefore, a doctor needs to check carefully for signs of lymphedema before doing a thigh lift.
People who are overweight often have a condition called chronic venous insufficiency, where the blood doesn’t flow well through the veins in your legs. This is becoming much more common, and a thigh lift could actually make it worse by damaging the superficial (close to the surface) veins.
People who want to get a thigh lift should try to keep their weight stable before the surgery. While there’s no specific amount of time to do this, many doctors recommend keeping a stable weight for one year before the procedure. This makes it easier for the surgeon to figure out how much fat tissue to remove to get the best results.
It’s also important to have a clear discussion of what results you can expect from the thigh lift. Both you and your surgeon should be on the same page about what’s practical and what’s not. If you can’t agree on what to expect, it might be best to reconsider the surgery. This is important because there have been cases where people have unrealistic expectations because of a condition called body dysmorphic disorder, which makes them see their own body inaccurately, often in a negative way. Up to 40% of people getting cosmetic surgery might have this condition, and it’s something that the surgeon needs to watch out for.
Equipment used for Thighplasty
For a procedure known as thighplasty, the doctor would need the tools listed below:
A sterile marking pen that is used for outlining the area where the surgery will take place.
A liposuction system with or without ultrasound, a machine that helps remove excess fat from your body. The ultrasound might be used to create images of the insides of your body, allowing the doctor to monitor the procedure more clearly.
Monopolar and bipolar electrocautery, which are tools that use electricity to heat up tissue and prevent or stop bleeding during the surgery.
A basic plastic surgery instrument tray would be required to hold all of the tools and equipment. This tray usually contains things like scissors, forceps, and scalpels, among other things.
Absorbable and nonabsorbable suture, which is a type of thread used to stitch up wounds. Absorbable sutures dissolve on their own, while nonabsorbable types may need to be removed by a doctor later.
Dressing supplies including Xeroform gauze, a type of bandage used to dress wounds and help stop any bleeding and to protect against infection.
Compression leggings would be worn by the patient after the surgery to help reduce swelling and improve circulation in the legs.
Who is needed to perform Thighplasty?
When a surgery called thighplasty is performed, a few key people are involved to make sure everything goes smoothly:
First is the surgeon, who is a specialized doctor trained to perform the operation. This doctor knows exactly how to do the surgery safely and effectively.
Next is the surgical first assistant. This is another medical professional who assists the surgeon during the operation.
The circulator or operating room nurse is also vital. This person makes sure everything in the operation room runs smoothly. This includes helping the surgeon and first assistant, ensuring all equipment is working correctly, and helping with other important tasks.
A surgical technician or another operating room nurse might also be present, providing additional support during the surgery.
Finally, the anesthetist is extremely important. This medical professional is responsible for administering anesthesia, which means they’re in charge of making sure you stay asleep and don’t feel any pain during your operation.
All these people work together to make sure your surgery goes as well as possible, and that you’re taken care of before, during, and after the procedure.
Preparing for Thighplasty
Before having a thighplasty, also known as a thigh lift, a detailed evaluation is necessary. The doctor talks about the surgery, possible complications, and what results to expect. They check the skin, fat, and location of excess tissue in your thighs. They also plan the surgery based on your overall health, especially the health of the blood vessels in your legs, how swollen your legs are, and any other existing health problems you may have.
Before the surgery, the doctor marks the areas on your thighs where the work will be done. This helps to guide the surgery. They do these markings while you stand and lie down in different positions, to get a complete picture of where the excess skin and fat are. They consider how loose your skin is, where the surgical scars may be, and how much strain will be on the surgical cut. They take into account how close the cut is to sensitive areas (like the genitals) to avoid any possible misshapes.
The surgery is performed while you’re under general anesthesia, meaning you’ll be completely asleep. You’ll be lying with your legs apart. However, this position can affect how the tissues in the thigh appear, so it’s crucial the doctor marks the area to be treated before your surgery. They also use specific devices and medication to lower the chance of blood clots forming in your veins during the surgery.
How is Thighplasty performed
There are several surgical methods that can help with fat accumulation and excessive soft fat tissue in the thigh. These include focused fat removal (also known as liposuction), a horizontal or sideways lift, a vertical lift, a combined lift, which can be divided into either T-shaped or L-shaped lift, and a double triangle. All these procedures can be carried out with or without liposuction. Your doctor will use their evaluation before surgery to choose the most suitable method.
Liposuction is most effective for patients with a low PRS score, which is a scoring system doctors use to evaluate the risk of complications after surgery, or patients who only have excessive fat under the skin. If your skin is not sagging, a thigh lift may not be the right treatment for you. Liposuction is usually well-tolerated and has good results in the right patients. However, liposuction alone does not help with excessive skin in people with sagging skin and might even make symptoms worse and lead to more complications.
A horizontal thigh lift involves cutting a line in the groin folds, which is about 1 cm below the fold line between the abdomen and the thigh. This cut stretches from the triangle area on the inside of your thigh to the middle of your buttock fold. This technique lifts the tissue upwards and is most often used to tackle sagging skin over the top part of the thigh. A crucial part of this technique is fixing the lower part of the skin flap to a layer of connective tissue with the thigh muscles; this prevents the resulting scar from moving downward over time.
The vertical thigh lift is used to reduce loose skin around the entire thigh in patients with excessive fat tissue extending to the knee. It creates a cut down the inner side of the thigh, so the scar is hidden when looking from the front. An elliptical cut is planned along the inner part of the thigh, extending from 3 cm below the genital area down to a little bit above the knee’s inner bony projection. The surgeon will assess the amount of excessive skin to remove and then determine the width of the cut. The higher part of the cut usually extends along the fold beneath your buttocks to address any resulting tissue redundancy.
In patients with a lot of soft fat tissue affecting the entire thigh, a combined horizontal and vertical thigh lift is often the best method. This helps lift the skin and reduce the circumference of the thigh tissue. In a T-shaped lift, the vertical cut is in the middle of the transverse or horizontal cut and runs down the inner thigh. The L-shaped lift, a slight variation, has the vertical cut coming off the back part of the horizontal cut. The vertical cut has a gentle curve, going down the center of the thigh, which provides the best results in terms of scar placement. The resulting scar is in the shape of an inverted “T” or “L”. A double triangle thigh lift addresses excessive tissue in the pubic area as well as the inner thigh.
When it comes to combining a thigh lift with liposuction, doctors have not yet agreed on whether to do it in stages or at the same time. However, using liposuction to reduce the skin envelope and fat deposits has helped plan the cuts and estimate the amount of skin removal and where the scar will be, which has resulted in better outcomes. If you’re having liposuction at the same time, your surgeon will inject a solution into the top layers of the skin in the inner and front parts of the thigh and then perform the liposuction. After liposuction, your doctor will re-evaluate the amount of excess skin and make sure the planned cuts are still appropriate. Usually, more skin needs to be removed after liposuction. Any additional adjustments will be made from the front line because the front part of the thigh has more mobility compared to the back.
In all techniques, it’s very important for the surgeon to stay above the connective tissue wrapping the thigh muscles to avoid damaging the surface system of lymph vessels and blood vessels running along the inner thigh. Before the wound is closed, using clamps or strong stitches can help tailor the edges of the skin to make sure the wound will close with the right amount of tension and provide the best scar.
Possible Complications of Thighplasty
A thigh lift, also known as thighplasty, is a surgical procedure that has a relatively high chance of complications, with reported rates of around 42% in some studies. This is because the thigh area often withstands humid, damp conditions and repeated friction, conditions which don’t support rapid healing. Even with advances in surgical techniques, the complication rate for this procedure still remains high. Patients considering thighplasty should be properly informed of these risks before moving forward with the surgery.
Complications from thighplasty can range from mild issues that don’t cause any symptoms, such as a seroma (a collection of fluid under the skin), to more serious problems like abnormal movement of the vulva or swelling from fluid buildup in the lymph system (lymphedema). Common wound-related complications can include wound separation (dehiscence), infection, and death of skin cells (necrosis). Other complications might include a hematoma (a collection of blood outside the blood vessels), lymphocele (a collection of lymph fluid), abnormally thick scars, and movement of the scar. In extreme cases, patients could face debilitating issues like inflammation of the veins (thrombophlebitis) and lymphedema. That said, in some studies, there have been cases where patients experienced no complications after thighplasty.
Despite the relatively high risk of complications, serious issues requiring additional surgery are rare. However, if surgery is needed, it’s usually because of the scar moving, thickening or widening, or to remove leftover excess skin.
Studies have found higher rates of complications in patients with a higher Body Mass Index (BMI) before surgery, those who undergo more challenging procedures at the same time, and those with underlying health conditions – particularly diabetes and tobacco use.
Lastly, it’s worth noting that dissatisfaction among patients isn’t technically a complication, but it can be a severe outcome in its own right. Therefore, it’s essential that doctors and patients set realistic expectations about the outcomes of thighplasty. This shared understanding will help to ensure a satisfactory result.
What Else Should I Know About Thighplasty?
There has been a rise in people seeking weight loss surgery, leading to an increased number of individuals achieving significant weight reduction. This, in turn, has raised the demand for body shaping procedures like thighplasty, a surgery designed to reshape the thighs.
Over time, the process of thighplasty has improved, becoming more efficient and providing better outcomes for patients, while also reducing associated risks. Although complications can occur, the overall result often greatly improves the person’s quality of life. This improvement stems from increased attractiveness, better functionality and mobility, and a lessened risk of health problems related to excess, saggy skin. This is particularly true for patients who are suitable candidates for the procedure.
While thighplasty is often sought for cosmetic reasons, this procedure has beneficial applications beyond aesthetics. It can be used to repair wounds caused by injury or by the removal of certain diseases in the genital or perineal region, and it can also help to make prosthetic fittings more comfortable.
