Medial Thigh Lift for Patients Following Massive Weight Loss: Our Postbariatric Experience

Medial Thigh Lift for Patients Following Massive Weight Loss: Our Postbariatric Experience We read with great interest the paper titled “Personal Evolution in Thighplasty Techniques for Patients Following Massive Weight Loss” by Xie et al.1 Indeed, with the augmentation of bariatric surgery, the medial thigh lift has become an increasingly common surgical procedure in plastic surgery to treat massive weight loss sequelae. We congratulate the authors for their work and their improvement of the surgical techniques over the years. The authors developed two very interesting points that we would like to discuss. First, we would like to emphasize that the decrease of lymphocele/seroma is probably due to the combination of liposuction with medial thighplasty for patients who underwent the horizontal vector fixation thighplasty technique. It is true that, in this study, there is no significant difference, just a propensity to go in this direction (the authors’ Table 3, P = 0.2207). However, most plastic surgeons currently use liposuction either combined with medial thighplasty2 or in other postbariatric procedures3 and obtain satisfactory outcomes (with very low rates of seroma). We have recently demonstrated that liposuction, in addition to protecting connective tissues, which contain nerves, lymphatic, and blood vessels, preserves a significant part of the microvascular network. The low rate of complications could possibly be explained as a consequence of possible better preservation of the physiology of the remaining tissues.4 However, additional work is needed to determine and understand any associations between the integrity of the microvascular network and its function. Secondly, we concur with the authors on the fact that a horizontal scar in addition to a Colles’ fascia suture fixation is limited to patients presenting a cutaneous ptosis related to aging and predominating in the upper third of the thigh.5 However, in our experience, patients with massive weight loss present with locally staged deformities ranging from cutaneous and fat excess of the upper third of the thigh to excess on the thigh in its entirety. For these patients, a vertical scar technique is almost always associated with a horizontal scar to obtain a satisfactory correction of cutaneous excess. In our daily practice, we have not managed to remove the horizontal scar that is systematically associated with a vertical scar. Indeed, this horizontal scar significantly improves the anterior part of the thigh (Figure 1) including the “adipo-cutaneous roll under the groin crease” which is not corrected without horizontal associated scar (Figure 2). We fully agree with the authors about the complications induced by Colles’ fascia anchoring, and especially prolonged pain during mobilizations. With the scar in “J” the pull has a vector up and back, so we could possibly do without anchoring. We possibly wouldn’t be faced with a cutaneous ptosis as important as with a pure horizontal technique. This particular point would have to be investigated prospectively. Figure 1. View largeDownload slide (A) Preoperative and (B) 6-month postoperative frontal views of a 59-year-old woman with massive weight loss. Figure 1. View largeDownload slide (A) Preoperative and (B) 6-month postoperative frontal views of a 59-year-old woman with massive weight loss. Figure 2. View largeDownload slide (A) Preoperative and (B) 6-month postoperative frontal views of a 42-year-old woman with “adipo-cutaneous roll under the groin crease.” Figure 2. View largeDownload slide (A) Preoperative and (B) 6-month postoperative frontal views of a 42-year-old woman with “adipo-cutaneous roll under the groin crease.” In conclusion, over the past decades, the medial thigh lift has markedly evolved and many operative techniques have been described. These types of surgery have become routine procedures in the massive weight loss population. As such, they lead to a significant upgrade in patients’ quality of life. Further studies are needed both to determine the mechanism of the benefit to the addition of liposuction in these procedures and to investigate the improvements of the patients’ quality of life. Disclosures The authors declared no potential conflicts of interest with respect to the research, authorship, and publication of this article. Funding The authors received no financial support for the research, authorship, and publication of this article. REFERENCES 1. Xie SM, Small K, Stark R, Constantine RS, Farkas JP, Kenkel JM. Personal evolution in thighplasty techniques for patients following massive weight loss. Aesthet Surg J . 2017; 37( 10): 1124- 1135. Google Scholar CrossRef Search ADS PubMed  2. Le Louarn C, Pascal JF. The concentric medial thigh lift. Aesthetic Plast Surg . 2004; 28( 1): 20- 23. Google Scholar CrossRef Search ADS PubMed  3. Bertheuil N, Chaput B, De Runz A, Girard P, Carloni R, Watier E. The lipo-body lift: a new circumferential body-contouring technique useful after bariatric surgery. Plast Reconstr Surg . 2017; 139( 1): 38e- 49e. Google Scholar CrossRef Search ADS PubMed  4. Bertheuil N, Chaput B, Berger-Müller Set al.   Liposuction preserves the morphological integrity of the microvascular network: flow cytometry and confocal microscopy evidence in a controlled study. Aesthet Surg J . 2016; 36( 5): 609- 618. Google Scholar CrossRef Search ADS PubMed  5. Bertheuil N, Carloni R, De Runz Aet al.   Medial thighplasty: current concepts and practices. Ann Chir Plast Esthet . 2016; 61( 1): e1- e7. Google Scholar CrossRef Search ADS PubMed  © 2018 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Aesthetic Surgery Journal Oxford University Press

Medial Thigh Lift for Patients Following Massive Weight Loss: Our Postbariatric Experience

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Publisher
Mosby Inc.
Copyright
© 2018 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com
ISSN
1090-820X
eISSN
1527-330X
D.O.I.
10.1093/asj/sjx256
Publisher site
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Abstract

We read with great interest the paper titled “Personal Evolution in Thighplasty Techniques for Patients Following Massive Weight Loss” by Xie et al.1 Indeed, with the augmentation of bariatric surgery, the medial thigh lift has become an increasingly common surgical procedure in plastic surgery to treat massive weight loss sequelae. We congratulate the authors for their work and their improvement of the surgical techniques over the years. The authors developed two very interesting points that we would like to discuss. First, we would like to emphasize that the decrease of lymphocele/seroma is probably due to the combination of liposuction with medial thighplasty for patients who underwent the horizontal vector fixation thighplasty technique. It is true that, in this study, there is no significant difference, just a propensity to go in this direction (the authors’ Table 3, P = 0.2207). However, most plastic surgeons currently use liposuction either combined with medial thighplasty2 or in other postbariatric procedures3 and obtain satisfactory outcomes (with very low rates of seroma). We have recently demonstrated that liposuction, in addition to protecting connective tissues, which contain nerves, lymphatic, and blood vessels, preserves a significant part of the microvascular network. The low rate of complications could possibly be explained as a consequence of possible better preservation of the physiology of the remaining tissues.4 However, additional work is needed to determine and understand any associations between the integrity of the microvascular network and its function. Secondly, we concur with the authors on the fact that a horizontal scar in addition to a Colles’ fascia suture fixation is limited to patients presenting a cutaneous ptosis related to aging and predominating in the upper third of the thigh.5 However, in our experience, patients with massive weight loss present with locally staged deformities ranging from cutaneous and fat excess of the upper third of the thigh to excess on the thigh in its entirety. For these patients, a vertical scar technique is almost always associated with a horizontal scar to obtain a satisfactory correction of cutaneous excess. In our daily practice, we have not managed to remove the horizontal scar that is systematically associated with a vertical scar. Indeed, this horizontal scar significantly improves the anterior part of the thigh (Figure 1) including the “adipo-cutaneous roll under the groin crease” which is not corrected without horizontal associated scar (Figure 2). We fully agree with the authors about the complications induced by Colles’ fascia anchoring, and especially prolonged pain during mobilizations. With the scar in “J” the pull has a vector up and back, so we could possibly do without anchoring. We possibly wouldn’t be faced with a cutaneous ptosis as important as with a pure horizontal technique. This particular point would have to be investigated prospectively. Figure 1. View largeDownload slide (A) Preoperative and (B) 6-month postoperative frontal views of a 59-year-old woman with massive weight loss. Figure 1. View largeDownload slide (A) Preoperative and (B) 6-month postoperative frontal views of a 59-year-old woman with massive weight loss. Figure 2. View largeDownload slide (A) Preoperative and (B) 6-month postoperative frontal views of a 42-year-old woman with “adipo-cutaneous roll under the groin crease.” Figure 2. View largeDownload slide (A) Preoperative and (B) 6-month postoperative frontal views of a 42-year-old woman with “adipo-cutaneous roll under the groin crease.” In conclusion, over the past decades, the medial thigh lift has markedly evolved and many operative techniques have been described. These types of surgery have become routine procedures in the massive weight loss population. As such, they lead to a significant upgrade in patients’ quality of life. Further studies are needed both to determine the mechanism of the benefit to the addition of liposuction in these procedures and to investigate the improvements of the patients’ quality of life. Disclosures The authors declared no potential conflicts of interest with respect to the research, authorship, and publication of this article. Funding The authors received no financial support for the research, authorship, and publication of this article. REFERENCES 1. Xie SM, Small K, Stark R, Constantine RS, Farkas JP, Kenkel JM. Personal evolution in thighplasty techniques for patients following massive weight loss. Aesthet Surg J . 2017; 37( 10): 1124- 1135. Google Scholar CrossRef Search ADS PubMed  2. Le Louarn C, Pascal JF. The concentric medial thigh lift. Aesthetic Plast Surg . 2004; 28( 1): 20- 23. Google Scholar CrossRef Search ADS PubMed  3. Bertheuil N, Chaput B, De Runz A, Girard P, Carloni R, Watier E. The lipo-body lift: a new circumferential body-contouring technique useful after bariatric surgery. Plast Reconstr Surg . 2017; 139( 1): 38e- 49e. Google Scholar CrossRef Search ADS PubMed  4. Bertheuil N, Chaput B, Berger-Müller Set al.   Liposuction preserves the morphological integrity of the microvascular network: flow cytometry and confocal microscopy evidence in a controlled study. Aesthet Surg J . 2016; 36( 5): 609- 618. Google Scholar CrossRef Search ADS PubMed  5. Bertheuil N, Carloni R, De Runz Aet al.   Medial thighplasty: current concepts and practices. Ann Chir Plast Esthet . 2016; 61( 1): e1- e7. Google Scholar CrossRef Search ADS PubMed  © 2018 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com

Journal

Aesthetic Surgery JournalOxford University Press

Published: Mar 1, 2018

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