Thigh lift
Definition and principles
When the skin on the inside thigh has lost its elasticity, a thigh lift on that area, also called curral lift, can be performed.
The operation is recommended when there is a clear excess of skin due to age, after significant weight loss or to correct certain liposuction of the inside thigh.
This operation is preferably carried out after weight loss, since there is no point in surgically tightening the skin if after the operation excess skin is caused by a weight loss diet.
The operation consists of removing excess skin caused by a slackening of the inner thigh, coupled or not with excess fat, by:
- a scar positioned under the panty line: this is a concentric lift of the inside thigh and is appropriate when there is moderate excess, since it is only performed on the upper thigh
- a vertical scar along the length of the inside thigh: this technique is effective along the thigh, but the scar is visible. Therefore, it is notably recommended after huge weight leaving a considerable excess of skin.
The lift of the inside thigh is very solicited by female patients, yet the potential scarring often dissuades patients when only a vertical scar is an option.
The two techniques to lift the inside thigh
The surgeon always begins the operation by a liposuction to remove excess fat but also to permit pinned back tissues elevation without lymphatic lesions. Then, he proceeds to the thigh lift itself.
Two principles are respected, regardless of the technique:
- the large lymphatic trunks are respected to avoid secondary lymphatic effusions (seroma)
- the closing up of all dead spaces using padding to limit haematomas and tension on scars which can cause skin suffering and post-operative slackening.
The technique of concentric thigh lift
Concentric thigh lift
Incisions are made in the inguinal creases on each side of the pubis. They then run along the perineum and end towards the point of the sacrum. They are therefore not in a visible place on the buttocks. Excess skin is removed and the tissues are brought in concentrically towards the inguinal crease, then fixed to the tendon at the top of the inside thigh to prevent the scar from dropping later into the thigh.
Vertical technique for thigh lift
Vertical thigh lift – long scar
Vertical incisions running down to the knees are made in addition to the incisions along the perineum as per the concentric lift. Excess skin is removed and the tissues are brought in concentrically towards the inguinal crease for the upper part and horizontally towards the inside for the middle and lower parts.
Operation
Practical recommendations prior to the operation
Do not arrive too morally or physically tired to the operation. Let us know about any change in your state of physical or mental health and do not forget that there is never any urgency to carry out an aesthetic operation. The operation will be cancelled if you are ill, or for women, if you are pregnant on the day of the operation.
– Due to the risk of necroses it is imperative that a patient stops smoking. Medicines that cause bleeding are prohibited during the days leading up to the operation: Aspirin, Anti-inflammatory medicines, Anticoagulants, Vitamin E….
Also, no progestin treatments (contraceptive pill) should be taken during the month before and after the operation to limit the risk of embolisms and scar inflammation.
It is imperative that you neither drink nor eat for the 6 hours prior to the operation.
The operation will be cancelled if preoperative advices are not adhered to: assessment, fast, stopping smoking…
When preparing your belongings DO NOT FORGET YOUR MEDICAL FILE AND PRESCRIBED SUPPORT (anti-thrombosis tights.)
Where possible, do not bring any valuable jewellery with you (or put it in the safe at the clinic with your other valuables during the operation.)
Have a shower or bath before coming to the clinic and make sure your hair is clean; women should obviously not wear nail varnish or make-up. Do not shave your pubic area before coming for the operation (risk of germs if there are micro-cuts, therefore a risk of infection during the operation.)
Prior to the anaesthetic contact lenses, dentures and hearing aids must imperatively be removed.
Anaesthetics and hospitalisation
The operation is always performed at the clinic and can be:
- either without hospitalisation under local assisted anaesthetic for the lighter concentric technique. This lasts 1 hour.
- or with an hospitalisation of 1 to 2 days and under general anaesthetic for the vertical technique. This operation lasts 1.5 to 2 hours.
Going home
– When the operation is carried out as an out-day surgery (concentric thigh technique)
You will usually leave a few hours after the operation. However, in certain cases (nausea, stress…) it can be preferable to spend the night at the hospital. Ask an ABLE-BODIED AND RESPONSIBLE person to take you home. Since anaesthetics are euphoriants, do not make any plans to do anything requiring concentration or the use of potentially dangerous equipment. If you are going home by car YOU WILL NOT BE ABLE TO DRIVE UNDER ANY CIRCUMSTANCES.
You should arrange for someone to be with you at home. In fact, you should not get up during the night following the operation without being accompanied, even to go to the toilet and even if you feel perfectly fine (anaesthetic products can produce effects identical to those of alcohol abuse).
Before leaving home prior to the operation, ensure that you have prepared everything for your return:
– Prepare a light meal
– Put Arnica 5CH, paracetamol-based painkillers (Dafalgan, Doliprane..) and a bottle of mineral water on your bedside table.
– When the operation is performed with hospitalisation (vertical technique)
Prepare clothing that is not too tight around the waist for when you leave hospital. In theory, you will be able to leave the clinic the day after the operation.
Next steps
Due to traction on the scar, the sitting position will be quite uncomfortable after the operation and should be avoided for 15 days to 1 month after the operation. It is also necessary to avoid any abrupt movements that could pull on the scar.
For the first few days at home you must relax as much as possible and avoid all over exertion. However, you should walk a little several times a day to prevent the risk of embolisms and should eat enough to enable healing.
It is important that you do not smoke for 15 days in order to facilitate healing and reduce the risks of necroses.
Note down the telephone number of the office (01 45 53 27 17 for France or 33 1 45 53 27 17 for international call), and the number of the clinic near your home telephone and in your mobile phone. Do not hesitate to call us if you are worried. Call us if, for example, you have a temperature, experience weeping, pain or other symptoms that give you cause to worry.
Leave from work: one to three weeks in function of your professional activity
Tights anti-thrombosis tights for 8 days
Stitches will be absorbable
Bruises 15 to 20 days
Swelling at its height on 3 rd /4 th pre-op day then fades progressively
Scars 6 to 9 months before they whiten
Exercise should not be resumed until 6 wks after the operation if sideways leg movements will be made that will pull on the scars.
Risks
In most cases, operations run smoothly and patients are happy with the result. However, before deciding to go ahead with an operation, you should be aware of the risks and possible complications.
General risks of all surgical operations: infections, haematomas, healing problems and risks from anaesthetics
Infections
The risk of infection can be increased by the proximity of natural orifices in the case of urogenital infection. Therefore, you will be asked to consult a specialist to detect them prior to the operation. It is also very important to keep the scars clean after the operation and to respect the antiseptic and antibiotic prescriptions. In case of infection, surgical draining may prove to be necessary.
Haematomas
Haematomas are very rare complications, but needs to be evacuated rapidly. They tend to occur in the hours following the operation. The risk of haematoma rises considerably when medicines that can cause bleeding are taken pre and post-op.
Healing problems
As in any plastic surgery operation, the quality of healing is not known in advance. Immediately after the operation a scar may inflame or weep, requiring specific local treatments that can often be long. Respect of advice concerning cleanliness, stopping smoking and attendance of monitoring sessions will be decisive. In the mid-term, a scar can sometimes develop poorly: thicken, expand, form keloids. This principally depends on the type of skin (red or black skins experience more problems) and health behaviour (cigarettes and the contraceptive pill increase this risk.)
Risks from anaesthetics
Anaesthetic techniques and monitoring methods have improved immensely and safety is high when an operation is performed in non-emergency conditions on a person in good health, when the anaesthetist is competent and working in a recognised establishment. However, the effect of anaesthetics on the body can be difficult to predict and treat. Therefore there are still risks and hazards inherent to all anaesthetics before and after the operation. This is why it is imperative that you consult the anaesthetist prior to the operation and fully inform him of the state of your health. In function of your health and the planned operation, he will assess the risks related to anaesthetics and tell you of any potential precautions to take. If the anaesthetist objects to the operation, this decision is final.
(see in chapter ” Before surgery ” section “Check up and anaesthetic consultation“)
Risks during any aesthetic operation: asymmetry, a result judged as insufficient or excessive, need to touch up results, sensitivity issues
The way in which tissues react to an operation is always specific and, to a certain extent, unpredictable. It depends on the patient correctly following the doctor’s recommendations, but luck also plays a role. This is why all risks of asymmetry, unsatisfactory or excessive results and the need to touch up results are evoked prior to any aesthetic operation.
Inside thigh lift-specific issues:
– Imperfection of the result
There is a serious risk of excessive results since it can lead to the vulva widening in female patients, together with movement of the scar and a repeat of the ptosis. This risk is limited by the fixation to the tendon to avoid excessive traction.
The risk of an insufficient or asymmetrical result, especially when patients have poor quality skin and notably on formerly obese patients, whose skin tends to slacken a great deal as of the day after the operation.
These two opposing risks require much vigilance in when operating and an appropriate dosage in replacing the tension which is the main difficulty in this operation.
– Need to touch up results
As we have just mentioned, formerly obese patients’ skin has a tendency to slacken quite soon after the operation. Therefore, the touching up of results or even repeat operations are not exceptional. Some once obese patients, though few in number, need to be operated on again twice for each operation to achieve a satisfactory result (body lift, arm lift, inner thigh lift).
– Sensitivity
The operation can cause, in 20% of cases, fairly considerable pains directly after the operation. Cases of loss, usually temporary (3 to 6 months), of sensation in the upper thigh region have been reported. Luckily, no vulva sensitivity issues have been reported.
Potential thigh lift complications
Thrombo-embolic problems
– These troubles are the most dreaded complications, even if they remain extremely rare.. The phlebitis can sometimes lead to pulmonary embolisms which can be fatal ( 1 in 10 000).This risk increases with long haul flights too soon after the operation and by certain pathologies. This is why an anaesthetic consultation and the respect of preventative measures will be decisive: anti-thrombosis supports, respect of potential anticoagulant prescriptions, halt of all progestin treatment early raising. Furthermore, if the anaesthetist feels that the patient should be rejected his decision is definitive. If in doubt in postoperative period, a blood test can be performed to measure the “D-Dymeres” and reseach impending trombo embolic issues.
Lymphatic effusions (seroma)
Effusions may require draining. Usually they dry with no further consequences, but can persist for several months. The two technique used have been developed especially to respect the large lymphatic trunks of the Scarpa triangle and to prevent secondary lymphatic effusions.
Necroses
Extensive necroses are very unlikely thanks to the closing up of all dead areas using padding to reduce tension on the scars, a source of skin suffering, but it should be pointed out that the risk does exist and increases considerably due to cigarettes.
Marginal necroses are, however, less rare, especially when the skin is of poor quality. They usually lead to a localised slackening of stitches due to the post-op tension (notably when the vertical technique is used in a T intersection between the pubic and vertical scars.) These necroses require specific treatment that is often long. They can be touched up later.
Risks of pubic or perineum string due to scar retraction
An abnormal string appearing when a female patient spreads her legs is due to wrong scar retraction. It is an exceptional complication which requires surgical correction.
The result
Two to three months after the operation, an initial evaluation of the result is possible. However, scars and tissues can experience an inflammatory peak at that moment, which is why it is often necessary to wait for nine to twelve months to see a final result.
Usually an appreciable aesthetic result is achieved with real psychological benefits and the comfort of the patient is also greatly improved.
The final appearance of the scar depends on the reaction of each patient and the stopping of smoking will be a decisive factor in this.
By way of conclusion, we remind you that precise and detailed information, an in-depth analysis of the reasons for the operation, teamwork between the patient and the surgeon during the preparatory phase, the search for surgical excellence coupled with a good analysis of benefits and risks, the respect of pre-op and post-op advice and regular monitoring of the patient are all key elements for aesthetic surgery to be a success.
References
General information about this surgery is available in french on the page« Lifting de la face interne des cuisses » of the SOFCPRE’s website (Société Française de Chirurgie Plastique Reconstructrice et Esthétique) : www.plasticiens.org
Specific information delivered on this website is based on Doctor Le Louarn’s practice and on his scientific works :
1 – LE LOUARN C., PASCAL J.F. : Complications du lifting des faces internes de cuisses – Inner thigh lift complications
Ann Chir Plast Esthet. 2004 Dec;49(6):610-3.
http://dx.doi.org/10.1016/j.anplas.2004.10.010
http://www.ncbi.nlm.nih.gov/pubmed/155822182 – LE LOUARN C., PASCAL J.F., : The Concentric Medial Thigh Lift
Aesthetic Plast Surg. 2004 Jan-Feb ; 28(1):20-3
http://www.springerlink.com/content/a4g8ty2qbaxkdqk7
http://www.ncbi.nlm.nih.gov/pubmed/15037958
http://cat.inist.fr/?aModele=afficheN&cpsidt=16036184
Regarding thigh lift, the following publications and works can also be listed (this list is obviously not exhaustive and may be amended) :
1 – GONZALES R. : Buttocks lifting: how and when to use medial, lateral, lower, and upper lifting techniques
Clin. Plast. Surg. 2006 Jul ; 33(3):467-78
http://www.ncbi.nlm.nih.gov/pubmed/168181012 – LOCKWOOD T. : Fascial anchoring technique in medial thigh lifts.
Plast. Reconstr. Surg. 1988 Aug ; 82(2):299-304
http://www.ncbi.nlm.nih.gov/pubmed/33995593 – GUERREROSANTOS J. : Secondary hip-buttock-thigh plasty
Clin. Plast. Surg. 1984 Jul ; 11(3):491-503
http://www.ncbi.nlm.nih.gov/pubmed/6467807