The thighs suffer loose and hanging skin after extreme weight loss and often look like ‘wax melting on a candle’. Thigh lifts or thighplasty is the plastic surgery procedure that can address some of these issues. Thigh liftsconsist of a variety of procedures that differ based on the location and extent of the procedure. There are inner and outer thigh lifts and vertical and extended vertical thigh lifts, all based on the nature of the excess skin on your thighs.
The outer thigh lift is done as either part of the circumferential body lift or as an isolated procedure. When the circumferential skin cutout of the body lift crosses the outer waistline (actually lower so it is an upper or outer thigh lift), the saddlebag area of the thighs is lifted. The final scar will cross or be just above the hip bone so this area can be quite tight when closed at the time of surgery. Some plastic surgeons choose to anchor the underside of the thigh skin to the tough lining of the hip bone (iliac crest) and this maneuver can be a good one to prevent scar widening later. In the extreme weight loss patient, the extended nature of the sagging ski n around the waistline makes the body lift a logical choice to get a tummy tuck, outer thigh lift, and buttock lift all in one procedure. Isolated outer thighs in extreme weight loss patients is unusual because if one has sagging thighs there will be other areas that sag as well.
Inner thighs lifts consist of two basic types, simplistically those that are oriented horizontally and those that are more oriented vertically. In either type of thigh lift, I don’t recommend doing them until after the tummy tuck or body lift is first completed. This is because these procedures will provide a mild thigh lift effect which may change the amount of thigh skin removed or the incision (cutout) pattern. Either inner thigh lift approach is a compromise. A horizontal inner thigh lift removes a crescent of skin and fat along the groin crease and this is where the final scar will be. A groin crease scar can be long, extending back into the buttock crease, but it is placed in a natural skin crease that is not that visible. A vertical thigh lift usually includes a horizontal excision of skin along the groin crease but also has a long vertical cut out, a T excision pattern. This is a very effective thigh reshaping procedure but results in a long visible scar down the inner thigh. Most extreme weight patients are usually better off with the combined horizontal/vertical inner thigh lift, if the scar is acceptable.
Dr. Barry Eppley