Operation Guide: Inner Thighplasty After Weight Loss [Vertical Thigh Lift]

This article describes how Dr Bernard Beldholm, FRACS performs VASER-assisted inner thigh lift surgery with a vertical scar on a patient following massive weight loss.

Email our Friendly Team

Click Here

Patient assessment and treatment planning

Thighplasty is a cosmetic surgical thigh contouring procedure that removes excessive thigh skin and fat. Elongated medial thighplasty is usually reserved for patients who present with extensive flaccidity of the inner thigh skin following extreme weight loss.

Pre-operative evaluation

During the initial consultation, a visual and tactile examination reveals the extent of thigh laxity and excess fat. Pre-operative photographs are taken from different angles to demonstrate cosmetic issues isolated to the pertinent areas of the medial thigh and knee.

Treatment planning

The degree of skin laxity and fat determines whether the patient will benefit from an inner thigh lift with or without liposculpture. If the patient has good skin elasticity and only presents with a modest amount of thigh fat, they may be a suitable candidate for liposculpture without tissue resection.

Contraindications

The patient is screened for contraindications to surgery during the consultation process with a self-report medical history questionnaire and diagnostic testing if applicable to rule out a heightened risk of complications. Contraindications to elective surgery typically include active pregnancy, obesity, bleeding disorders, uncontrolled diabetes, somatic disease, a history of poor scarring, and nicotine use. Smokers are advised to quit at least six weeks before and after surgery to facilitate healing.

Discussion of drawbacks and considerations

Before agreeing to undergo thighplasty, the patient has several factors to consider as part of the consultation process.

Thigh lift scar

The main disadvantage of vertical thighplasty is the long scar it leaves on the medial thigh from knee to groin. While the surgical scar generally fades to a fine line upon maturation of the scar, it never fully disappears.

Patients must be advised of the scar and urged to consider whether they are willing to trade a long scar for an improved inner thigh contour. The scar is visible anytime the thighs are exposed, e.g. when the patient wears shorts or swimwear.

Downtime

Patients must also be advised of the recovery period. Mobility, including walking and climbing stairs, is limited in early recovery. Most patients take two to three weeks away from job duties and resume driving after ten days. Physical exertion, including heavy lifting and exercise, are off limits for a period of at least six weeks post operatively. Numbness in the thigh area may persist for three months or longer.

Risks and complications

The patient must be advised of possible risks and complications, including but not limited to seroma, hematoma, infection, blood clots, pulmonary embolism, cardiac issues related to anaesthesia, wound dehiscence, skin necrosis, skin irregularities from liposuction, permanent nerve damage, prolonged pain, difficult recovery, poor scarring, dissatisfaction with results, and the possible need for revision thighplasty. Risks and complications are disclosed in oral and written form. The patient must be comfortable accepting the risks and have realistic expectations. A consent form must be signed confirming the patient has read and understood the risks.

Operation Guide: VASER-assisted Elongated Medial Thighplasty

This surgical training guide describes how Dr Bernard Beldholm, FRACS performs a vertical medial thigh lift assisted by VASER liposculpture to create slimmer and more toned thigh contours after massive weight loss.

PHASE 1: SURGICAL PREPARATION

Pre-operative markings

While the patient stands upright in the anaesthetic bay, markings are drawn on the medial thigh in an oval shape from knee to groin as a reference for resection. The liposuction areas are also marked prior to surgery and confirmed with the patient.

Patient positioning

The patient lies supine on the operating table, draped and with the pertinent thigh areas exposed.

General anaesthesia

The patient is sedated intravenously and intubated.

PHASE 2: VASER LIPOSCULPTURE

VASER high-definition liposculpture is performed initially to reduce subcutaneous adipose tissue on the inner thigh contour of the left leg. The VASER process takes approximately 30 minutes to one hour to finalise.

Dr Beldholm performing liposuction

Benefits of VASER

Dr Beldholm prefers to use VASER liposculpture for most of his body contouring work as an initial step. While VASER takes longer to perform than standard liposuction, he finds it provides numerous advantages.

VASER benefit 1

Since vertical thighplasty entails significant resection, it is beneficial to be as gentle as possible with the tissues during liposuction. VASER is tissue selective. It minimises damage to the blood vessels and nerves for a less traumatic surgery.

VASER benefit 2

VASER allows for enhanced shaping and sculpting of the thigh contours for a slimmer result than resection alone.

VASER benefit 3

Arguably one of the most important benefits of VASER liposculpture is that Dr Beldholm finds it greatly reduces the risk of seroma, a common post-operative complication among body contouring patients.

VASER benefit 4

Performing VASER as the initial step makes dissection easier as the underlying tissues are partially dissected.

VASER benefit 5

The tumescent fluid that is applied to the tissues prior to VASER provides a safety margin as the wetting solution expands the tissues, allowing for a maximally tight incision closure while still allowing room for the tissues to relax post operatively as the initial swelling subsides.

VASER benefit 6

Finally, VASER targets fat closer to the skin surface than traditional liposuction. This provides enhanced slimming of the thigh area, which is often predisposed to store excessive fat due to heredity.

Tumescent fluid application

VASER’s mechanism of action is the use of high frequency ultrasound to emulsify fat cells. The tumescent fluid is critical to this process as it allows for bubbles to rapidly form within the target adipose layer, thereby dislodging the fat cells so they can be properly emulsified via cavitation.

Dr Beldholm uses 1 mg of adrenaline with 400 mg of lignocaine in 1 litre of saline for this operation. The safe dose for lignocaine during liposuction is 35 mg per kg. It is possible to increase the lignocaine amount to 55 mg per kg, but he finds it is better to use less lignocaine when possible.

The tumescent solution is evenly distributed throughout the tissues.

Protective ports

Protective ports are inserted superficially to protect the patient’s skin from heat burns as the VASER probe gets hot as it oscillates.

Fat emulsification

An aggressive approach to fat reduction is acceptable since most patients prefer a slim result. Generally speaking, Dr Beldholm sets the VASER machine to 80% strength on continuous mode and proceeds with VASER for approximately 30 minutes or more depending on the amount of fat to be removed.

Fat aspiration

Once the fat cells are emulsified to the consistency of melted butter, the fat is removed with machine-assisted aspiration through a cannula. Since the fat has been liquefied, low power is all that is needed to extract it. This minimises trauma on the tissues.

PHASE 3: VERTICAL THIGHPLASTY

Inner thighplasty with an elongated scar is performed to address the excessive medial thigh skin from groin to knee.

Trialing the resection

Prior to resection, allis forceps are placed along the medial thigh to trial the extent of skin removal. The goal is ensure the skin purses tightly after resection without risking difficulties closing the incision.

Incision and dissection

Dr Beldholm making initial incision to remove excess skin

After the markings are confirmed, a vertical incision is placed on the left medial thigh from knee to groin using the markings as a guide. Any blood vessels that open are sealed progressively with diathermy. Dissection progresses through the superficial layers to free the skin.

Resection

Dr Beldholm removing excess inner thigh skin

The excessive skin is elevated and resected. Due to the discontinuous dissection that took place during the VASER liposculpture, skin removal is quite easy at this stage.

Closure

The wound is closed in layers. Approximately 10 ml of fibrinogen tissue sealant is applied throughout the tissues to minimise the risk of seroma. This enables Dr Beldholm to perform a drainless thighplasty as the tissue glue reduces vacancies throughout the tissues where fluid can accumulate. As an added benefit, fibrinogen tissue sealant appears to also minimise bruising. It also allows for easier closure of the layers as the glue aids in securing the tissues in place as the sutures are applied.

Dr Beldholm closes inner thigh skin incision

Sutures are applied deep and superficially to close the wound. The superficial closure appears tight initially due to expansion from the tumescent fluid as well as localised inflammation. Indentations that form between the interrupted superficial sutures tend to resolve during the first month post operatively.

Repeats all steps on the other leg

The process is identical for the right thigh. A similar amount of skin and fat is removed on both sides to ensure a symmetrical result.

PHASE 4: FINALISING THE SURGERY

Wound dressings

Sterile bandages are applied to support the wound and protect against contaminants.

Compression garments

Compression garments may be provided to minimise inflammation and aid in skin retraction around the new thigh contours.

Scar protocol

The surgical scar during medial vertical thighplasty is significant. To promote optimal scar healing, the patient is advised to use silicone scar sheets approximately three to six weeks after the surgery when the incision has healed and crusting is no longer present. Scar maturation is a process that takes approximately one year. Light therapy, cosmetic injectables, and scar revision treatments such as dermabrasion or surgical revision are available to refine the scars if needed.

Results

The pertinent thigh area appears tight and swollen initially. After the inflammation resolves and the tissues relax over the next six months to a year, the final thighplasty results become apparent. The inner thigh skin ideally takes on a firm, toned appearance and redundancy is eliminated. The excess fat will not return so long as the patient adheres to a routine diet and exercise plan after surgery.

Subscribe to our Podcast on iTunes "Body Contouring with Dr Bernard Beldholm"

Learn to perform VASER-assisted thighplasty

To gain practical experience in body contouring procedures such as thighplasty, aesthetic breast work, and abdominoplasty, contact the office of Dr Bernard Beldholm, FRACS to inquire about his one-year surgical training programme.

Disclaimer

This webpage may include descriptions or demonstrations of one or more surgical procedures. The aforementioned content is a general overview that is provided solely for informational purposes regarding Dr Beldholm’s preferred methodology at the time of publishing, which is subject to change without notice. The content on this site is not intended to be a substitute for formal medical training or certification. Appropriate medical licensure and training are required before attempting any surgical procedure in accordance with local, state, and federal laws. Dr Bernard Beldholm does not take responsibility for any actions or services rendered by independent surgeons with regard to the performance of the surgical techniques described on this page.