We would like to thank Dr. Webster for his stimulating comments on our article about liposuction-assisted medial thigh lifts.1 Numerous techniques have been described to correct the medial thigh after massive weight loss with respect to the patient’s individual deformity.2–4 It was reported that an incision at the groin is associated with a higher incidence of wound complications. This is likely attributable to increased motion in this rather moist area with immediate proximity to the genitals.5 For this reason, we hardly ever perform horizontal thigh lifts and try to avoid a T-point incision in the groin if possible. However, we apply additional contouring liposuction to the uppermost area of the medial thigh for correction of local lipomatosis and induction of skin retraction. The remaining skin redundancy is then assessed by hip adduction and a pinch test. We only convert to a T-point excision if the skin surplus is fairly extensive. In our opinion, even a secondary minor revision at the medial upper thigh is preferred over a primary T-point to correct eventual residual skin redundancy.
However, the technique described by Webster might represent a valuable and interesting alternative to our approach, which we will consider in our future clinical practice. An approach quite similar to that of Webster was recently published by Bracaglia et al.6 They used an L-shaped incision to overcome the evident problems associated with a T-point at the groin area. Despite the possible advantage of either the helicoidal or L-shaped approach, we try to avoid extending the incision in the area of the popliteal fossa to prevent functional problems from potential scar contracture in the posterior knee area. We feel that wound healing may be impaired when incisions run in this area because of the imminent motion. Therefore, we perform our incision along the axis of the adductor magnus muscle down to the inner aspect of the knee. A further aspect that should be discussed with the patient preoperatively is scar visibility in this helicoidal approach. Inevitably, there will be some caudal migration of the scar in the postoperative course, and this will move the scar on the anterior aspect of the thigh, at least in the upper part. This part cannot be covered with clothing such as underwear or swimsuits. In patients where there are a lot of striae, this might not be too conspicuous, but in patients with otherwise good skin conditions, this scar will be very obvious. Finally, we would like to congratulate Dr. Webster for his efforts in advancing the surgical care of patients after massive weight loss and for his kind comments on our article.
The authors have no financial interest to declare in relation to the content of this communication. No funding was received for this work.
Manfred Schmidt, M.D.
Dominik Duscher, M.D.
Georg M. Huemer, M.D., M.Sc., M.B.A.
Section of Plastic, Aesthetic, and Reconstructive Surgery
Department of General Surgery
Kepler University Hospital
1. Schmidt M, Pollhammer MS, Januszyk M, Duscher D, Huemer GMConcomitant liposuction reduces complications of vertical medial thigh lift in massive weight loss patients.Plast Reconstr Surg20161371748–1757
2. Le Louarn C, Pascal JFThe concentric medial thigh lift.Aesthetic Plast Surg20042820–23
3. Richter DF, Stoff AThe Scarpa lift: A novel technique for minimal invasive medial thigh lifts.Obes Surg2011211975–1980
4. Armijo BS, Campbell CF, Rohrich RJFour-step medial thighplasty: Refined and reproducible.Plast Reconstr Surg2014134717e–725e
5. Gusenoff JA, Coon D, Nayar H, Kling RE, Rubin JPMedial thigh lift in the massive weight loss population: Outcomes and complications.Plast Reconstr Surg201513598–106
6. Bracaglia R, Tambasco D, Gentileschi S, D’Ettorre ML-shaped lipothighplasty.Ann Plast Surg201575261–265
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