We would like to congratulate Drs. Schmidt et al.1 on their recently published article regarding vertical thighplasty. In the article, they use the avulsion technique described by us in 2014 with regard to brachioplasty2 and then again related to thighplasty in 2016.3 In their article, comparison is made between traditional excision thighplasty and avulsion thighplasty. The authors found the complication profile to be so much more favorable with the avulsion technique that the excisional technique was abandoned, an experience that mimics our own.
We would like to support the authors’ mention regarding moving the procedure to a purely outpatient setting and abandoning the use of drains. In our current experience and in previously published studies regarding the avulsion technique, the risk of major complications is low, including zero deep venous thromboses, pulmonary emboli, or hospital admissions. The risk of minor complications such as seroma (2 percent in our published data) or wound healing problems (40 percent in our published data) was more common, but neither of these conditions would benefit from inpatient care. We routinely perform avulsion thigh and arm surgery in combination with more significant body and facial contouring procedures, all on an outpatient basis, and encourage other surgeons to do so as well.
Performing these procedures in a private practice setting in the United States is considered “cosmetic,” and requiring a week-long hospital stay after a thigh lift would mean increased cost to the patient and would be seen as careless use of hospital resources better suited for seriously ill patients. We have not published our data regarding oral pain medication use after surgery, but the overarching finding is that patients experience good pain control with an oral medication regimen, and admission for intravenous pain medication is also unwarranted.
Regarding the potential for addition of adjunctive liposuction techniques such as ultrasound, discussed in the article by Schmidt et al., our experience has been that adding laser liposuction near the area of resection increases the complication profile. Although these heat-based techniques do supposedly lead to less bruising and possibly more skin retraction,4 they likely do so by altering the blood flow, which can lead to healing complications when heat-based adjuncts are coupled with skin excision.4–7
We applaud the authors on the nature of their retrospective study and agree with their assessment of the avulsion technique. It is our hope that more surgeons will bring away from their published work the repeated safety profile of the technique and begin to implement it to care for their own patients.
The authors have no financial interest in any of the products, devices, or drugs mentioned in this communication.
Christopher D. Knotts, M.D.
Austin-Weston Center for Cosmetic Surgery
Joseph P. Hunstad, M.D.
Hunstad-Kortesis Center for Cosmetic Surgery
University of North Carolina at Chapel Hill
Chapel Hill, N.C.
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 Surg. 2016;137:1748–1757.
2. Knotts CD, Kortesis BG, Hunstad JPAvulsion brachioplasty: Technique overview and 5-year experience. Plast Reconstr Surg. 2014;133:283–288.
3. Hunstad JP, Kortesis BG, Knotts CDAvulsion thighplasty: Technique overview and 6-year experience. Plast Reconstr Surg. 2016;137:84–87.
4. Karmo FR, Milan MF, Silbergleit ABlood loss in major liposuction procedures: A comparison study using suction-assisted versus ultrasonically assisted lipoplasty. Plast Reconstr Surg. 2001;108:241–247; discussion 248.
5. Vanek PF, Nagy MWA multicenter, prospective, randomized, single-blind, controlled clinical trial comparing VASER-assisted lipoplasty and suction-assisted lipoplasty. Plast Reconstr Surg. 2009;124(Suppl):23.
6. DiBernardo BE, Reyes JEvaluation of skin tightening after laser-assisted liposuction. Aesthet Surg J. 2009;29:400–407.
7. Prado A, Andrades P, Danilla S, Leniz P, Castillo P, Gaete FA prospective, randomized, double-blind, controlled clinical trial comparing laser-assisted lipoplasty with suction-assisted lipoplasty. Plast Reconstr Surg. 2006;118:1032–1045.
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