We would like to thank Drs. Knotts and Hunstad for their favorable comments on our article about liposuction-assisted medial thigh lifts.1 We consider liposuction-assisted procedures in combination with avulsion techniques a breakthrough in body contouring surgery. Because of the drastic reduction of complications, we feel that these techniques should be used as the gold standard in this patient population. Already increasingly used in the extremities, this technique may also be an interesting option in trunk contouring procedures such as lipoabdominoplasty or belt lipectomy.
We have indeed been inspired by the article by Knotts et al.2 to apply the avulsion technique, initially described for brachioplasty, to our thigh-lift procedures. We have the impression that avoiding the additional thermal tissue damage induced by skin removal by means of electrosurgery adds to preserving wound edge blood supply and lymphatic microvasculature. The recently published article about avulsion thighplasty3 by Hunstad et al. was not available at the time we wrote our article, and we are delighted to see that this approach is gaining more widespread use.
It has been shown that laser-assisted liposuction indeed damages tissue at the cellular level,4 whereas ultrasound-assisted liposuction spares cell functionality.5 Although currently not formally assessed, we are experiencing very favorable results using third-generation ultrasound-assisted liposuction for additional thigh contouring without encountering further problems. As outlined in our article, we specifically focus on the proximal medial thigh, the inner aspect of the knee, and the mediodorsal aspect of the thigh to achieve optimal thigh contouring.
Because of local health insurance policy, the majority of postbariatric surgery is fully covered in Austria. This leads to inpatient procedures as a standard treatment. However, we certainly agree with Drs. Knotts and Hunstad that liposuction-assisted avulsion thighplasty can be performed in an outpatient setting, which is especially useful in private practice. We want to thank Drs. Knotts and Hunstad again for their kind comments and appreciation of our article to increase safety for patients undergoing medial thigh lifts.
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 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. Chung MT, Zimmermann AS, Paik KJ, et alIsolation of human adipose-derived stromal cells using laser-assisted liposuction and their therapeutic potential in regenerative medicine. Stem Cells Transl Med. 2013;2:808–817.
5. Duscher D, Atashroo D, Maan ZN, et alUltrasound-assisted liposuction does not compromise the regenerative potential of adipose-derived stem cells. Stem Cells Transl Med. 2016;5:248–257.
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