In the massive weight loss patient, ptosis and other deformities resulting from bidimensional thigh skin excess and bidimensional mons skin excess are frequently encountered.1 The ideal procedure to treat these deformities would provide (1) simultaneous and integrated treatment of the mons at the time of vertical medial thigh lift; (2) cephalic lift and circumferential reduction of the thigh; (3) lateral mons reduction; (4) correction of mons ptosis; and (5) a smooth incision with no “triple-point” closure. We present a simple technique that incorporates all of these features to simultaneously treat the thigh and mons.
The technique described in this article was performed in seven massive weight loss patients with a body mass index less than 30 who required a vertical-pattern medial thigh lift. The overall geometric plan of the technique is to use hockey stick–shaped incisions extending along the medial thigh and then cephalad into the lateral extent of the mons, forming the lateral borders of a picture-frame monsplasty.2,3 The vertical medial thigh lift is planned to allow maximum circumferential reduction of the skin excess in the medial thigh. The tissue to be resected is first treated with ultrasonic liposuction to defat the area and create a safe plane of dissection to avoid damage to lymphatic channels.2,4 The vertically oriented medial thigh tissue is then excised and closed using a tailor-tack method, leaving the proximal third of the thigh incision open. The proximal portion of the posterior flap is then advanced cephalad and anterior, forming the lower “triangle.” These two triangles are shown before advancement in the intraoperative photograph in Figure 1.
The lateral mons incisions are then made according to measurements, which delimit the desired width of the mons aesthetic unit. The tissue lateral to these mons incisions, which includes the upper anterior thigh skin, is elevated as a flap and advanced medial and cephalad, creating the second triangle, illustrated in Figure 2. The triangles are then opposed, marked, and trimmed. No true undermining is performed, and drains are not necessary. Closure of the superficial fascial system in the thigh is performed as a separate layer.4 Skin closure is then performed in two layers.
An adequate aesthetic result was achieved in all patients, as judged by both patient and surgeon, with no significant complications. There was no lymphedema or lymphocele, although one patient had prolonged lower extremity swelling for 8 weeks. No episodes of permanent or long-term mons edema occurred in this group. One patient required intravenous antibiotics for cellulitis and a small wound dehiscence in the groin area. No seromas or hematomas were encountered.
Managing the mons and the thigh simultaneously is complicated in the massive weight loss patient yet has the advantage of using an integrated approach to these adjacent aesthetic units. The double-triangle technique described here provides an approach that is safe, reliable, and reproducible.
Kristen M. Rezak, M.D.
Department of Plastic Surgery
Cleveland Clinic Florida
Loren J. Borud, M.D.
Kellogg School of Management
The authors have no financial interest to declare in relation to the content of this article.
1.Mathes DW, Kenkel JM. Current concepts in medial thighplasty. Clin Plast Surg
2.Hurwitz DJ. Medial thighplasty. Aesthet Surg J
3.Hurwitz DJ, Rubin JP, Risin M, Sajjadian A, Sereika S. Correcting the saddlebag deformity in the massive weight loss patient. Plast Reconstr Surg
4.Lockwood TE. Fascial anchoring technique in medial thigh lifts. Plast Reconstr Surg
Viewpoints, pertaining to issues of general interest, are welcome, even if they are not related to items previously published. Viewpoints may present unique techniques, brief technology updates, technical notes, and so on. Viewpoints will be published on a space-available basis because they are typically less timesensitive than Letters and other types of articles. Please note the following criteria:
Authors will be listed in the order in which they appear in the submission. Viewpoints should be submitted electronically via PRS' enkwell, at www.editorialmanager.com/prs/. We strongly encourage authors to submit figures in color.
We reserve the right to edit Viewpoints to meet requirements of space and format. Any financial interests relevant to the content must be disclosed. Submission of a Viewpoint constitutes permission for the American Society of Plastic Surgeons and its licensees and assignees to publish it in the Journal and in any other form or medium.
The views, opinions, and conclusions expressed in the Viewpoints represent the personal opinions of the individual writers and not those of the publisher, the Editorial Board, or the sponsors of the Journal. Any stated views, opinions, and conclusions do not reflect the policy of any of the sponsoring organizations or of the institutions with which the writer is affiliated, and the publisher, the Editorial Board, and the sponsoring organizations assume no responsibility for the content of such correspondence.