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Management of the Postbariatric Medial Thigh Deformity

Sisti, Andrea M.D.; Cuomo, Roberto M.D.; Brandi, Cesare M.D.; Grimaldi, Luca M.D.; D’Aniello, Carlo M.D.; Nisi, Giuseppe M.D.

Plastic and Reconstructive Surgery: March 2017 - Volume 139 - Issue 3 - p 798e–799e
doi: 10.1097/PRS.0000000000003093

Plastic and Reconstructive Surgery, S. Maria alle Scotte Hospital, University of Siena, Siena, Italy

Correspondence to Dr. Sisti, Plastic and Reconstructive Surgery, S. Maria alle Scotte Hospital, Viale Bracci 16, Siena, Italy,

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We read with great interest the article by Capella and Matarasso entitled “Management of the Postbariatric Medial Thigh Deformity.”1 The charts of 350 consecutive individuals who had undergone vertical medial thigh lifts were reviewed for complications and other variables. The overall complication rate was 45.14 percent. Skin dehiscence and seroma formation were the most frequent complications, at 31.14 percent and 18.18 percent, respectively. The authors concluded that medial thigh deformities of the weight-loss patient are effectively addressed by a vertical medial thigh lift when the variables adjacent to the medial thighs are first treated by a body lift.

The complication rate was similar to the literature data.2 Liposuction, early mobilization, and appropriate postoperative management are fundamental for reducing postoperative downtime and complications of vertical medial thigh lift in massive weight loss patients.3 Gusenoff et al. found a complication rate of 74 percent associated with full-length vertical thighplasty in a case series of 68 patients. Full-length vertical thighplasty was associated with prolonged edema.4

In our common practice, we use a surgical technique proposed by Le Louarn and Pascal in 2004.5 They called it “concentric medial thigh lift.” This horizontal technique presents several interesting points: the incision line located along the labia majora in the perineal crease remains at the same height backward; the incision never descends into the buttock fold; the direction of the skin stretching is concentric toward the labia minora; and liposuction is always associated with the surgical procedure.

In the past 20 years, 254 patients, most of them as outpatients, have undergone surgery using this technique, with a complication rate of 35.2 percent. The most frequent complications associated with this surgical procedure were wound dehiscence (16.4 percent) and seroma (15.3 percent). No major complications were observed. The vast majority of patients were pleased with the aesthetic and functional results of their surgery.

In our opinion, this horizontal technique (associated with liposuction) allows excellent results and has a low complication rate, compared with the vertical medial thigh lift, in the massive weight loss population. Moreover, abdominoplasty can be performed at the same time (Fig. 1), before or after medial thigh lift, joining the incision lines. We called it the ''Greek pi procedure," because the final scars resemble the Greek letter pi (Π or π) (Fig. 2) and can be easily hidden by common underwear.

Fig. 1

Fig. 1

Fig. 2

Fig. 2

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The authors have no financial interest to declare in relation to the content of this communication.

Andrea Sisti, M.D.

Roberto Cuomo, M.D.

Cesare Brandi, M.D.

Luca Grimaldi, M.D.

Carlo D’Aniello, M.D.

Giuseppe Nisi, M.D.

Plastic and Reconstructive Surgery

S. Maria alle Scotte Hospital

University of Siena

Siena, Italy

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1. Capella JF, Matarasso AManagement of the postbariatric medial thigh deformity.Plast Reconstr Surg20161371434–1446
2. Sisti A, Cuomo R, Zerini I, et alComplications associated with medial thigh lift: A comprehensive literature review.J Cutan Aesthet Surg20158191–197
3. 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
4. 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
5. Le Louarn C, Pascal JFThe concentric medial thigh lift.Aesthetic Plast Surg20042820–23
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