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Özkaya Ö, Yasak T. Vertical Medial Thigh Lift with the 'Anchor L Liposculpture' Technique in Massive Weight Loss Patients: Preliminary results. Aesthetic Plast Surg 2022; 46:276-286. [PMID: 34173029 DOI: 10.1007/s00266-021-02394-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 06/03/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Among all post bariatric surgical procedures, vertical thigh lift has the highest complication rates. Many modifications have been described to achieve better aesthetic results and decrease complication rates. The study aimed to present ''Anchor L Liposculpture Technique'' and discuss the results in the light of current literature. METHOD Between 2016 and 2020, 33 patients were operated with the Anchor L Liposculpture technique. In this technique, liposuction is performed similarly with the other techniques, but the liposuction area is not extended to posterior or anterior compartments to prevent complications. The technique also used a deepithelized flap to anchor the superficial fascial system to the pubic arch periosteum. The patients' characteristics (age, sex, body mass index, smoking history, amount of weight loss, comorbidities) volume of liposuction and postoperative complications were recorded. Results were compared between uncomplicated (group A) and complicated patients (group B). RESULT Six (n=6, %18.2) out of 33 patients experienced complications (Group B). There were no major complication. The most common complications are wound dehiscence (n = 2) and lymphocele (n = 2). All complication cases managed conservatively. Age and amount of liposuction were found to be statistically associated with increased complications. Other comparisons between group A and B did not show any significant difference. Scar migration was not observed in any patient during follow-up. CONCLUSION Anchor L Liposculpture technique is an easy-to-apply and reliable technique aimed better surgical results and lower complication rates. Surgeons especially at beginning of the learning curve or who experienced high complication rates can utilize this technique. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
| | - Tuğçe Yasak
- Prof. Dr. Cemil Taşçıoğlu State Hospital Plastic, Reconstructive and Aesthetic Surgery Clinic, Piyalepaşa Street, Istanbul, Turkey.
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Di Pietro V, Gianfranco MC, Cervelli V, Gentile P. Medial Thigh Contouring in Massive Weight Loss: A Liposuction-Assisted Medial Thigh Lift. World J Plast Surg 2019; 8:171-180. [PMID: 31309053 PMCID: PMC6620815 DOI: 10.29252/wjps.8.2.171] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Thigh’s lifting can be associated with significant complications, if the medial thigh excess is removed en bloc. In this study, the liposuction-assisted medial thigh’s lift (LAMeT) procedure, outcomes and complications were assessed. METHODS Twenty four females between 25 and 61 years with grade 2 or 3 on Pittsburgh Rating Scale (PRS) treated with medial thigh’s reduction were enrolled. Medial thigh’s reduction was performed in three different procedures of vertical, horizontal and LAMeT. Vertical thigh’s lift with fascia suspension was conducted in 13 patients with grade 3 of ptosis on PRS; horizontal thigh’s lift with fascia suspension was undertaken in 3 patients with grade 2 on PRS; vertical and horizontal thigh’s lift considered as control group was described as excision-only group; and LAMeT was performed in 8 patients with grade 2 and 3 on PRS. RESULTS Complications were observed in 62.5% of patients who underwent vertical or horizontal thigh’s lift with fascia suspension and in 16.7% who experienced the LAMeT without fascia suspension. The most frequent complication was seroma. Hospital stay was significantly lower in the LAMeT. CONCLUSION Medial thigh’s lift is a safe and satisfying procedure because it provides aesthetic improvement in massive weight loss patients. The complication rate is higher when skin excess and laxity are removed en bloc, as the resection of excess tissue is poorly selective. The LAMeT preserves lymphatic and blood vessels and allows a more anatomical resection of the excess skin. Thus postoperative complications incidence is lower and the patient heals faster.
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Affiliation(s)
- Verdiana Di Pietro
- Department of Plastic, Reconstructive and Regenerative Surgery, University of Rome "Tor Vergata", Italy
| | | | - Valerio Cervelli
- Department of Plastic and Reconstructive Surgery, Catholic University, "Our Lady of Good Counsel", Tirane, Albania
| | - Pietro Gentile
- Department of Plastic, Reconstructive and Regenerative Surgery, University of Rome "Tor Vergata", Italy
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Beidas OE, Gusenoff JA. Common Complications and Management After Massive Weight Loss Patient Safety in Plastic Surgery. Clin Plast Surg 2019; 46:115-122. [DOI: 10.1016/j.cps.2018.08.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Clinical, Biomechanical, and Anatomic Investigation of Colles Fascia and Pubic Ramus Periosteum for Use During Medial Thighplasty. Ann Plast Surg 2017; 78:S305-S310. [DOI: 10.1097/sap.0000000000001033] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Abstract
BACKGROUND In addition to the already-known postoperative complications in patients formerly obese, for medial thigh lift, there are many more problematic issues. The main ones are represented as follows: by the frequent downward displacement of the scars that become, in this way, extremely visible; by the distortion of the vulva or scrotal region; by serious and disabling disorders of the lymphatic system; and by the early recurrence of ptosis in this anatomical site. MATERIALS AND METHODS From 2004 to 2010, 16 patients with moderate to severe laxity of the medial area of the thighs were treated by an L-shaped medial thigh lift after selective liposuction. Ten have been previously treated with biliopancreatic diversion and 6 have been previously treated with gastric bypass. Mean (standard deviation [SD]) height before bariatric surgery was 1.62 (0.08) m, mean (SD) weight was 141.53 (23.12) kg, and mean (SD) body mass index was 57.13 (8.21) kg/m. After the intervention, mean (SD) weight decreased to 81.12 (16.43) kg, whereas mean (SD) body mass index decreased to 31.83 (8.51) kg/m. RESULTS After L-shaped lipothighplasty, 13 patients (81%) had no complications in the postoperative period. No skin necrosis, hematoma, seroma, or thromboembolic events were reported. Two patients experienced hypertophic scarring and 1 patient had a wound infection because of poor hygienic care. CONCLUSIONS The medial lifting technique defined as L-shaped lipothighplasty is a valid, fast, and safe technique and can reduce early and late postoperative complications in a critical and troublesome area for the surgeon who is going to correct the deformity.
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Concomitant Liposuction Reduces Complications of Vertical Medial Thigh Lift in Massive Weight Loss Patients. Plast Reconstr Surg 2016; 137:1748-1757. [DOI: 10.1097/prs.0000000000002194] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Simone P, Carusi C, Del Buono R, Persichetti P. Medial thigh lift in post-bariatric patients: Our encouraging experience. J Plast Surg Hand Surg 2016; 50:359-366. [DOI: 10.1080/2000656x.2016.1184157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Sisti A, Cuomo R, Zerini I, Tassinari J, Brandi C, Grimaldi L, D'Aniello C, Nisi G. Complications Associated With Medial Thigh Lift: A Comprehensive Literature Review. J Cutan Aesthet Surg 2016; 8:191-7. [PMID: 26865783 PMCID: PMC4728900 DOI: 10.4103/0974-2077.172189] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Medial contouring of the thigh is frequently requested to improve appearance and function of medial thigh deformities, following massive weight loss or aging process. This surgical procedure can be associated with a significant rate of complications. Our aim was to consider the complications and outcomes according to the performed technique, through a wide and comprehensive review of the literature. A search on PubMed/Medline was performed using “medial thighplasty”, “medial thigh lifting” and “technique” as key words. As inclusion criteria, we selected the clinical studies describing techniques of medial thighplasty. We excluded the papers in which complications related to medial thighplasty were not specified. We also excluded literature-review articles. We found 16 studies from 1988 to 2015. Overall, 447 patients were treated. Different techniques were applied. Complications were observed in 191/447 patients (42.72%). The most frequent complications were wound dehiscence(18.34%) and seroma (8.05%). No major complications, such as thromboembolism and sepsis, were observed. Minor complications occurred in a high percent of patients, regardless of the performed surgical procedure. Patients should be informed about the possible occurrence of wound dehiscence and seroma, as common complications associated with this surgical procedure.
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Affiliation(s)
- Andrea Sisti
- Plastic Surgery Division, Department of General and Specialist Surgery, University of Siena, Siena, Italy
| | - Roberto Cuomo
- Plastic Surgery Division, Department of General and Specialist Surgery, University of Siena, Siena, Italy
| | - Irene Zerini
- Plastic Surgery Division, Department of General and Specialist Surgery, University of Siena, Siena, Italy
| | - Juri Tassinari
- Plastic Surgery Division, Department of General and Specialist Surgery, University of Siena, Siena, Italy
| | - Cesare Brandi
- Plastic Surgery Division, Department of General and Specialist Surgery, University of Siena, Siena, Italy
| | - Luca Grimaldi
- Plastic Surgery Division, Department of General and Specialist Surgery, University of Siena, Siena, Italy
| | - Carlo D'Aniello
- Plastic Surgery Division, Department of General and Specialist Surgery, University of Siena, Siena, Italy
| | - Giuseppe Nisi
- Plastic Surgery Division, Department of General and Specialist Surgery, University of Siena, Siena, Italy
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Gunnarson GL, Frøyen JK, Sandbu R, Thomsen JB, Hjelmesæth J. Plastic surgery after bariatric surgery. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2015; 135:1044-9. [PMID: 26080780 DOI: 10.4045/tidsskr.14.0814] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Massive weight loss after bariatric surgery often results in excess skin, which can lead to stigma due to appearance and pronounced physical and psychological impairments. This review considers the evidence base for post-bariatric plastic surgery and the treatment options that are available. METHOD The article is based on a literature search in PubMed with the keywords «bariatric surgery» AND «plastic surgery», in addition to the authors' experience with a large number of patients. RESULTS Body contouring surgery after massive weight loss is offered primarily for the treatment of troublesome skin conditions. The surgery can help to improve quality of life and functional status. However, there is little scientific evidence regarding indications for surgery, choice of surgical techniques and risk of complications, and the surgeon's own opinions and clinical experience often play a major role. Many plastic surgeons limit body contouring surgery to those with BMI < 28 kg/m². However, most patients who have undergone bariatric surgery have BMI ≥ 30 kg/m², and requests for body contouring surgery for these individuals are often denied, except when there are compelling medical grounds. INTERPRETATION Plastic surgery can lead to improved functioning and increased quality of life. The evidence base with respect to indications, treatment methods and outcomes should be strengthened through well-planned prospective studies and a patient registry. There is a particular need for documentation of treatment outcomes in the large group of patients with BMI ≥ 30 kg/m².
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Affiliation(s)
| | | | - Rune Sandbu
- Senter for sykelig overvekt i Helse Sør-Øst Sykehuset i Vestfold
| | - Jørn Bo Thomsen
- Avdeling for plastikkirurgi Odense Universitetshospital og Vejle Sykehus Lillebælt
| | - Jøran Hjelmesæth
- Senter for sykelig overvekt i Helse Sør-Øst Sykehuset i Vestfold og Avdeling for endokrinologi, sykelig overvekt og forebyggende medisin Medisinsk klinikk Institutt for klinisk medisin Universitetet i Oslo
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Understanding the Three-Dimensional Anatomy of the Superficial Lymphatics of the Limbs. Plast Reconstr Surg 2014; 134:1065-1074. [DOI: 10.1097/prs.0000000000000640] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Gusenoff JA. Prevention and Management of Complications in Body Contouring Surgery. Clin Plast Surg 2014; 41:805-18. [DOI: 10.1016/j.cps.2014.06.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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The Influence of Preexisting Lower Extremity Edema and Venous Stasis Disease on Body Contouring Outcomes. Ann Plast Surg 2014; 73:365-70. [DOI: 10.1097/sap.0b013e31827fb44c] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Labardi L, Gentile P, Gigliotti S, Marianetti M, Colicchia GM, Pascali M, Brinci L, Cervelli V. Medial thighplasty: horizontal and vertical procedures after massive weight loss. J Cutan Aesthet Surg 2012; 5:20-5. [PMID: 22557851 PMCID: PMC3339123 DOI: 10.4103/0974-2077.94330] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background: The ‘medial thigh lift’ was first described by Lewis in 1957, but did not receive the widespread acceptance because of the various postoperative complications, such as scar migration with vulvar deformities and early recurrence of ptosis. For this reason, Lockwood developed a technique of anchoring the dermis to the Colles’ fascia, to make the surgical outcome more stable over time and to prevent scar migration. In this article, we describe our approaches to the medial thigh lift in post-bariatric surgery patients. Materials and Methods: A total of 45 females underwent medial thigh reduction. In 15 patients with Grade 2 on Pittsburgh Scale (PS), we performed a thigh lift with a horizontal scar; in 15 patients with Grade 2 on PS, we used a technique with a vertical scar; in 15 patients with Grade 3 on PS, the above-mentioned two procedures were combined. When it was really necessary, we also did the liposuction of the medial thigh. The patients were observed every 6 months with a 60-month median follow-up (range: 12–108 months). Results: In six patients was observed scar enlargement due to poor wound healing (one patient with a horizontal scar, three patients with a vertical scar and two with the combined procedure). In two patients with a horizontal scar, minimal scar migration was observed. In three patients, the recurrence of ptosis was evident (one patient with a horizontal scar and two patients with the combined procedure). No skin necrosis was observed. Conclusion: The medial thigh lift surgery is remarkably simple and free of major complications, if the basic anatomy of this region is understood, in order to preserve important structures such as the great saphenous vein and femoral vessels. The only complication is the presence of extensive and visible scars along the thigh, in the case of vertical procedure, and along the inguinal canal, with a possible distortion of the labia major, in the case of horizontal procedure.
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Affiliation(s)
- L Labardi
- Department of Plastic and Reconstructive Surgery, University of Tor Vergata, Rome, Italy
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Literature Watch. Lymphat Res Biol 2008. [DOI: 10.1089/lrb.2008.63411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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