Thigh Lift and Surgery After Massive Weight Loss

  • Eric Swanson


Thigh lifts have become much more popular recently because of the large number of patients who lose weight by dieting or after bariatric surgery. In men, the abdomen and inner thighs are affected. Skin redundancy in women also affects the buttocks, outer thighs, arms, and scapular areas.

Surgery to treat these deformities has been fraught with wound healing complications, as high as 50%. Fortunately the results tend to be quite dramatic, and patient satisfaction is typically high in patients who understand and accept the scarring.

A major change in recent years is in the performance of medial thigh lifts. Traditionally an incision has been made in the groin crease. This scar tends to migrate and cause tension on the perineum. A vertical thighplasty is much more effective in correcting circumferential skin laxity and avoids perineal traction. Wound healing problems tend to occur at a T-point if a combined horizontal and vertical resection is used. The author prefers a J-shaped incision, which reduces the risk of wound dehiscence. Revisions may be needed proximally in patients who have severe skin laxity. Framing the mons pubis with scars is best avoided.

The outer thigh lift/buttock lift may be done on its own or combined with an abdominoplasty to provide a lower body lift. The incision is kept high so as to preserve the gluteal aesthetic unit. A near-circumferential incision avoids healing problems in the midline of the lower back.

Thigh lifts may be done on an outpatient basis provided that the surgeon understands how to limit blood loss, avoid hypothermia, and administer a safe anesthetic that allows a quick patient recovery. Prolonged operating times are avoided. It is much better to stage surgery than to risk excessive blood loss and patient morbidity. Blood transfusions should rarely be necessary.

Prolonged operating times are avoided. It is much better to stage surgery than to risk excessive blood loss and patient morbidity.


Thigh Lift Body Buttock Thighplasty Medial Outer Massive weight loss 


  1. 1.
    Nemerofsky RB, Oliak DA, Capella JF. Body lift: an account of 200 consecutive cases in the massive weight loss patient. Plast Reconstr Surg. 2006;117:414–30.CrossRefPubMedGoogle Scholar
  2. 2.
    Pitanguy I. Trochanteric lipodystrophy. Plast Reconstr Surg. 1964;34:280–6.CrossRefPubMedGoogle Scholar
  3. 3.
    Lockwood TE. Transverse flank-thigh-buttock lift with superficial fascial suspension. Plast Reconstr Surg. 1991;87:1019–27.CrossRefPubMedGoogle Scholar
  4. 4.
    Lockwood TE. Lower body lift with superficial fascial system suspension. Plast Reconstr Surg. 1993;92:1112–22. discussion 1123–5CrossRefPubMedGoogle Scholar
  5. 5.
    Hamra ST, Small KH. Cosmetic body lift. Plast Reconstr Surg. 2016;137:453–61.CrossRefPubMedGoogle Scholar
  6. 6.
    Hunstad JP, Repta R. Extended abdominoplasty. In: Hunstad JP, Repta R, editors. Atlas of abdominoplasty. 1st ed. Philadelphia: Saunders Elsevier; 2009. p. 75–7.CrossRefGoogle Scholar
  7. 7.
    Almutairi K, Gusenoff JA, Rubin JP. Body contouring. Plast Reconstr Surg. 2016;137:586e–602e.CrossRefPubMedGoogle Scholar
  8. 8.
    Lockwood TE. Fascial anchoring technique in medial thigh lifts. Plast Reconstr Surg. 1988;82:299–304.CrossRefPubMedGoogle Scholar
  9. 9.
    Gusenoff JA, Coon D, Nayar H, Kling RE, Rubin JP. Medial thigh lift in the massive weight loss population: outcomes and complications. Plast Reconstr Surg. 2015;135:98–106.CrossRefPubMedGoogle Scholar
  10. 10.
    Capella JF, Matarasso A. Management of the postbariatric medial thigh deformity. Plast Reconstr Surg. 2016;137:1434–46.CrossRefPubMedGoogle Scholar
  11. 11.
    Shermak MA, Mallalieu J, Chang D. Does thighplasty for upper thigh laxity after massive weight loss require a vertical incision? Aesthet Surg J. 2009;29:513–23.CrossRefPubMedGoogle Scholar
  12. 12.
    Cram A, Aly A. Thigh reduction in the massive weight loss patient. Clin Plast Surg. 2008;35:165–72.CrossRefPubMedGoogle Scholar
  13. 13.
    Kenkel JM, Eaves FF. Medial thigh lift. Plast Reconstr Surg. 2008;122:621–2.CrossRefPubMedGoogle Scholar
  14. 14.
    Hunstad JP, Kortesis BG, Knotts CD. Avulsion thighplasty: technique overview and 6-year experience. Plast Reconstr Surg. 2016;137:84–7.CrossRefPubMedGoogle Scholar
  15. 15.
    Armijo BS, Campbell CF, Rohrich RJ. Four-step medial thighplasty: refined and reproducible. Plast Reconstr Surg. 2014;134:717e–25e.CrossRefPubMedGoogle Scholar
  16. 16.
    Schmidt M, Duscher D, Huemer GM. Reply: concomitant liposuction reduces complications of vertical medial thigh lift in massive weight loss patients. Plast Reconstr Surg. 2017;139:803e–4e.CrossRefPubMedGoogle Scholar
  17. 17.
    Buchanan PJ, Nasajpour H, Mast BA. Safety and efficacy of outpatient lower body lifting. Ann Plast Surg. 2013;70:493–6.CrossRefPubMedGoogle Scholar
  18. 18.
    Swanson E. Prospective study of lidocaine, bupivacaine and epinephrine levels and blood loss in patients undergoing liposuction and abdominoplasty. Plast Reconstr Surg. 2012;130:702–22. discussion 723–5CrossRefPubMedGoogle Scholar
  19. 19.
    Ducic I, Zakaria HM, Felder JM, Arnspiger S. Abdominoplasty-related nerve injuries: systematic review and treatment options. Aesthet Surg J. 2014;34:284–97.CrossRefPubMedGoogle Scholar
  20. 20.
    Pascal JF, Le Louarn C. Remodeling bodylift with high lateral tension. Aesthetic Plast Surg. 2002;26:223–30.CrossRefPubMedGoogle Scholar
  21. 21.
    Shermak MA. Body contouring. Plast Reconstr Surg. 2012;129:963e–78e.CrossRefPubMedGoogle Scholar
  22. 22.
    Centeno RF, Mendieta CG, Young VL. Gluteal contouring in the massive weight loss patient. Clin Plast Surg. 2008;35:73–91.CrossRefPubMedGoogle Scholar
  23. 23.
    Sozer SO, Agullo FJ, Palladino H. Split gluteal muscle flap for autoprosthesis buttock augmentation. Plast Reconstr Surg. 2012;129:766–76.CrossRefPubMedGoogle Scholar
  24. 24.
    Strivastava U, Rubin JP, Gusenoff JA. Lower body lift after massive weight loss: autoaugmentation versus no augmentation. Plast Reconstr Surg. 2015;135:762–72.CrossRefGoogle Scholar
  25. 25.
    Bertheuil N, Chaput B, De Runz A, Girard P, Carloni R, Watier E. The lipo-body lift: a new circumferential body-contouring technique useful after bariatric surgery. Plast Reconstr Surg. 2017;139:38e–49e.CrossRefPubMedGoogle Scholar
  26. 26.
    Hunstad JP, Repta R. Purse-string gluteoplasty. Plast Reconstr Surg. 2009;123:123e–5e.CrossRefPubMedGoogle Scholar
  27. 27.
    Editorial commentary. Clin Plast Surg. 2008;35:93.CrossRefGoogle Scholar
  28. 28.
    Rohrich RJ, Morales DE, Krueger JE, et al. Comparative lipoplasty analysis of in vivo-treated adipose tissue. Plast Reconstr Surg. 2000;105:2152–8. discussion 2159–0CrossRefPubMedGoogle Scholar
  29. 29.
    Swanson E. Prospective controlled study of buttock fat transfer using ultrasound and photographic measurements. Plast Reconstr Surg Glob Open. 2016;4:e697.CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Makipour JJ, Nuveen E, Abbott D. Safety of outpatient circumferential body lift: evidence from 42 consecutive cases. Plast Reconstr Surg. 2017;139:1355–62.CrossRefPubMedGoogle Scholar
  31. 31.
    Swanson E. Seroma prevention in abdominoplasty: eliminating the cause. Aesthet Surg J. 2016;36:NP23–4.CrossRefPubMedGoogle Scholar
  32. 32.
    Hatef DA, Kenkel JM, Nguyen MQ, et al. Thromboembolic risk assessment and the efficacy of enoxaparin prophylaxis in excisional body contouring surgery. Plast Reconstr Surg. 2008;122:269–79.CrossRefPubMedGoogle Scholar
  33. 33.
    Aly AS, Cram AE, Chao M, Pang J, McKeon M. Belt lipectomy for circumferential truncal excess: the University of Iowa experience. Plast Reconstr Surg. 2003;111:398–413.CrossRefPubMedGoogle Scholar
  34. 34.
    Swanson E, Gordon R. Comparing a propofol infusion with general endotracheal anesthesia in plastic surgery patients. Aesthet Surg J. 2017;37:NP48–50.CrossRefPubMedGoogle Scholar
  35. 35.
    Baca ME, Neaman KC, Renucci JD. Outpatient circumferential abdominoplasty in the non post-bariatric surgery patient. Plast Reconstr Surg. 2014;134(Suppl.4S-1):128–9.CrossRefGoogle Scholar
  36. 36.
    Moreno CH, Neto HJ, Junior AH, Malheiros CA. Thighplasty after bariatric surgery: evaluation of lymphatic drainage in lower extremities. Obes Surg. 2008;18:1160–4.CrossRefPubMedGoogle Scholar
  37. 37.
    Katzel EB, Nayar HS, Davenport MP, Bossert RP, Rubin JP, Gusenoff JA. The influence of preexisting lower extremity edema and venous stasis disease on body contouring outcomes. Ann Plast Surg. 2014;73:365–70.CrossRefPubMedGoogle Scholar
  38. 38.
    Birdsell DC, Gavelin GE, Kemsley GM, Hein KS. “Staying power” – absorbable vs. nonabsorbable. Plast Reconstr Surg. 1981;68:742–5.CrossRefPubMedGoogle Scholar
  39. 39.
    Egrari S. Outpatient-based massive weight loss body contouring: a review of 260 consecutive cases. Aesthet Surg J. 2012;32:474–83.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  • Eric Swanson
    • 1
  1. 1.Swanson CenterLeawoodUSA

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