Thigh Lift and Thighplasty AFter Weight Loss in Newport Beach, Orange County, California

Thighplasty Procedures

One of the most challenging procedures in Post-bariatric Plastic Surgery is the thigh lift or thighplasty surgery. This is because the thigh deformity is variable; the thigh contour is heavily influenced by the adjacent regions such as the abdomen, waist and buttocks; the tissues are heavy and subject to considerable movement; and the location of the thigh incisions next to the groin make them more prone to contamination. Thighplasty refers to a number of thigh surgeries that involve removal of excess thigh skin and fat. The aim of a successful thighplasty procedure should be reduction of the thigh excess and thigh descent. The new contour should follow the aesthetic features of the thigh, the scars should be inconspicuous, and the creases reconstructed meticulously. Dr. Agha prefers to use the term “thigh lift” to denote elevation of the thigh in a vertical direction and reserves the term “thighplasty” for circumferential (horizontal) reduction of the thigh.

The current thighplasty techniques include:

1. Upper and inner thigh lift for correction of the loose of the inner thigh. This is the current thigh lift procedure that is used for non-bariatric patients. The procedure however does not elevate the back or the front of the thigh.
2. Lower body lift to correct the outer thigh.
3. Vertical thighplasty to correct for the excess circumferential laxity

Many plastic surgeons prefer to use predominantly the vertical thighplasty to reduce the degree of thigh laxity in weight loss patients. This is understandable given the limitations of the current inner thigh lift in correcting the vertical thigh laxity of the weight loss patient. In recent years, Dr. Agha together with Dr. Dennis Hurwitz have pioneered a new technique of thigh lift. Termed the “Spiral Thigh Lift” by Dr. Agha, the new thigh lift procedure corrects for the vertical laxity of the back, inner surface and front of the thigh. When performed together with a lower body lift, the Spiral Thigh Lift produces circumferential thigh lift that is needed by almost all weight loss patients.

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Thigh Lift and Thighplasty AFter Weight Loss in Newport Beach, Orange County, California

Spiral Thigh Lift

Spiral Thigh Lift ™ is the signature thigh lift procedure that Dr. Agha has developed for those who have vertical laxity of the thighs. As the name implies, the Spiral Thigh Lift ™ improves the laxity of thigh front, back, and the inner surface. In many weight loss patients, the infra-gluteal crease becomes loose. This results in loss of demarcation between the lower buttock and upper thigh regions. Consequently, the buttock flows into the thigh obscuring both the buttock and thigh shapes.

This picture shows the loss of the infra-gluteal crease in a weight loss patient. The buttock area is deflated, sagging and loose. The lower buttock flows into the upper thigh adversely affecting the contour and boundaries of both structures.

The procedure starts on the back with an incision below the buttock fold (infra-gluteal crease). Through this incision, the excess tissue of the upper thigh back is excised. The thigh is then elevated to a higher position and secured to the underlying tissue. The infra-gluteal crease is then meticulously reconstructed. This will enhance the shape of both the buttock region as well as the thigh. The remaining laxity of the front and inner thigh are then corrected by continuing the 2 incisions over the groin crease and on upper thigh parallel to it. A wedge of excess skin with fat is then removed, and the inner thigh is lifted and secured at a higher position. The groin crease is then reconstructed so that the scar is undetectable under clothing. This provides a tighter and smoother thigh contour and enhanced skin flow.

In essence, the Spiral Thigh Lift combines the incisions of the thigh lift with that of a lower body lift to improve the thigh contour circumferentially. For many patients, the Spiral Thigh Lift can provide adequate improvement in thigh laxity, without the more disfiguring scar of the thighplasty. However, this depends on each person’s expectations and desires.

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Thigh Lift and Thighplasty AFter Weight Loss in Newport Beach, Orange County, California

Vertical Thighplasty

A vertical thighplasty is recommended for the treatment of loose thigh skin in a circumferential (horizontal) dimension. The procedure involves removal of a large ellipse of skin and tissue of the inner thigh through a vertical incision that starts at the groin crease and extends to the inner knee. It is a thigh reduction procedure, not a lift. Also, vertical thighplasty is the procedure that is often performed by many plastic surgeons, instead of a thigh lift. In Dr. Agha’s practice, the procedure is recommended for a select number of patients who have lost significant weight and present with significant thigh laxity. About one third of the weight loss patients typically require a vertical thighplasty. For these patients, Dr. Agha combines the vertical thighplasty and the Spiral Thigh Lift ™ to obtain circumferential thigh reduction and thigh lift. Whereas the scars after the Spiral Thigh Lift ™ are covered by most underpants, the vertical thighplasty scar will be seen when the inner thighs are exposed.

These pictures show the pre-operative pictures of a weight loss patient who has significant thigh laxity in both a vertical and circumferential direction. The patient would have benefited from both a Spiral Thigh Lift ™ and a vertical thighplasty. However, the patient only wanted a vertical thighplasty. Her pre-operative pictures and markings are shown on the top row. The lower row shows her corresponding post-operative pictures at 6 months after her surgery.

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Surgical Risks and Potential Complications of Body Lift and Body Contouring in Orange County, Los Angeles, Riverside, California

Surgical Risks and Potential Complications with Body Contouring After Massive Weight Loss

All surgical procedures have potential risks associated with their performance. The decision to have body contouring procedures is extremely personal, and you’ll have to decide if the procedure will achieve your goals and whether or not the risks and potential complications are acceptable. You should next visit the appropriate sections to attain a greater understanding of the potential complications of each procedure. It is important for you to realize that combined lower or upper body contouring procedures may increase the risks related to wound healing, need for revisional surgery, and deep venous thrombosis (DVT). Below you will find further information regarding the potential risks associated with various procedures.

Possible risks of body contouring surgery include:

• Surgical Anesthesia: On the day of surgery, your anesthesiologist will discuss with you the risks of both local and general anesthesia.
• Unfavorable Scarring: All surgeries leave scars at the site of incisions. If the sutured area doesn’t heal properly or takes too long to heal, the scars may be thicker than normal. If the patient heals relatively quickly, thinner scarring is expected. Scars will take years to fade, but they are permanent. Despite Dr. Agha’s best efforts, scar appearance and healing are not fully predictable. The scars may be uneven, excessively wide, and/or asymmetrical. Scar appearance may vary within the same region, exhibit unevenness, or bunching. Scars may also appear asymmetrical, unattractive, and of a different color than the surrounding skin. Excessive, hypertrophic, and keloid scarring are uncommon but can occur. Additional treatments, including surgery, may be necessary to treat abnormal scarring.
• Bleeding/Hematoma: Bleeding may result if the sutured areas do not heal correctly or if there is improper coagulation after the body contouring procedures. If a patient notices any unusual bleeding after a surgical procedure, contact Dr. Agha immediately. Do not take any aspirin or anti-inflammatory medications for two weeks prior to your surgery as this will increase the risk of bleeding. Non-prescription “herbs” and dietary supplements can also increase the risk of surgical bleeding. Should bleeding occur, hematoma (blood collection) may develop under the skin and expand as a tender bulge. This may require an emergency treatment to remove the blood collection. Furthermore, blood transfusions may be needed to replace the lost blood volume.
• Infection: Major infection with fever and large areas of red skin (cellulitis) is unusual after this type of surgery. Should a serious infection occur, treatment, including intravenous antibiotics or additional surgery to remove dead tissue, may be necessary. Minor wound infections accompanied by exposed and “spitting” sutures can occur and are usually easily dealt with by limited debridement, antibiotics, and dressing care. There is a greater risk of infection in smokers, malnourished patients, those with diabetes, and with multiple surgical procedures.
• Fluid Accumulation (Seroma): Drains are often placed at the surgical site at the end of the operation to collect seepage of fluid. After their removal in about five to seven days, body fluids (serum) occasionally accumulate underneath the skin. Should this occur, it may require aspirations. If that fails to cure the seroma, then the patient will need to be seen either in the office or the operating room for insertion of new drainage tubes and removal of seroma cavities. This is very rarely necessarily.
• Poor Wound Healing: Individuals who have a slower than average healing rate or smokers may find that they do not heal properly, that the sutured areas reopen easily, or that they are more prone to infection. Patients should avoid smoking three weeks prior to and after the procedure so that their body’s natural healing process is not hindered. Patients with nutritional deficiencies may be at risk for poor wound healing.
• Wound Dehiscence: In general, your skin closure is in multiple layers. Separation of the superficial, deep, and/or both layers may occur any time during your first post-operative month. Suture breakage, knots untying, suture tearing, too much movement or bending, and skin necrosis (death) are some of the recognized causes of dehiscence. Breakage of sutures in the superficial layer of skin may be sutured closed or allowed to heal secondarily at the judgment of Dr. Agha.
  Deep dehiscence may require a return trip to the operating room for closure under anesthesia. These healing problems may require frequent dressing changes, extra office visits, and further surgery to remove the non-healed tissue. Open wounds may take weeks to heal or a secondary closure may be appropriate. Wounds allowed to heal on their own usually benefit from secondary scar revision. Smokers have a high risk of skin loss and wound healing complications. Do not smoke for three weeks before and after your surgery.
• Suture Granuloma: Body contouring techniques use multiple deep sutures. Occasionally, one or more sutures may be noticed by the patient following surgery. These usually resolve since most of the stitches used by Dr. Agha will be absorbed by your body. However, sutures can spontaneously extrude through the skin, be visible, or produce irritation that requires removal.
• Skin Necrosis (Skin Death): The skin at the site of surgery or incision site may become necrotic or “die.” When this happens, skin may change color and slough (fall) off. Necrotic skin may become infected with bacteria or microorganisms. This may require further surgical management.
• Numbness in Skin Sensation: This is a normal consequence that occurs at the site of surgery in everyone to a different extent. You may experience “paresthesia,” which is an altered sensation. This may either be increased sensitivity (pain) in the area, or loss of any feeling (numbness) in the area. In most patients, numbness goes away within the first four to sixth months after surgery. Massaging the surgical area helps increase circulation and facilitates the return of normal skin sensation. As nerve endings regenerate, you may experience pins and needles, burning or itching. Numbness is permanent in very rare cases.
• Contour Irregularities: Contour irregularities and depressions may occur after body contouring procedures. Occasionally, asymmetrical fullness, bulges, and depressions may be present.
• Asymmetry: Most patients are asymmetrical in reference to their right and left face, breast, and body sides. Thus, asymmetrical body appearance, contour, and scar placement may occur after body contouring surgery. This may require additional surgery.
• Skin Discoloration/Swelling: Some skin discoloration and swelling can occur following body contouring surgery. In rare situations, swelling and skin discoloration may persist for long periods of time. Permanent skin discoloration is rare.
• Pain that Persists: Long-term persistent pain may occur very infrequently from nerves becoming trapped in scar tissue after surgery.
• Nerve Damage: If improper healing occurs, the patient may have some nerve damage. The possibility of nerve damage should be discussed with the physician before the procedure. Nerve damage can result in over-sensitivity or it can result in a lack of sensitivity at the surgical site.
• Damage to Deeper Structures: There is the potential for injury to fat, muscles, blood vessels, nerves, bowels, and lungs during any surgical procedure. Injury to the deeper structures may be temporary or permanent.
• Fatty Necrosis: Occasionally, fatty tissue under the skin can undergo necrosis (death) after surgery. This usually presents at the incision sites as a small lump of firm tissue that can be excised at a later date.
• Allergic Reactions: In rare cases, local allergies to tape, gloves, suture material, injected agents, or topical preparations have been reported. More serious systemic reactions which may occur in response to drugs used during surgery and prescription medicines. Allergic reactions may require additional treatment.
• Residual Deformity: Despite the best efforts to obtain tight contours, a small degree of residual deformity may persist or develop months after the surgery.
• Need for Revisional Surgery: The practice of medicine and surgery is not an exact science. Should complications occur or some aesthetic expectations remain unmet, additional procedures or other treatments may be necessary. Other complications and risks can occur, but are even more uncommon.
• Suboptimal Aesthetic Result: You may be disappointed with the results of surgery. Under-treatment with residual laxity and looseness or over-treatment with excessive tightness of the skin can occur with the flattening of regional contours and the widening or thickening of scars. Considerable judgment is used to achieve the optimum shape, but for a variety of reasons, the ultimate results may be suboptimal. At times, it is desirable to perform additional procedures to improve your results.

Deep Vein Thrombosis (DVT) and Pulmonary Complications: Deep vein thrombosis is a rare but worrisome complication of plastic surgery. It represents formation of blood clot in the deep veins of the legs during anesthesia and surgery. Although a sequential compression device will be used for up to five days after surgery to reduce the risks during and after the surgery, a few patients may still develop DVTs. Its frequency is reduced by early post-operative mobility so that blood does not have time to become stagnant in calf muscles. A fat embolism during liposuction is an extremely rare condition where loosened fat enters the blood through injured blood vessels during liposuction. Fat fragments can then become trapped in the blood vessels, gather in the lungs, or travel to the brain. Pulmonary complications may occur secondarily to the migration of blood clots or fat clots into the lungs (pulmonary emboli) or partial collapse of the lungs after general anesthesia. The signs of pulmonary emboli may be shortness of breath or difficulty breathing. If you have the signs or symptoms of pulmonary emboli, it is important for you to seek emergency medical care at once. Should this complication occur, you may require hospitalization and additional treatment. Pulmonary emboli can be life-threatening or fatal in some circumstances. Also, inactivity and certain medical conditions (see above) may increase your risk of blood clot formation.
Many factors can increase the risk of deep venous thrombosis and pulmonary complications. These include:

1. Age greater than 60
2. Active or passive smoking
3. Recent surgery within three months
4. Oral contraceptive use and estrogen therapy
5. Family history of clotting disorders, such as Factor V Leiden mutation
6. Cardiac failure
7. Recent trauma
8. Leg immobilization or paralysis
9. Cancer
10. White blood cell disorders, such as leukemia and polycythemia vera
11. Kidney disorders
12. Lupus
13. Pregnancy and the postpartum period (period after childbirth)
14. Paroxysmal nocturnal hemoglobinuria (episodic loss of hemoglobin)
15. Anticancer drug use, including tamoxifen
16. Inflammatory bowel disease

• Cardiac Complications: Cardiac complications are a risk with any major stress, surgery, and anesthesia even in those who have no heart symptoms. It is important to have a full medical evaluation and clearance by your primary care physician before major surgery.
• Long Term Effects: Subsequent alterations in body contour may occur as the result of aging, weight loss or gain, pregnancy, or other circumstances unrelated to the above procedures.

Procedure Specific Complications

Abdominoplasty

• Loss of Umbilicus: Malposition, scarring, unacceptable appearance, and partial or complete loss of the umbilicus (navel) may occur after an abdominoplasty procedure.
• Pubic Distortion: It is possible, although often transient, to have distortion of the pubic area in one side more than the other. This may require revision surgery.

Thigh Lift or Thighplasty

• Pubic Distortion: It is possible, although unusual for women to develop distortion of the pubic area or labia after a medial thigh lift or the Spiral thighplasty. This may require revision surgery.
• Persistent Swelling or Lymphedema: This may occur in the lower extremities after a thighplasty or thigh lift procedure due to disruption of the lymphatic vessels that drain lymph from the legs. Although rare in our practice, this complication can last for up to 12 months or longer. Compression stockings are often helpful.
• Sensation of Thigh Tightness: This rare sensation is often transient.

Liposuction

• Visceral Perforations (Puncture Wounds in the Organs): There have been reports of visceral perforations during liposuction that damage internal organs with the liposuction cannula. When organs are damaged, surgery may be required to repair them. Visceral perforations may also be fatal.

Buttock Lipoaugmentation

• Fat Absorption and Sclerosis: Approximately 20-30% of the fat injected into the buttocks does not survive and gets absorbed. If this happens unevenly, there could be areas were you feel or see asymmetry due to fat resorption. Gentle massage over the buttock area helps even out and smooth these areas during the recovery phase.
• Skin Irregularities or Dimples: Contour irregularities and depressions in the skin may occur after liposuction. Also, the areas of injected fat can occasionally develop contour irregularities, including bumps and dimples depending on your skin elasticity. Usually, post-operative massage can be helpful in smoothing these areas. On occasion, asymmetrical fullness, bulges, and depressions may be present.
• Asymmetry in Buttock Contour and Size: No two halves of the body are identical. Therefore, following buttock augmentation, these asymmetries may persist and appear as differences between the contour and size of the two sides. Scoliosis or other spine disorders can magnify body asymmetry.
• Buttock Infection: Infection may occur after any surgery and may occur after buttock lipoaugmentation. The rate of infection increases with the increasing amounts of injected fat, but the overall rate still remains very low due to routine use of antibiotics during and after your procedure.