Medial Thigh Lift in the Massive Weight Loss Population

Sir: We read with great interest the article by Gusenoff et al.1 about a 10-year experience on medial thigh lift after massive weight loss. Outcomes and complications observed performing horizontal and full-length vertical thighplasty were carefully investigated to give an authoritative and reliable indication to clinicians interested in body contouring surgery. Interestingly, the authors emphasize the high rate of complications, such as dehiscence, seroma, infection, and hematoma. Overall, 68 percent of patients experienced at least one complication, leading to the conclusion that patients should be counseled appropriately about the potential for minor wound healing problems. The highest number of complications (74 percent) was observed in patients treated with full-length vertical thighplasty. Over the past years, many attempts were made to improve results and reduce complications. Especially, less-invasive surgical techniques were proposed for patients presenting skin redundancy extending no farther than the midportion of the medial thigh. However, labial spreading and poor aesthetic results requiring further surgery to correct the defects were observed as a consequence of this approach.2 Capella3 supported concomitant liposuction in vertical medial thigh lift procedures to create a readily identifiable and safe plane of dissection and to improve outcome by optimizing the amount of soft tissue that can be removed. However, to date, when a greater amount of skin needs to be removed, the most commonly used techniques remain the T incision, which extends the horizontal inguinal crease incision vertically down to the medial knee region; and the L incision, which combines the horizontal and vertical cut, eliminating the T-point by cheating the design more posteriorly.4 Recently, a lower rate of complications has been reported by Jandali et al.,5 who proposed a modified T-incision technique. In their series of 21 consecutive patients, a staged liposuction and subsequent resection of the horizontal component followed by deepithelialization of the vertical component were performed. The horizontal scar is planned at the inguinal crease, and the vertical scar runs along the medial aspect of the leg. The anterior part of the vertical scar is marked first, and then the posterior aspect is determined by pinching the skin. This marking scheme minimizes the visibility of both scars. The reported low rate of complications, especially seroma, can be related to the reduction of dead space with a buried dermal flap and to the combined use of liposuction, which generally preserves lymphatic channels. Although further and prospective investigations with longer follow-up and a greater number of patients are needed to validate these findings, we really appreciated the attempt of Jandali et al., which was shown to be effective. Moreover, considering the high number of complications observed by the most prestigious institutions and to guarantee our patient a better assistance, we strongly believe that every attempt of technical modification needs to be considered with great attention and warmly welcomed. DISCLOSURE The authors have no financial interest to declare in relation to the content of this communication. Carlo M. Oranges, M.D. Plastic, Reconstructive and Aesthetic Surgery School Marche Polytechnic University Ancona, Italy Andrea Sisti, M.D. General and Specialist Surgery Department Plastic Surgery Division University of Siena Siena, Italy