"The post-bariatric patient presents us with unusually loose skin almost throughout the thigh," says Dennis J. Hurwitz, M.D., F.A.C.S., clinical professor of plastic surgery, University of Pittsburgh, and director of the Hurwitz Center for Plastic Surgery. "Having worked on a steady number of these patients over the last five to six years, I have discovered that the traditional crescent upper inner thighplasty does not serve these patients adequately in most instances. If one pulls up the skin on the inner thigh against the labia or scrotum and there's still loose skin on the distal thigh, you still will have loose skin (after traditional thighplasty)."
L thighplasty Lower-body lifts and abdominoplasties can improve this problem.Even more helpful, Dr. Hurwitz says, is combining these procedures with a modified approach he calls the L thighplasty.
"There is some controversy about whether these procedures should be staged — the lower-body lift, followed by the abdominoplasty, then, at least a month later, the inner thigh (treatment). I argue that the biodynamics of the pull that I do, and the results that I get, indicate that a comprehensive approach will result in optimum improvement of thigh laxity," he tells Cosmetic Surgery Times.
Unique features of the L thighplasty include its presurgical marking method, which allows surgeons to resect the appropriate amount of tissue with accuracy and confidence. Specifically, Dr. Hurwitz's method requires patients to lie down with their leg raised at various angles rather than "struggling to push the skin around while the patient is standing," he says.
Two-part procedure Dr. Hurwitz plans the procedure in two parts, starting with the hanging skin that a crescent excision resolves fairly effectively.
"I plan that first, with the patient lying on her back with the leg up, then out," he says. "As I pull the skin away, I can easily define the junction between the labia and the thigh. Then I adduct the leg toward the center and push the skin down with the help of gravity. All that extra skin gets pushed into the pubic area. I pull it out like an accordion to see the amount" that must be excised.
For the second phase, Dr. Hurwitz has the patient put her leg down and angle it outward in a frog leg position.
In this phase, he says, "I pull the skin back and forth on the inner thigh, down the mid and distal thigh, pull it together as a vertical band and see how much gathers so I can adequately but still safely take away like an inseam tuxedo stripe down the leg. That tapers to the knee and flutes outward to the previous planning. Then I shift it backwards a little bit so the scar drifts from the knee backwards toward the sitting bone. When I'm finished, I stand the patient up and have them pull up the first part in order to confirm the first measurement."
Procedurally, he operates on the lower portion before the upper (after completing a lower-body lift and abdominoplasty).
"This operation commits one to a scar that goes up the inner thigh, as in the traditional thighplasty, and then down the thigh such that I can reliably leave a scar along the inner aspect of the thigh that lies toward the back of the thigh so that the scar is the least aesthetically intrusive as possible," he adds. "The L comes from the fact that the scar goes up the thigh, backwards towards the ischial tuberosity, then takes a right-hand turn and comes up between the thigh and the scrotum (or labia) all the way up to the mons pubic area abdominoplasty."