Thigh Reduction

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What is a thigh lift?

A thigh lift or thigh reduction is a procedure to reduce excess skin and fat from the thigh. Usually it is done by removing an ellipse of skin and fat from the thigh often combined with liposuction. Sometimes liposuction may be sufficient to improve the appearance of the thigh.

Who might consider having a thigh lift?

A thigh lift could be considered by someone who feels self conscious about excess skin and fat on the thighs. It is most frequently used to treat the inside of the thigh but there are procedures to tighten the outside of thigh as well.

How is the thigh lift operation done?

A thigh lift is usually carried out under a general anaesthetic with you asleep. It may be helpful to use liposuction to remove fat before taking the skin away. The excess skin is marked before the operation. Once the excess has been removed the wound is closed with stitches. The stitches are usually dissolvable and under the skin. Normally it is necessary to leave a drain in for a day or so. A drain is a narrow tube (about 4-6mm wide) which passes through the skin and into a drain bottle or bag. It collects excess blood and tissue fluid which would otherwise build up under the skin. Usually the drain is removed the next day but it may be advisable to leave it in longer. A dressing is left on the wound and a bandage placed over the top. Most people will go home after 1 to 2 days. There several surgical approaches to thigh lifts or thigh reductions:

Inner thigh lift (the standard thigh lift)

The inner thigh lift is the most usual technique for a thigh lift. A vertical ellipse of skin is removed from the inner thigh. Frequently a crescent of skin running from front to back is removed from the groin crease as well, so the end result is a ‘T’ shaped scar. The long component of the scar runs down the inside of the thigh sometimes to below the knee.

Transverse thigh lift

For smaller degrees of laxity a crescent of skin can be removed from the groin crease area. This leaves a scar running from front to back in the groin crease around the inner upper thigh. This has the advantage of a more limited less visible scar but is much less effective in removing excess skin.

lower body lift and lateral thigh lift

The lower body lift is where the tummy tuck operation is continued around to the back. This is sometimes called a belt lipectomy or a circumferential abdominoplasty although a lower body lift usually aims to achieve a greater degree of lift. The lower body lift enables a significant lift to the lateral thigh. This procedure would not be carried out at the same time as an inner thigh lift although an inner thigh lift could be carried out at a later date.

Liposuction

Liposuction is often helpful combined with a thigh reduction. In some people with less excess skin then liposuction alone may be sufficient to achieve the desired result. This has the great advantage of a considerably shorter scar and more rapid recovery.

How can I prepare for surgery?

Firstly you should ensure that you understand what is involved with surgery, what it may be able to achieve for you, how long you are likely to need for recovery and the risks. If you are overweight or are planning to lose weight you should do so before your surgery. This will make your surgery safer and is likely to give you a better result in the longer term. Smoking increases the risks of surgery so you are strongly advised to stop smoking 4 to 6 weeks prior to your operation. If you take medication you should discuss this with your surgeon before the operation. Certain drugs can increase the risk of bleeding and this needs special consideration with surgery. The combined oral contraceptive pill (not the progesterone only ‘mini-pill) and hormone replacement therapy increases the risk of deep vein thrombosis (DVT or clots in the legs). You would normally be advised to stop these for 4-6 weeks before your surgery so that the risk can return to near normal. You should discuss this with your surgeon. If you discontinue the contraceptive pill you must take alternative contraceptive measures otherwise you may become pregnant. If you are planning to stop the contraceptive pill you should discuss this and alternative contraception with you General Practitioner or family planning service. You should avoid aspirin and aspirin like drugs for 10 days before your operation as these increase the likelihood of bleeding with surgery. (If you take aspirin for medical reasons stopping the aspirin should be discussed carefully with your surgeon before stopping). Please do not take alternative or complimentary medicines or herbal remedies for 2 weeks before your surgery. Do not take omega fish oils. (Homeopathic arnica if bought from a reputable source is safe).

How long will I need to recover?

People vary considerably in how long they need to recover from surgery. If you had complications then your recovery can take considerably longer.

When will I be allowed home from hospital?

The majority of people go home 1 to 2 days after surgery.

When will I be able to drive?

You must not drive by law for 48 hours after a general anaesthetic. You should also check your car insurance. In general most people will return to driving about 2 – 4 weeks following surgery. It is essential that you feel comfortable driving and able to control the car in an emergency.

When will I be able to return to work?

Most people will take 2 – 4 weeks off work if they do office type work. More active work will require longer.

When will I be able to exercise?

You should rest for 2 weeks following the surgery. However walking is good and protects you against clots in the legs (DVT / Deep Vein Thrombosis). So taking regular short walks is healthy. Between 2 and 4 weeks after surgery you can start some gentle upper body exercise. If the wounds are healed then you can start some lower body exercise between 4 and 6 weeks after your operation. Cycling or power walking may be a good starting point. Some people may recover faster and others will require longer. You need to see how your body responds to activity. If you find exercise painful or causing excessive swelling then you should reduce or your exercise and allow more time for healing.

When and what can I lift?

You should avoid lifting for 2 weeks and straining to lift for 4 weeks. After 4 weeks you may start lifting heavier items but be guided by feedback from your body.

When can I return to swimming?

The wounds need to be fully healed before you swim. It is unlikely that you would return to swimming with in 4 weeks and 6 weeks is more realistic. If there are problems with the wound healing it may be necessary to avoid swimming for longer.

When will I be back to normal?

Recovery varies from one person to another. The majority of people feel they are mostly recovered by 6 to 8 weeks following surgery. However some areas of tenders, lumpiness or swelling may take longer to settle.

What results can I expect from a thigh lift?

A thigh lift is an effective procedure for improving the shape of the thigh by reducing the extra loose hanging skin. Immediately following the surgery the thigh will be swollen and bruised. This normally settles over a few weeks. It is common to have altered sensation down the inside of the thigh and this may extend to the ankle. This may feel tingly or numb. The area of changed sensation usually becomes smaller over time but areas of numbness may always be present although most people come not to notice them with time.

What will the scars look like?

It must be understood that the surgery leaves a long scar running down the inside of the thigh. This varies with the operation. A small thigh lift may be accomplished with a scar running round the groin crease or just on the upper part of the thigh. This is usually inconspicuous. Usually larger excisions are necessary and the scar extends down the inside of the leg. With larger excisions this may extend to below the knee. The appearance of scars varies from one individual to another. One hopes that the scars will rapidly fade to a thin pale line that will be barely noticeable. However often scars stay pink for many months even years. Although one attempts to make the scars as symmetrical as possible between the 2 thighs there are usually differences.

Will the results last?

In general the results do last although the aging process of the body does not stop. If you put on significant amounts of weight and lose it again then you may develop further loose skin.

What are the risks of having a thigh lift?

The majority of healthy people undergoing a thigh lift procedure are pleased with the outcome of their surgery. However as with all surgery there is the potential for complications. Complications include those of having a general anaesthetic, complications that may occur with any operation and those that need particular consideration for a thigh lift procedure. Serious complications are rare but as with all surgery could be life threatening.

General anaesthetic:

There are the risks of having a general anaesthetic such as allergic reactions, chest problems, for example a chest infection and the possibility of clots in the legs (deep vein thrombosis or DVT). A clot in the legs can move to lungs causing a pulmonary embolus which is a particularly serious complication. Underlying medical conditions e.g. asthma can be aggravated. In general if you are healthy modern anaesthetics are very safe. If you are concerned about your anaesthetic we can arrange for you to meet with an anaesthetist before your surgery for an assessment and a discussion.

Bleeding and haematoma:

During surgery great care is taken to stop bleeding. However after the end of the operation, particularly if the blood pressure is raised, a bleeding point may start bleeding again. This causes a build up of blood under the wound called a haematoma. Small haematomas usually are absorbed by the body over time. Larger haematomas may need to be removed with a further operation. Most people will then recover normally. It would be most exceptional to need a blood transfusion following a thigh lift.

Infection and slow wound healing:

With all surgery there is the potential for wound infection. Thigh reductions usually result in a T shaped scar at the top of the inside of the thigh. This area is particularly susceptible to infection and wound breakdowns. Most wound infections settle down with a short course of antibiotics. If a wound becomes badly infected the wound may open up and take time to heal up. It is common for the wound at the top of the thigh to be slow to heal and dressings are often required for several weeks until it is fully healed.

Seroma:

Seroma is a build up of tissue fluid in the wound. This causes swelling which may need to be drained but usually resolves on its own. Seromas are quite common following a thigh lift. Draining a seroma is usually a simple procedure in outpatients.

Scarring:

It is important to understand that scarring varies from one person to another. Some scars can be thin pale lines but this can never be guaranteed. Poor scars may stretch and be wide or become lumpy, hypertrophic or keloid. Keloid scars are lumpy and grow out from the incision that caused the original scar. Hypertrophic scars are more frequently seen than keloids. Hypertrophic scars become widened, thickened and red for a few months after surgery. They then settle down to a pale widened scar although this may take many months and even several years. Scars may be itchy and occasionally tender or painful.

Leg and ankle swelling:

Leg swelling is normal in the initial weeks following the surgery. This normally settles down over several weeks although can take longer. It would be unusual for swelling to become permanent or cause long term problems such as lymphoedeama. If you already suffer with leg and ankle swelling surgery is likely to make it worse and you may be better advised not to have the procedure.

Over or under correction:

The amount of fat to be removed with liposuction is a matter for clinical judgment. There is the possibility that too much fat is removed or that you feel not enough fat has been removed. It is generally better to remove too little rather than too much as it is easier to remove more later than to put fat back.

Liposuction: skin irregularities, skin laxity and skin excess:

When liposuction is used the end result for the overlying skin needs to be considered. The elasticity of the skin is very important in the end result from liposuction. If the skin has little elasticity it is more likely that the skin will show irregularities following liposuction. With larger amounts of fat removal there is the possibility that the skin will be loose and wrinkled following the procedure.

Lumpy tenderness:

Following liposuction the tissues under the skin tend to swell, may feel hard and be tender. This usually settles over a few weeks. In some people this may take longer but usually settles over a few months. Permanent lumpy tenderness is rare but possible.

Tenderness and pain:

Following surgery the inside of the thigh area will be painful and remain tender for several weeks. In some people the these symptoms may last several months. It is very unusual for symptoms to last longer than this or be permanent.

Residual laxity:

Following surgery the tissues swell and so the skin may be stretched a little. As the swelling goes down usually skin retracts. However there may be some residual laxity although usually there is a considerable improvement on the appearance before surgery.

Vulval gaping:

With removal of skin from the upper inner thigh and lifting of the skin it is possible to transfer tension to the labia major (outer lips) of the vulva. This causes the vulva to gape and it can be uncomfortable. The aim of the surgery is not to cause vulval gaping but you must understand that this can happen.

Deep vein thrombosis (DVT) and pulmonary embolus (PE):

Deep vein thrombosis is a blood clot forming in the veins, usually in a leg vein and a pulmonary embolus is where one of these clots breaks off and travels to the lungs. These are serious complications as a pulmonary embolus can be life threatening. This is a recognised complication of surgery. There are many factors that can increase the your risk such as a family history of clots, having previously had a clot yourself and various drugs and illnesses. Being over weight or obese, having an operation and being inactive are some of the most common factors that increase the risk of deep vein thrombosis (clots). For patients undergoing a thigh lift precautions are routinely employed to reduce the risk, although the risk can never be completely eliminated. You can help to protect yourself by getting up and walking around as soon as you can following your operation and continuing to take regular short walks during the early stages of your recovery.

What else should I consider?

There are no other special considerations.

What are the alternatives to surgery?

Do nothing

There is always the option to live with your current appearance and not have surgery. Suitable clothing will cover the thighs.

Lose weight

If you are overweight or obese then losing weight may be helpful in reducing excess fat in the thighs. An important consideration will be how well your skin retracts.

Liposuction

The main surgical alternative to a thigh reduction is liposuction. This can be very effective at reducing excess fat but does not remove skin. There may be some retraction of the skin but this is difficult to predict accurately prior to surgery.

Where can I get further information?

Speak to your General Practitioner:

Your General Practitioner has a broad knowledge of medicine. Your GP may recommend a surgeon or a hospital where they feel you will get good advice and treatment about surgery.

Outpatient consultation with a Consultant Plastic Surgeon:

An outpatient consultation with a Consultant Plastic Surgeon will enable you to discuss what result you would like to achieve. They will also be able to make recommendations as to how best to treat you and whether there are any special considerations for you.

Department of Health (England and Wales):

www.dh.gov.uk search under – Cosmetic surgery and non-surgical cosmetic treatments. Independent and objective advice on cosmetic surgery from the department of health.

British Association of Aesthetic Plastic Surgeons (BAAPS):

www.baaps.org.uk/ The association of British Plastic Surgeons with a particular interest in cosmetic surgery. Jeremy Hurren is a member of BAAPS.

British Association of Plastic Reconstructive and Aesthetic Plastic Surgeons (BAPRAS):

www.bapras.org.uk/ The association of British Plastic Surgeons. Jeremy Hurren is a member of BAPRAS. Formerly British Association of Plastic Surgeons (BAPS).

General Medical Council (GMC):

www.gmc-uk.org/ Tel: 0207 915 3630 The register of British registered doctors. Check whether a particular doctor is on the medical register as a specialist. Jeremy Hurren is on the GMC register (registration number 3243048) as a Specialist Plastic Surgeon.