This is a delicate and often unsatisfactory area of aesthetic surgery. The ¿a operation is requested by women over 50, and usually the patients expect too much. In horizontal and inguinal tightening of the thigh, the traction component is often so high that it later results in an unsightly scar, and after only a few months the inner side of the thigh develops creases. In the case of skin that has significant cellulite and slackness of the thighs as far as the knee area, it may be possible to carry out tightening in a vertical direction in a similar way to upper arm tightening, and this can be discussed with the patient. It should be made clear to the patient, however, that this may produce an unsightly scar.
The technique in an inner thigh lift is similar to that used with the upper arm, namely, a deep, subcutaneous dissection on the fascia and a step-by-step skin resection that has previously been drawn precisely. The crucial point when it comes to horizontal, inguinal thigh lifts is the strong traction forces. It is important in this operation that the thigh flaps are "hung" at two points in order to reduce the traction forces on the skin. First, this subcutaneous cutaneous/fatty flap is fixed to the periosteum of the pubic bone with a nylon suture. Laterally the inguinal ligament must be visualized. This is where the second anchorage takes place in order to prevent dehiscence and subsequent descent of the scar. Yet despite hanging at these two points, long-term results are often unsatisfactory. Patients should be told this when they are given information about the operation. Nevertheless. the distress of patients is often so great that they are prepared to put up with these disadvantages and therefore often still want the operation.
When tightening the inside of the thigh, after fixing the two anchoring sutures with the upper body slightly flexed, the excess cutaneous/fatty flap is resected without tension and without steps, so that after the operation a tension-free wound in the bikini area is produced, which must be treated appropriately postoperatively using ointments and silicone plasters. For an additional 3 weeks, antibiotic protection must also be given and the patients must wear a specially adapted girdle.
The same applies to the buttock lift. In this operation the problem is the incision line and the visible scar. With a buttock lift, the incision line should not be much beyond the buttock crease, since this scar is very unsightly. Similarly, the resection must be carried out in a wedge shape in the form of an equilateral triangle, so that the deepest point, the so-called zero point of the fascia corresponds exactly to the changed crease and the resulting suture lies in what will be the new buttock fold. Otherwise there is problematic scar formation that is very difficult to correct.
In general, one should not combine liposuction with lifting operations, since this may impair the healing process and increase the risk of thrombosis and embolism.
When the skin is still young and elastic, it is possible to remove smaller limited deposits of fat by means of isolated liposuction. If skin has lost its elasticity through aging or major weight loss, a lifting operation is recommended to achieve cosmetic improvements. Often, the loose skin on the inner side of the thigh is operated on together with the loose skin on the buttock, since this is a cosmetic unit. This operation, which is frequently requested, is also demonstrated in the video.
Generally, the operation is largely without complications. Nevertheless, there may be isolated cases of complications during or after the surgical intervention, despite taking the greatest care. More severe bleeding is stopped immediately during the operation. Pressure damage on nerves and soft tissues resulting from incorrect positioning should be avoided. These injuries recede, however, after a few days in most cases. This also applies to skin damage resulting from disinfectant.
After the operation there may be pain and tension that can sometimes last for a lengthy period. There is also sometimes swelling in the area of the joints, which may last for up to 6 months and can be treated easily by lymph drainage. The risk of thrombosis is extremely rare since blood-thinning measures are used, surgical stockings are worn, and there is early mobilization.
The main complication is permanent scar formation as a result of impaired wound healing. Occasionally, if there is a predisposition to this, thick, bulging, discolored, and painful scars are produced (scar proliferation; hypertrophic scars). With prompt treatment of the scar changes using injections of 40 mg triamcinolone, a corrective operation can be avoided.
1. Anterior superior iliac spine
2. Pubic bone
3. Hip bone
4. Long saphenous vein
5. Iliotibial tract
6. Femoral vein
7. Femoral artery
8. M.tensor fascia lata
9. Saphenous opening
10. Inguinal superficial lymph nodes
11. Inguinal ligament
1. Gluteal fascia 4. M.adductor magnus
3. Gluteal fold 6. M.semimembranosus
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