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Original Article | Open Access | Eur. J. Med. Health Sci., 6(3), 57-69 | doi: 10.34104/ejmhs.024.057069

Liposuction Assisted Medial Thighplasty: An Objective Assessment Using Thigh Circumference

Ahmed M. Gamal* Mail Img Orcid Img ,
Eduardo Matos Mail Img ,
Rui Medeiros Mail Img ,
Moustafa Elsonbaty Mail Img ,
Mohamed Makboul Mail Img ,
Wagdi M. Ali Mail Img

Abstract

Medial thighplasty is becoming more common among patients who have had massive weight loss (MWL). The excess skin on the inner thigh might create functionality, infection, and mental health difficulties. Popularity notwithstanding, the surgery has a high risk of complications. The purpose of this research was to determine the efficacy and safety of liposuction-assisted medial thighplasty by measuring the effect on thigh circumference in relation to fat aspirate volume and the breadth of the skin that was vertically removed. The Pittsburgh Rating Scale (PRS) was used for patient evaluation. A total of fourteen patients had liposuction-assisted medial thighplasty. Ten patients were categorized as having PRS grade II and four as having PRS grade III, and only those patients were considered for inclusion. The average patient was 48.42 years old, with 12 being female, and their mean body mass index (BMI) was 27.42 kg/m². Among the total complications, wound dehiscence accounted for 35.7% of 50%. Differences in upper (r=0.75, p=0.001) and middle (r=0.77, p=0.001) thigh circumferences were positively correlated with the quantity of lipoaspirate. A weak association was found between variations in upper, middle, and lower thigh circumferences and the breadth of skin that was vertically resected. Patient categorization according to their unique demands is of utmost significance, as is a thorough evaluation of patient wants and needs before medial thighplasty. The overall clinical results are improved by this personalized strategy, which guarantees the best selection of surgical procedures.

INTRODUCTION

Obesity has become more common among people of all ages and economic levels as a result of modern lifestyle changes and easy access to fast food. As a result, healthcare delivery systems are under a lot of pressure due to the obesity epidemic and its related comorbidities. However, there is a rising group of people who have successfully lost a lot of weight because of the advent of safe bariatric surgery met-hods and the increased public awareness of the dangers of obesity (Khan, 2021). The appearance of skin excess is a regrettable consequence of massive weight loss (MWL) that may affect peoples physical and mental health (Khan, 2021). Body contouring surgery (BCS) is a viable option for certain patients seeking reconstruction after experiencing dressing problems, poor cleanliness, dermatological disor-ders, hampered physical activity, and even challen-ges with sexual function (Wolfe et al., 2016). Patients often complain of sagging skin and extra fat in many parts of the body, including the breasts, thighs, arms, and abdominal wall (Eduardo MC, 2016). Plastic surgeons encounter a significant task in correcting the complex abnormalities that result from MWL. Particularly common among those looking for body shaping procedures are abnor-malities of the thigh contour, especially those affect-ting the medial thighs (Capella & Matarasso, 2016). Even though this is a common worry, some plastic surgeons are hesitant to do medial thigh lifts because they fear serious problems and less-than-ideal results (Capella & Matarasso, 2016). The inner thigh pre-sents special difficulties for surgeons due to its damp environment, which slows wound healing; the skins thinness and weakness, which increases the likely-hood of wound complications; and the areas close-ness to the anus and external genitalia, which incre-ases the chance of infection (Di Pietro et al., 2019). Some other things to think about are the risks of lymphedema due to the superficial nature of lymp-hatic vessels, lower limb edema from damage to the superficial venous system, and vulvar deformities and enlargements caused by scars, such as retraction and enlargement in the inguinal fold, which affect the labia majora (Di Pietro et al., 2019). In 2014, 17,109 thighplasty operations were done, marking a 491% rise since 1997 (Tasfap, 2012), according to statistics from the American Society for Aesthetic Plastic Surgery (ASAPS). Similar tendencies are seen in MWL patients who want cosmetic surgery after bariatric treatments; over 75% of females and 68% of males want interventions to shape their bodies (Kitzinger et al., 2012). Despite the growing demand, there is a lack of thorough data about the rates of complications and risk factors linked with thighplasty (Afshari et al., 2016). This research aims to fill that informational vacuum by providing results that will help surgeons and patients understand what to anticipate. Despite its effectiveness in treating abnormalities in the thigh area, there is surprisingly little evidence, especially in addressing medial thighplasty (MTP) (Mocquard et al., 2020; Biswas et al., 2021; Almomani M. and Almomani M., 2024).

Patients and methods 

The 14 participants in this prospective research took place between January 2018 and January 2023 at the North Lisbon University Hospital (Hospital de Santa Maria) in Portugal and the Assiut University Hospital in Egypt. Research on liposuction-assisted medial thighplasty, a surgical technique for correc-ting abnormalities in the shape of the thighs, was the primary aim of the present investigation. As shown in Table 1, the Pittsburgh Rating Scale (PRS) was used for patient evaluation. This scale is a rating system that was developed to determine three levels of abnormalities. The PRS classifies deformities into three degrees: the non-deflated type, marked by an excess of volume but no skin laxity; the mixed type, involving moderate excess of both skin and volume; and the deflated type, marked by minimal volume excess but considerable skin excess. Only indivi-duals with PRS grades II and III abnormalities were considered for inclusion in this research.

Table 1: Pittsburgh Rating Scale (Song et al., 2005).

Preoperative assessment 

A thorough preoperative evaluation was conducted on each patient before surgery. The pinch test was used to assess the amount of extra fat. Extreme care was taken to determine the location, direction (verti-cal, horizontal, or both), and degree of skin laxity. Since smoking might affect the results of surgery, patients who had smoked in the past were told to stop smoking at least three weeks before their planned operation. In order to determine each pati-ents unique goals and requirements for the proce-dure, extensive consultations were conducted. There were two main reasons given for seeking surgery: one, to make clothes fit better, and second, to make the thighs seem younger. Careful consideration of these aims was critical in deciding on the best surgical approach. The surgery and its possible effects were explained in great detail to the patients. Patients were clearly informed about the surgical procedure, its expected final scars, postoperative effects (e.g., ecchymosis and edema), recovery time (estimated) and potential complications (described in detail) in the informed consent form that they signed. All of the patients had their height, weight, and BMI taken. To ensure uniformity, the same surgeon consistently measured the patients thighs while they were upright before surgery. The upper and lower thigh circumferences were measured horizontally just beneath the inguinal crease and two centimetres above the upper patellar border respectively. The middle thigh circumference was measured at mid-point of vertical line extending from greater troche-nter down to lateral condyle of femur. Preoperative images were methodically captured from three different angles: anteroposterior, posteroanterior, and medial. An extensive visual record of the thigh contour before surgery was possible because of this systematic documenting procedure, which is useful for assessing the success of the operation. This systematic and exacting preoperative approach laid the groundwork for an in-depth examination of the results of liposuction-assisted medial thighplasty by guaranteeing a full comprehension of patient traits, objectives, and architectural factors. 

Surgical technique 

Marking and positioning 

The surgical marks were carefully made while the patients were standing. The location and orientation of the skin redundancy were used to decide the incision design strategically. Patients were instructed to adduct their thigh against resistance and a line was drawn from the proximal thigh following the palpa-ted adductor magnus muscle extending down to the medial epicondyle of femur to determine the vertical scar location. The standard practice was to end the vertical incision a finger or two finger breadths above the patellas top border. It was possible to designate the inguinal crease for the horizontal incision and, if needed, extend it to the cruro-gluteal sulcus. All patients underwent surgery under general anaesthesia. Intraoperatively, Patients assumed the frog leg position, which is defined as the following: hips abducted, knees bent at 90 degrees, and both feet facing each other while the procedure was being performed. In addition, all patients were given a urinary catheter, which was usually withdrawn 24 hours after surgery, in order to promote the best possible intraoperative circumstances (Fig. 1). For maximizing surgical accuracy and addressing indivi-dual differences in skin redundancy, this standar-dized approach to operational marks and patient positioning ensures a personalized and successful procedure.An incision that had been originally made at a straight angle was modified to be more obtuse and sloping. The goal of this change was to reduce the likelihood of wound complications in that particular region.

Fig. 1: Operative Markings with the patient in frog leg position.

The pinch test was used to identify the vertical and horizontal extents of skin to be excised, guaranteeing a precise and personalized approach.

Infiltration and liposuction

The subcutaneous layer inside the specified region of resection was injected with a tumescent solution. A 4 mm blunt-tip cannula was used for aggressive liposuction, which left a visible hollow in the middle of the thigh. It was the goal of the liposuction process, as determined by clinical judgment using methods like the rolling and pinch tests (Fig. 2), to completely remove the subcutaneous tissue. Subse-quently, the medial knee region and ventral and dorsal proximal thighs were all treated using stand-ard liposuction procedures. In order to get a more balanced result once the surgical incisions were closed, this typical liposuction step helped to smooth out the thigh shape and reduce bulging in the front.

Skin resection and closure 

The incisions were performed with great attention to detail, extending to the superficial fascial system. The skin island was then avulsed in a distal-to-proximal manner, as shown in Fig. 3, to avoid dam-aging the subcutaneous connective tissues, veins, nerves, and lymphatic branches in the thigh. Temp-orary wound closure was accomplished using stapler clips after full hemostasis. Sutures made of 2/0 polypropylene were used to attach the superficial fascial system to Colles fascia. The placement of a 16-gauge suction drain was deliberate. Two layers of deep dermal sutures (3/0 absorbable interrupted) and intradermal Monocryl sutures (3/0 running) were used to close the wound. Elastic bandages were then placed, starting at the foot and working their way up to the proximal thigh, after which adhesive strips and dressing were applied. The overall success of the liposuction-assisted medial thighplasty treatment was due in part to this meticulous and multi-step closure approach, which sought to assure optimum wound healing and reduce complications.Elastic bandages were then placed, starting at the foot and 

working their way up to the proximal thigh, after which adhesive strips and dressing were applied. The overall success of the liposuction-assisted medial thighplasty treatment was due in part to this meti-culous and multi-step closure approach, which sought to assure optimum wound healing and reduce complications.

Fig. 2: Pinch test to ensure thorough evacuation after aggressive liposuction (Note the marked thinning of the area to be resected).                                                                             

Fig. 3: Skin avulsion at the level of superficial fascial system from distal to proximal (Note the long saphenous vein preserved).

Postoperative care

Prophylaxis against thrombosis was started by adm-inistering subcutaneously enoxaparin sodium (Low-molecular-weight heparin LMWH) for 7 days to all patients, and they were all given a thorough broad-spectrum antibacterial treatment. Leg wrapping and early mobilization were part of the protocol, which also stressed the need to keep the hips in an abducted position to avoid friction. It was recommended that patients wear compression garments continuously for at least three weeks, both at night and throughout the day. After the first fifteen days of scheduling regular follow-up sessions every five days to track drug replacement, the plan was changed to weekly check-ups for the first month.

Fig. 4: Measurement of the maximum width of vertically resected skin.

The amount of fat aspirate and the maximum width of vertically resected skin were measured to be analyzed in relation to postoperative differences in thigh circumference (Fig. 4). The goal of this all-encompassing plan for postoperative care after lipo-suction-assisted medial thighplasty was to hasten healing and reduce the likelihood of problems. Fig. 5 shows the postoperative final scar one month after surgery.

Fig. 5: Postoperative final scar.

Postoperative assessment 

The evaluation process was thorough, including questions about patient satisfaction, measuring the variations in thigh circumference objectively, look-ing for correlations with fat aspirate volume and maximum breadth of vertically resected skin, and evaluating any issues that may have occurred. The results of the operation were evaluated by admin-istering a direct questionnaire to each patient, who was asked to rate their level of satisfaction with the results as outstanding, good, fair, or bad. The clear-ance of postoperative edema was confirmed three months after surgery by taking objective measures of the upper, middle, and lower thigh circumferences. In order to determine the changes, these measure-ments were compared to the values that were recorded before the operation. Complication evalu-ation was performed at various intervals. Within the first two weeks after surgery, surgeons looked for signs of seroma, hematoma, wound dehiscence, infection, skin necrosis, and thromboembolism. When evaluated three months later, late problems included lymphedema, asymmetry, recurrent ptosis, hypertrophic scarring, scar migration and labial spreading. 

Statistical analysis 

The statistical package used for data collection and analysis was SPSS (Statistical Package for the Social Sciences, version 20, IBM, Armonk, New York). The normality of the data was checked using the Shapiro test. The mean ± standard deviation (SD) is used to show quantitative data that follows a normal distri-bution. The Student t test was used for comparison. A Pearson correlation was used to ascertain the relationship between lipoaspirate and resected skin with respect to the mean difference in thigh circum-ference. A statistically significant result was deter-mined when the confidence level was maintained at 95%, which is less than 0.05. The statistical app-roach used in this study was quite rigorous, which allowed for a thorough examination of the data gathered from medial thighplasty surgeries that included liposuction. 

RESULTS

The research results indicated that the average age of the fourteen patients who underwent medial thigh-plasty with liposuction was 48.42 years. The average body mass index (BMI) of these patients was 27.42 kg/m2, and 12 of them were female. It should be noted that a considerable majority of the patients, making up 85.7% (12/14), had previously procedures to alter their body shape, with 64.2% of those procedures being abdominoplasty. One patient had brachioplasty with liposuction-assisted medial thigh-plasty done simultaneously (Table 2). A total of 10 patients out of 14 were found to have undergone MWL. There was one person who lost weight by changing their diet alone and nine others who underwent bariatric surgery. The majority of patients surveyed reported high levels of satisfaction with the results. In Table 3, we can see that out of the ten patients who had liposuction-assisted medial thigh-plasty, two were very satisfied, seven were satisfied, four were neutral, and a single patient was dis-appointed (Table 3). A typical liposuction-assisted medial thighplasty operation took an average of 125.79 minutes, and patients typically stayed in the hospital for an average of 1.74 days after the treatment, according to the studys results.

Table 2: Characteristics of studied patients.

Data expressed as frequency (percentage) mean (SD). MWL: Massive Weight Loss.

Table 3: Patient satisfaction.

Notably, according to Table 4, the average volume of lipoaspirate retrieved from both thighs was 989.28 cc, with a range of 200 to 2100 cc. The findings include important information about the procedure, such as how long the operation took, how long the patient had to remain in the hospital, and how much lipoaspirate was taken from the thighs.

Table 4: Amount of lipoaspirate, duration of procedure and length of hospital stay.

Data expressed as mean (SD) 

The results showed that the average width of verti-cally resected skin was 13.29 cm, with a range of 11 to 16 cm (Table 5). Regarding the incision design, 

an inverted L-shaped incision was performed on 64.3% of the patients. Table 5 and Fig. 6 show that 21.4% of instances had a T-shaped incision, whereas 14.3% had an incision that was vertical only. 

Table 5: Width of vertically resected skin and incision pattern.

Data expressed as mean (SD), frequency (percentage).

Fig. 6: Incision pattern.

Frequency of complications 

The research found that seven patients, or 50% of the total, had problems after liposuction-assisted medial thighplasty. Table 6 and Fig. 7 shows that the most prevalent complication was wound dehi-scence, which occurred in 35.7% of cases. Hyper-trophic scar formation followed at 21.4%, seroma at 14.3%, recurrent ptosis at 7.1%, wound infection at 7.1%, and scar migration at 7.1%. A throm-boembolism, hematoma, asymmetry, skin necrosis, or lymphedema did not occur in a single patient.

Table 6: Frequency of complications.

Data expressed as frequency (percentage)

Fig. 7: Frequency of complications among liposuction-assisted medial thigh lift patients.

Mean differences in thigh circumference

Results showed that the average variations in upper, middle, and lower thigh circumferences were 3.57 ± 1.50, 4.42 ± 1.89, and 2.50 ± 1.17 cm, respectively (Table 7 & Fig. 8). A quantitative understanding of the postoperative changes in thigh dimensions after liposuction-assisted medial thighplasty may be gai-ned from these measures. 

Table 7: Mean differences in thigh circumference.

Data expressed as mean (SD)

Fig. 8: Mean differences in thigh circumference among studied patients.

Correlation between the amount of lipoaspirate and mean difference in thigh circumference 

A significant positive link between the quantity of lipoaspirate and the mean differences in both upper (r= 0.75, p= 0.001) and middle (r= 0.77, p= 0.001) thigh circumferences was shown by the study results (Fig. 9 and Fig. 10). Table 8 shows that there was a weak positive connection (r=0.12, p=0.68) between the quantity of lipoaspirate and the mean change in lower thigh circumference. 

Table 8: Correlation between the amount of lipoaspirate and mean differences in thigh circumference.

Data expressed as r value (p value). P value was significant if < 0.05

Fig. 9: Correlation between lipoaspirate and mean difference in upper thigh circumference.

Correlation between width of resected skin and mean differences in thigh circumference

According to Table 9, there were no statistically significant relationships between the breadth of the 

removed skin and the average differences in upper, middle, and lower thigh circumferences (r= 0.30, p= 0.29, r= 0.21, p= 0.45, and r= 0.10, p= 0.73 respectively).

Fig. 10: Correlation between lipoaspirate and mean difference in middle thigh circumference.

Table 9: Correlation between width of resected skin and mean differences in thigh circumference.

Data expressed as r value (p value). P value was significant if < 0.05

Association between preoperative BMI and occ-urrence of complications (n= 14)

There was no significant difference in the baseline preoperative BMI between patients who had issues after surgery and those who did not, according to the study (27.40 ± 4.15 vs. 27.85 ± 2.51 kg/m2; p= 0.77), as shown in Table 10. This finding implies that the presence of problems after liposuction-assisted medial thighplasty was not exclusively predicted by baseline BMI. Investigating this corre-lation may shed light on the variables that may affect surgical complications and outcomes in connection to patients baseline body mass index.

Table 10: Complications and preoperative BMI.

Data expressed as mean (SD). P value was significant if < 0.05

Case presentation

Fig. 11: A 42-year-old woman who underwent sleeve gastrectomy and lost about 50 kg presented with grade II PRS medial thigh deformity and underwent inverted L-shaped liposuction-assisted medial thighplasty.

A&B: preoperative                        A: anteroposterior view.       B: posteroanterior view.

C&D: 3 months postoperative       C:  anteroposterior view.      D: posteroanterior view.

Fig. 12: A 52-year-old woman who underwent sleeve gastrectomy and lost 65 kg presented with grade II PRS medial thigh deformity and underwent inverted L-shaped liposuction-assisted medial thighplasty

A&B: preoperative                        A: anteroposterior view.       B: posteroanterior view.

C&D: 3months postoperative       C: anteroposterior view.       D: posteroanterior view.

Fig. 13: A 21-year-old woman who underwent one anastomosis gastric bypass and lost 62 kg presented with grade III PRS medial thigh deformity and underwent inverted L-shaped liposuction assisted medial thighplasty.

A: preoperative anterior view.

B: postoperative anterior view (Note the scar migration developed in the upper left thigh).

DISCUSSION

The Pittsburgh Rating Scale (PRS) classifies abnor-malities into three degrees: non-deflated, mixed, and deflated forms; thigh lift treatments are essential for removing extra skin after major weight reduction. Patients with PRS grades II and III, namely those with moderate to severe extra skin, were the primary focus of this investigation.Complications like as vulvar distortion, vascular difficulties, lymphatic abnormalities, and early ptosis recurrence have led to several revisions to the medial thigh lift, which Lewis first proposed more than 60 years ago. Lockwood devised the method of superficial fascial suspension, which is especially useful in horizontal surgeries, to alleviate these difficulties (Labardi et al., 2012). Our studys participants averaged 48.42 years of age, with 12 of the 14 participants being female and a mean BMI of 27.42 kg/m2. At 84.7%, abdominoplasty was the most prevalent procedure. Notably, nine of the total 14 patients were post-bariatric, demonstrating how often there were cases of substantial weight loss.The results demonstrated a spectrum of patient satisfaction levels, ranging from very delighted to extremely unhappy. After surgery, measuring the circumference of the thighs was more strongly correlated with lipoaspirate volume than with the width of the skin that was removed, indicating that this variable should be included in the development of future objective assessments.Among the patients who had complications, wound dehi-scence was the underlying cause in 35.7% of those cases. Beyond conventional liposuction and into more complex procedures like modified stages, medial thigh lifts can be useful comparisons for future studies.An extensive study conducted by our team assessed the outcomes of liposuction assisted medial thigh lift procedures via a combination of methods. Fundamental components of our assess-ment were patient satisfaction, objective measures of postoperative thigh circumference changes, and their relationship with the quantity of fat aspirate and breadth of vertically resected skin. The results provide light on the challenges of reaching the best possible results for this group of patients.The results showed a wide range of replies when we asked participants about their level of satisfaction with the outcomes; half were somewhat satisfied, four were fair or mildly satisfied, two were very satisfied, and one was dissatisfied. The wide variety of answers highlights how individual patients experiences after medial thigh lifts are.

Our investigation into the quantitative components of the outcomes was made possible by objectively assessing the variations in postoperative thigh cir-cumference. The quantity of lipoaspirate was signifi-cantly correlated with the postoperative difference in thigh circumference (r=0.77, p value= 0.001). Un-expectedly, there was a much lesser connection (r=0.21, p=0.45) with the quantity of skin that was removed. This fascinating discovery implies that the skins elastic characteristics were vital and that skin resections mostly affected the skins appearance, fixing problems with folding and abnormalities rather than significantly reducing size.The findings may be better understood in the light of a 2011 prospective research by Modolin MLA et al. who measured thigh volumes both before and after thigh-plasty. Despite the fact that this research proved a geometric decrease in thigh volume after medial and lateral thigh lift procedures, it failed to examine the precise correlation between size reduction and the quantity of fat aspirate or skin removed (Modolin et al., 2011). In this comprehensive study, we carefully evaluated the rates of complications related to medial thigh lift surgeries, with the goal of providing useful information about the difficulties and differences in results in this particular surgical setting. The total complication rate that our research found was 50%, which is in line with the typical range that has been seen in similar studies.The majority of our patients (35.7%) had wound dehiscence, which was carefully controlled since its severity did not need any further procedures. Wound dehiscence was one of 39.6% of complications found in a 2014 retrospective case study by (Bertheuil et al., 2014). An important takeaway from medial thigh lift procedures is the high rate of wound dehiscence. Hypertrophic scarring affected 21.4% of patients, making it the second most prevalent result, contrary to the trend in comparable studies. While seroma is more common, hypertrophic scarring is a real concern in postopera-tive treatment for medial thigh lift procedures and further highlights their complexity. The removal of proximal right-angled cuts was a clever adjustment to our method, especially at the intersection of the L-shaped patterns horizontal and vertical incisions. This alteration was spurred by the increased risk of local wound dehiscence owing to the moist environ-ment and the fact that movement in this region is inevitable. This, in turn, might induce skin necrosis at the margins. Georg and colleagues, (2016) studied 30 people to determine the efficacy of medial thigh lifts with liposuction. With a total complication rate of 36%, the group who had liposuction in addition to excision did not have an increase in wound dehiscence or wound infection. Georg et al. demon-strated that liposuction significantly improved limb size/ circumference reduction, patient happiness, and esthetic results. The inability to explicitly evaluate objective criteria was a consequence of their study being retroactive (Schmidt et al., 2016). This data contradicts the results of Gusenoff et al. (2015), who found that liposuction-assisted thighplasty was related to a higher risk of infection (68%, 72 out of 106 patients). A full-length vertical incision was linked to the largest number of problems, with wound dehiscence being the most common (Gusenoff et al., 2015). Sisti et al. (2015) used the phrases "medial thighplasty," "medial thigh lifting," and "technique" in their review research. According to a systematic review of sixteen papers published between 1988 and 2015, the most common postoperative complications after medial thigh lift procedures were wound dehiscence and seroma(Sisti et al., 2015). Previous studies had shown that a higher body mass index (BMI) before surgery had a negative effect on postoperative outcomes; however, this study revealed no such correlation. This finding contradicts earlier claims by showing how multi-faceted the causes of postoperative problems are. Patients with a higher body mass index (BMI) before surgery and a substantial reduction in weight were more likely to have medial thighplasty complications (Bertheuil et al., 2015).

Pavan et al. (2017) presented new parameters that may predict surgical complications and patient out-comes. Patients postoperative care needs are affect-ted by a variety of factors, including cosmetic treat-ments, weight reduction strategies, and the existence or absence of prior excisional surgeries (e.g., Bra-chioplasty, abdominoplasty, or mastopexy) (Pavan et al., 2017). Researching the superficial lymphatic networks, great saphenous vein branches, and the intricacies of medial thigh lift surgery requires cau-tion. Tourani et al. (2014) evaluated lymphoscinti-graphy and found that thigh lifts change lymphatic outflow from the lower extremities. Recurring lymphomas need surgical removal and percutaneous draining, according to (Tourani et al., 2014). Addi-tionally, Tourani et al. (2014) examined the super-ficial lymphatics of the lower leg in great detail, focusing on the superficial collectors of the ventromedial bundle at the level of the superficial fascia and below it. Tourani et al. (2014) suggested a careful method that involves aggressive liposuction followed by skin excision to preserve lymphatic fun-ction after medial thigh lifts (Tourani et al., 2014). Similarly, in 2015, Bertheuil et al. questioned whether liposuction during a medial thigh lift may alleviate persistent edema while protecting the con-nective tissue-containing vascular and lymphatic network (Bertheuil et al., 2015). In 2016, Eduardo and colleagues conducted research on seven patients who had a medial thigh lift with liposuction assis-tance. They found that wound healing issues impro-ved, and the seroma rate was almost nonexistent. The wound healing issues were common, but each one was little and easily addressed with caution (Eduardo MC, 2016).

However, the inherent drawbacks to our study should not be disregarded. One fundamental downside is that it cant be compared to the modified phases medial thigh lift approach. We cant get a whole picture of the outcomes and relative merits of the two approaches without comparing them. Incor-porating such comparative assessments into future research initiatives could help to provide a more balanced perspective of the advantages and disadv-antages of different surgical methods. Another limitation of our study is that it only included tradi-tional liposuction techniques. The potential for improved skin redraping prompted discussions about including third-generation ultrasound-assisted lipo-suction techniques in future studies. This is based on the well-documented benefits of ultra-sound-assisted liposuction, which extend beyond just eliminating fat. Improved skin retraction and less blood loss during liposuction were the results of randomized controlled trials (Nagy & Vanek Jr, 2012) this demonstrates that our previously described surgical procedure, when combined with ultrasound assisted liposuction, has a strong possibility of being success-ful.

CONCLUSION

To conclude, the medial thigh lift is quite popular, especially among post-bariatric patients who are dealing with functional impairment, frequent skin infections, and emotional anguish due to extra skin on the inner thighs. There is a significant rate of postoperative problems connected with the surgery despite its broad usage. The intricate nature of the elements at play is shown by our results, which highlight how difficult it is to forecast patient outcomes and the development of surgical compli-cations. It is critical to take into account a whole range of factors impacting postoperative outcomes rather than relying on a single-parameter approach. Every patients wants and requirements should be carefully considered before surgery. Our suggested categorization into two groups - those hoping to increase their aesthetics and wardrobe freedomand those looking to improve their skin condition, phy-sical dynamics and cleanliness via surgery- offers auseful foundation. When it comes to the former, one important factor to consider is the quantity of fat that is aspirated, which is directly related to the priority of reducing size via comprehensive liposuction. The second group, on the other hand, has their skin looked better and unsightly folds removed by exci-sional operations. In order to choose the best surgical method, this patient centred categorization comes before the clinical evaluation of abnormalities. Overall, our findings highlight the need for careful and individual consideration when making decisions on medial thigh lift surgeries. The goal is to improve the cosmetic and functional results of this surgical procedure by tailoring treatments to each patients demands and traits.

ACKNOWLEDGEMENT

I express my deepest gratitude to the Assiut University.

CONFLICTS OF INTEREST

Authors do not have any conflicts of interest.

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Article Info:

Academic Editor 

Md. Ekhlas Uddin Dipu, Department of Biochemistry and Molecular Biology Gono Bishwabidalay, Dhaka, Bangladesh.

Received

March 20, 2024

Accepted

April 26, 2024

Published

May 4, 2024

Article DOI: 10.34104/ejmhs.024.057069

Corresponding author

Cite this article

Gamal AM, Matos E, Medeiros R, Elsonbaty M, Makboul M, and Wagdi Ali WM. (2024). Liposuction assisted medial thighplasty: an objective assessment using thigh circumference. Eur. J. Med. Health Sci., 6(3), 57-69. https://doi.org/10.34104/ejmhs.024.057069  

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