Lower Body Lift and Thighplasty Flashcards
the lower body lift does address the medial
thighs,
F a medial thighplasty is required to treat the thigh
deformity
The lower trunk and thighs can be dramatically improved by
combining a lower body lift (LBL) and thighplasty.
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medial thighs where a
vertical scar is necessary to correct the circumferential excess of skin
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Not every patient presenting after MWL needs an excisional procedure
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patients who have plateaued at a high BM! or require optimization of medical comorbidities may not be ready for major elective surgery.
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How you can assess the patient after MWL that he need excision or not
The Pittsburgh Rating Scale3 is a useful tool to grade a
patient’s deformities and can assist the surgeon with operative planning
low-grade deformities have excess adipose tissue
with adequate skin tone and may be treated with liposuction alone.
Patients with high-grade deformities require skin and subcutaneous
tissue resection with or without liposuction
Lockwood classification for MWL
(LBL #1)-a combination of abdominoplasty and medial thighplasty
(LBL #2)-a combination of high-lateraltension abdominoplasty, lateral thigh lift, and buttock lift.
LBL # 1 is
best suited for patients with minimal abdominal laxity
T is infrequently applied to the MWL population as many require a significant abdominal resection
The LBL #2 is applied for patients
with abdominal skin laxity, and this circumferential approach is the
most common and familiar variant in current practice
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Both variants
exert a significant upward lifting effect on the medial thighs
F Both variants
exert a significant upward lifting effect on the lateral thighs
patients with significant laxity of the medial thigh
skin will require a medial thighplasty procedure
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Complications of medial thigh lift
vulvar distortion due to scar migration and early
recurrence of ptosis
Lockwood wrote about anchoring
the SFS of the thigh to Colles fascia that thighplasty gained popularity
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Various incision patterns are described, for thigh lift
longitudinal medial incision, a longitudinal lateral incision, or a transverse incision in or near the groin
crease.
The transverse thigh lift is not the procedure of choice in MWL why?
because it can only treat the proximal third of the thigh deformity
transverse-only excisions have low
power to correct thigh deformities and the force of pull is not transmitted past the proximal third of the thigh
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The medial vertical thigh lift is
better suited for the MWL patient whose excess tissue can be treated
along the entire length of the thigh.
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Lateral vertical thigh excisions
are rarely used, but have a role in cases of severe deformities in which
both medial and lateral excisions may be of benefit
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An LBL generally needs a more inferior resection, and a belt lipectomy resection is located more superiorly, at the
level of the waistline.
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LBL enables more control thigh and buttock shape and is better for patients with andiod
F LBL enables more control oflateral thigh and buttock shape and is better for patients with a gynecoid
body type whose excess adiposity is in the hips and thighs
A belt lipectomy tends to emphasize waist shape, directly excising the central adiposity of the flanks and is
therefore well suited for the typical android body fat distribution
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Although
the higher incisions ofa belt lipectomy give the surgeon better control
over the contour of the waist and flank
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the lower incisions of the LBL
exert a more powerful and direct lifting effect of the lateral thighs for
gluteal autoaugmentation with autologous flaps.
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Patients almost never present requesting an LBL
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MWL patients
have a characteristic appearance of the buttocks, with loss of adiposity, decreased projection, and ptosis, in addition to lengthening of the
infragluteal fold
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Markings begin posteriorly by identifying the midline
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To preserve the sacral dimple, the scar should come together in
a “V” at the midline
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If
gluteal autoaugmentation is planned, the resection width is adjusted
to accommodate the anticipated additional volume
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The superior line-the stable anchor posteriorly
the inferior line is now the stable anchor anteriorly
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The marking is carried laterally over the thigh superior to the inguinal ligament to avoid disrupting lymphatic drainage
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The superior line anteriorly need not be drawn as it is determined intraoperatively
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Preservation of gluteal fat
pads to ensure adequate gluteal projection is vital to avoid flattening
of the buttock shape.
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THIGHPLASTY In the long scar version, the incision stays
medial to the patella before curving inferiorly in a lateral direction
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Combined with LBL, thighplasty completely reshapes the lower trunk
and thigh circumferentially.
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Most patients present in consultation requesting a solution to excess
skin in the medial upper thigh that causes chaffing, moisture buildup,
and difficulty fitting into clothes
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Often, vertical thigh lift is combined with liposuction of the medial thigh and medial knee to debulk tissue
F Often, a vertical thigh lift is combined with liposuction of the lateral thigh and medial knee to debulk tissue that is not treated by the excision
The first mark is made
4 cm away from the midline at the level of the mons pubis
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he incision should stay in or near the proximal
thigh crease to avoid scar migration and labial widening.
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The procedure begins with subcutanouse injection of a 1:100,000 epinephrine solution.
F The procedure begins with subdermal injection of a 1:100,000 epinephrine solution.
Dissection proceeds in a plan
immediately superficial to the muscular fascia toward the posterior
marking.
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Care must be taken during this step to avoid injury to the
the saphenous vein, which courses superficially, or lymphatic structures
of the groin
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The SFS of the thigh flap is secured to the Colles fascia using
2-0 absorbable suture to prevent labial distortion
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Resection site liposuction can be applied to thighplasty with comparable results.
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Resection site liposuction can be applied to thighplasty with comparable results.
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Common complications with truncal or extremity contouring procedures are usually minor and easily managed on an outpatient
basis.
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Recurrent skin laxity is a source ofdissatisfaction for the
patient and is an unpredictable complication
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Excision-Site Liposuction can lead to
over-resection
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Compression is maintained for 6 weeks in thinght plasty
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thighplasty is the one that is most likely to result in
recurrent skin laxity. Unfortunately, this is neither avoidable nor
predictable by the surgeon preoperatively
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