Is Thigh Lift Too Risky, Should I Just Be Happy? (photo)

Question

I lost over 200 lbs in the past yr w/the Gastric Sleeve. Had LBL 3 weeks ago, complications- internal bleeding, second surgery the same night to stop (terrifying- I have a young family) but recovering nicely since. As you can see my thighs are a big, pardon the pun, problem, lots of rashes and a real eye sore. My ins. is actually pretty flexible, they say nothing is off the table if it's medically necessary. I have until June (end of ins. fiscal yr) to decide. Two other prob areas-chest/arms

J. Timothy Katzen, MD, FACS · Answer

Congratulations on losing over 200 pounds in the past year with your gastric sleeve. This is a great accomplishment. I would not be too concerned with your complications of internal bleeding after your gastric sleeve. These are not predictive of your plastic surgery results. Gastric sleeve surgery and reconstructive plastic surgery after my massive weight loss are completely different types of surgeries. Based on your pictures, I would suggest a vertical medial thigh lift. Most reconstructive plastic surgeons specializing in massive weight loss patients would perform a medial thigh lift by performing liposuction either during the medial thigh lift or several months before the formal medial thigh lift. Typically, the incision extends from the groin to the knee. The excess skin and fat in the inner thigh is thus directly removed. The medial thigh lift with liposuction is preformed under general anesthesia and takes approximately 3 to 4 hours. Everyone has a different recovery rate, however, the recovery rate for most patients after a medial thigh lift is typically 3 to 4 weeks. Since your insurance is "pretty flexible", I would definitely try to use insurance. Insurance companies are becoming more strict on covering inner or medial thigh lifts. Some insurance companies categorically do not cover inner thigh lifts, no matter what the problem is and no matter how big the size of the thigh or leg. Consider yourself lucky. Congratulations again on your massive weight loss. Good luck with your reconstructive plastic surgery.The medial thigh lift is a very complex and difficult procedure. I would do your research and go to a board-certified reconstructive plastic surgeon specializing in massive weight loss patients. I would ask to see pictures. In addition, I would ask to see pictures of patients with legs similar to yours. I would seek a plastic surgeon who has performed at least 50 medial thigh lift procedures in massive weight loss patients. I would ask to see pictures of at least 40 medial thigh lift patients that your plastic surgeon has performed. Do not become someone to guinea pig.

Richard J. Bruneteau, MD · Answer

Patients who have had a major complication following massive weight loss surgery are often reluctant to have additional surgical procedures. This is often unfortunate because many of these patients will derive significant benefit from these procedures.In your particular case, it's unlikely that you will have another bleeding episode. Furthermore, the laxity of your thigh skin represents a significant problem for you. This procedure has the potential to significantly improve the quality of your life.The best way to handle the anxiety associated with your previous procedure is to be optimally prepared for the next one. Thigh lift surgery is one of the most extensive procedures performed in cosmetic surgery. For this reason, preparing for surgery in every possible way, will not only improve your result, but the quality of the experience as well. It's important to prepare physically, medically and mentally for this procedure.It's important to be in good physical condition before proceeding with this procedure. Ideally, results are best when patients are within ten percent of their ideal body weight. In some cases, patients are unable to reach this goal. This group still benefits from the procedure. In addition, it's also important to maintain good nutrition, exercise and maintain a healthy lift style.It's also important to be medically ready for thigh lift surgery. Patients should be extensively evaluated to rule out other medical conditions. Areas of particular concern include cigarette smoking, blood pressure management and the patient's baseline hemoglobin.Mental preparation for thigh lift surgery is also extremely important and helps lower anxiety levels before surgery. It's important that you have a comfort level with your anesthesiologist, surgeon and the surgical facility. It's essential that all your questions be answered so there are no surprises.Arrangements for post-operative care also need to be in order. It's important to have a care giver not only for yourself, but your children as well. Addressing as many of these issues as possible before surgery will significantly improve results and the quality of the experience.

Kenneth Hughes, MD · Answer

As long as nutrition is optimized and there are no abnormal clotting parameters, a thigh lift can certainly be considered. Find a plastic surgeon with ELITE credentials who performs thigh lifts on a regular basis. I perform these quite frequently on an outpatient basis and have not had any problems. Kenneth Hughes, MD Los Angeles, CA

Sanjay Lalla, MD, FACS · Answer

Hello. It is always prudent to be careful before undergoing surgery. However, this surgery should be fine if you did okay with a body lift. Make sure you check all of your bloodwork and get medically optimized before proceeding. Good luck

Steven Wallach, MD · Answer

Why did you bleed?  Was there an underlying medical condition?  If not, a thigh lift can be accomplished. Certainly you shoudl wait until you are completely healed from your lower body  lift.

Scott E. Kasden, MD, FACS · Answer

I think you are reasonable to give this a second thought, given your complication. 

	You must put things in perspective however.  A LBL is a huge operation, and carries risks, including bleeding.  The big question to ask is "why did you bleed?".  Did this just occur, or do you have some bleeding problem.  If the reason is the former, then you don't have any increased risk vs. the rest of the population, as long as you are healthy.  If you have a bleeding problem, address it with a hematologist, and evaluate your risks, and see what can be done to minimize them.

	My guess is that you will be fine to have the surgery, and you won't be happy until you get it done.  You should work with your doctor however.

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