Thank you for your question regarding loose skin above the knees. There are two primary surgical options that can help tighten this area and remove excess skin. The first option is a vertical medial knee reduction, which involves placing an incision along the inseam of your knee, similar to where the seam of a pair of jeans would be. This procedure removes an elliptical section of skin and fat, pulling the excess skin inward to tighten the knee area. The advantage of this procedure is that the scar is relatively well-hidden along the inside of the knee. However, only a limited amount of skin can be removed with this method, and since the incision crosses a natural crease, healing may be a bit slower. The second option is the horseshoe technique, where an incision is made around the upper knee, above the kneecap (patella), in a horseshoe shape. This method allows for a more substantial removal of excess skin and fat, providing a more dramatic result. However, the scar from this procedure is more visible than with the vertical medial knee reduction, so the decision largely depends on your preference for scar concealment versus more noticeable results. Both options can be effective in reducing loose skin around the knees, and the choice between them will depend on your aesthetic goals and how comfortable you are with the visibility of the resulting scar. I recommend consulting with an experienced board-certified plastic surgeon to help you decide which approach is best suited to your needs. Sincerely, Dr. Katzen