Thigh Lift Scars: Vertical vs. Horizontal

Question

i had a liopscution in May and planning to do thigh lift as i have saggin in the inner thigh and little sagging from outer thigh. i heard is vertical scar is bad as it's get wide and it's visiable as the horizontal scar which will be in the bikini area so it's not visiable and usually its good scar. so what would you recommend ? and also am planning to do tatto on the scar. so how long i need to wait to get the tatto on the scar ?

Richard H. Tholen, MD, FACS · Answer

But if you must tattoo your scars, I would wait until the scars have fully matured and you and your doctor have decided that no touch-up or revisional surgery is recommended. A year (rarely more) may be necessary for maximum scar softening, settling, and fading (maturation).

	Vertical or horizontal incision choice depends on the distribution and degree of skin laxity. No one answer is "correct" for all patients, especially for those who have has massive weight loss and have lots of loose skin to tailor surgically.

	The vertical scar is not as bad as the wrinkled saggy skin, so I would disagree with my colleagues who would try to dissuade you from this scar (if you truly need it). The horizontal scar is not a "slam dunk" of scar perfection either, and needs careful technique with someone experienced in proper attachment of the thigh skin to Colles ligament and other support tissues, in order to minimize scar widening and migration down the inner thigh.

J. Timothy Katzen, MD, FACS · Answer

Hello, and thank you for your question regarding the differences between vertical and horizontal scars from a thigh lift.

When deciding between a vertical and horizontal thigh lift, it's essential to consider the extent of sagging skin you want to address and your comfort level with visible scars.

A vertical thigh lift involves an incision that runs down the inner thigh from the groin to the knee. This procedure is best suited for patients with significant skin laxity along the entire length of the thigh. However, as you mentioned, the vertical scar can be more visible, and there is a risk of the scar widening over time due to the tension on the incision.

On the other hand, a horizontal thigh lift focuses on tightening the skin in the upper inner thigh area, with the incision hidden in the groin crease or bikini line. This option may be preferable if your primary concern is the upper thigh, as the scar will be less visible when wearing swimwear or underwear. However, if you have more extensive sagging, a horizontal thigh lift alone may not provide the results you desire.

If you are concerned about the visibility of the vertical scar but need more extensive skin removal, some patients opt for a combination of both horizontal and vertical incisions to balance skin removal and scar visibility.

Regarding tattooing over the scar, I would recommend waiting until the scar is fully healed before proceeding. Scars can take up to two years to fully mature and heal, so patience is key. Tattooing too soon could interfere with the healing process and affect the appearance of both the scar and the tattoo.

Good luck with your decision, and I hope this helps to answer your question regarding thigh lift scars.

Sincerely,

J. Timothy Katzen, MD, FASMBS, FICS

Richard J. Bruneteau, MD · Answer

The
type of incision utilized when performing thigh lift surgery is entirely dependent
upon the patients anatomy and aesthetic goals.  When the deformity is relatively mild a horizontal incision
can be placed in the groin crease.  This incision is nicely hidden in this
location and usually provides a good aesthetic result.

When
the deformity is more significant and excess tissue is present in multiple
dimensions a more aggressive procedure is indicated.  This procedure will require excision of excess tissue in
both the vertical and horizontal planes. 
This usually involves extending the transverse incision along the inner
aspect of the thigh to level of the knee.

Both
of these incisions remove and tighten excess thigh skin and significantly
improve thigh contour.  They are
associated with high satisfaction rates amongst patients.  Unfortunately both horizontal and
vertical thigh lift incisions can be associated with unattractive scars.  For this reason, meticulous surgical
technique is necessary whenever performing this procedure.  Horizontal incisions can be easily
hidden by clothing along the groin crease, but in many cases there’s no way to
hide the vertical incision.

It’s
not unusual for patients to develop skin sag after aggressive liposuction.  Under these circumstances many patients
require some type of thigh lift procedure.  The exact procedure chosen is dependent upon the patient’s
anatomy.  In your case it’s hard to
make a determination without a physical examination or pictures that extend to
the knee level.  In addition,
tattoos can be utilized to hide scarring, but that should be delayed until
wound healing is complete.

If
you’re considering thigh lift surgery, consultation with a board certified
plastic surgeon is appropriate. This surgeon should be able to formulate an
appropriate treatment plan that addresses your concerns.

Larry S. Nichter, MD, MS, FACS · Answer

Different Plastic Surgeons with great experience and results often argue the answer to your question. The most important choice is finding the best surgeon (see below link). My choice as to whether a vertical scar is needed is on the basis of my exam and where the most excess skin is located. For example if a roll of skin high up on the inside of the thigh then a groin scar incision is preferred, where as if there is circumferential excess from the knee to the groin then a vertical incision is best in my hands

Marshall T. Partington, MD, FACS · Answer

In general I rely on horizontal incisions and I avoid vertical incisions when doing thigh lifts. This usually gives a better cosmetic outcome while adequately addressing loose skin.

Jeffrey E. Schreiber, MD, FACS · Answer

The vertical scar is longer and more noticeable than the medial thigh lift scar.  However, it's difficult to tell you without actually examining you what will give you the best result.

Vishnu Rumalla, MD · Answer

Without looking at a picture it is hard to say in your case. In general if you have laxity to the mid-thigh you will need a vertical component to your lift. I place this scar in the middle of the medial thigh and the scar does fade with time. You are trading a scar for contour. Good luck.

Thomas Fiala, MD, FACS, FRCSC · Answer

The vertical design thigh lift removes more skin, and gets more of a better improvement in the mid and lower thigh than the smaller horizontal design, but at the expense of a significantly longer scar.  It's more commonly needed in people that have had MWL (massive weight loss), or significant previous liposuction of the inner thigh.

	It's a trade-off of amount of improvement vs. amount of scar.

	 

	Hope that helps,

Joseph Michaels, MD · Answer

The type of incision will depend on the degree of laxity and how far this laxity extends down your thigh. Body contouring is really a trade off between skin and scar and you have to know in yourself what you will be able to tolerate. Horizontal scars are better hidden, but the tradeoff is that it really only corrects laxity in the superior portion of the thigh. Unfortunately it is not possible to get an adequate lift of the middle/lower thigh through this type of incision. Placing too much tension on a horizontal incision can lead to widening of the scar and distortion of the pubic region. Vertical scars can be well hidden on the inner thigh and often fade well. This is a more appropriate operation for patients with laxity of the middle and lower thighs. Regarding the tattoo, it takes the incisions/scars about one year to mature so I would wait at least that long before getting some new ink. Best of luck.

Otto Joseph Placik, MD · Answer

In reality, for major thigh laxity following major weight loss, both a vertical AND horizontal incision for removal of vertical and horizontal excess are useful for removal of thigh cutaneous redundancy in 3 dimensions. However, you are correct about the cosmetic appearance with many individuals reporting satisfaction with correction of skin ecess but dissatisfaction with the visibily of the scar. Therfore many patients chose a compromise with the length of the vertical component.

William Bruno, MD · Answer

There are two types of scars used for a thigh lift.  A horizontal scar placed in the groin crease is best for patients who have significant vertical laxity(loose skin which can easily be pulled upward).  A vertical incision along the inner aspect of the thigh from groin to knee is best used in you have significant horizontal skin laxity or looseness. The specific incision needs to be tailored to your specific anatomy.

	I would add that the scars can migrate or widen from their original position; something patients should be made aware of before their surgery.

	I recommend consulting with a board certified plastic surgeon who is experienced in this type of body contouring procedure.

	Best wishes,

	Dr. Bruno

Thigh Lift Scars: Vertical vs. Horizontal

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