The concentric medial thigh lift.
Plastic surgeons often are asked to perform horizontal medial thigh lifts because the skin of this area has poor elasticity, inducing excess skin, and also because there is upper fat deposit. This excess skin and fat lead to irritation and even functional problems. But surgeons dislike this operation because of its justified bad reputation. Obviously, this area is difficult to manage because of the many possible side effects (e.g., healing difficulty, scar migration, necrosis, effusions, pain) and unreliable results. A new way of thinking is proposed to lighten this operation and make its more frequent use possible. This horizontal technique presents several innovating points: -A new incision line located along the labia major in the perineal crease remains at the same height backward. The incision never descends into the buttock fold. -No undermining whatsoever occurs even in the resection area. Liposuction is the key to avoidance of any undermining. It is performed everywhere in the thigh, but most importantly under the resection area where all the fat must be eliminated to lighten the flap and favor its lifting. -The resection removes only the skin layers (epidermis and dermis) and not the liposucted tissue, which is very thin. Consequently, all lymphatic and other vessels are preserved, and the healing process is much easier. Moreover, there is no dead space after ascension of the flap and no risk of effusion. -The resection is realized on demand, depending on the excess of skin brought on the incision line by each anchor suture. Therefore, any tension on the skin closure is avoided. -The direction of the skin stretching is concentric toward the labia minor. Consequently, the length of the scar is shortened at both the front and the rear. -Anchor sutures pull a nonundermined skin, thus drastically decreasing the risk of necrosis. In the past 2 years, 25 patients, most of them as outpatients, have undergone surgery using this technique, with a real improvement in the quality of the result, as compared with the results from the standard technique.