Latest / Alabama The Beautiful: The Eastern Shore Cosmetic Surgery Podcast / How to Get Rid of Loose Thigh Skin After Weight Loss
Transcript
- Announcer (00:02): You're listening to Alabama the Beautiful. Kirstin (00:05): I'm Kirstin and I'm here with Alabama Cosmetic Surgeons, Dr. James Koehler and Dr. Vincent Gardner. Hey, Dr. Gardner. Dr. Gardner (00:12): Hey, how are you? Kirstin (00:13): Good. You want to know what we're talking about today? Dr. Gardner (00:16): Hit me with it. Kirstin (00:17): Okay. We are talking about the thigh lift, the procedure that nobody warned you about in a good way. I feel like that's your specialty lately. You've done a few of them here at the office in the past couple weeks. Paint me a picture of the person sitting across from you asking about a thigh lift. What's their story? Why are they here? What brought them to you? Dr. Gardner (00:39): I would argue that the majority of patients that are seeking a thigh lift have lost a significant amount of weight. Now, whether that's they've had a gastric bypass, gastric sleeve, they've done it on their own, they're Ozempic, tirzepatide. Doesn't matter. If they've lost a significant amount of weight, then a lot of times they're interested in a thigh lift. And the way you can tell is they look in the mirror and they grab the top of their thighs and they pull up. And they say, "Oh gosh, look at my thighs before, and then now look when I pull up." That's the patient population that typically wants it. Now, we do see people that for whatever reason just have bigger thighs and sometimes they want a thigh lift as well. And there's really kind of two categories in my mind. There's the patient that would benefit from mainly upper medial, but you're still going to end up extending that incision down to the knee just because of the amount of skin that they're going to have removed. (01:44): But it depends on where people carry their weight. And a lot of people, when they lose a significant amount of weight, their legs actually look pretty good except for that upper medial thigh. And then there's others that carry their weight in their thighs and they lose quite a bit of weight, but their thighs are still bulky. They still have a lot of fat in their thighs. So those are my two main categories. Kirstin (02:09): Okay. So let's talk about reality and what this surgery actually involves because there's more than one kind of thigh lift and the incision placement kind of changes everything. So walk us through how you decide which one a patient needs. Dr. Gardner (02:26): Well, almost always, not always, but almost always they're going to need what I call a medial thigh lift, which is typically an incision from the groin all the way down to the knee. Sometimes it extends below the knee, depending on how much skin they have. A lot of times you're going to take out quite a bit of skin. And if you do, you're going to have some redundancy left in the groin. So you're either going to extend that up into the groin crease anteriorly or posteriorly into the buttock crease, or sometimes both, where you end up with a T junction where you've got an incision going anterior and one posterior. And what that allows you to do is to pull that skin up and in at the very top. And so it keeps them from getting that redundancy in that location. Now, you can do that in men with impunity. (03:19): With women, you have to be careful because there is a dreaded complication called vaginal gaping. And what that means is if you take too much skin in that crease, in the groin crease, what happens is, is that if you don't anchor it correctly, either to the tendon or to the bone, when they spread their legs, it actually pulls the vagina open. And it's a terrible complication. It's really hard to fix. And so the best way to fix it is to avoid it altogether. And the way you do that is taking the majority of the skin out in that vertical plane, meaning this direction, and taking a small amount in the groin. Kirstin (04:02): Well, it sounds like with this procedure, you're going to have large scars or long scars. Is there something that you do to actively manage that scarring or is that kind of up to the patient? Dr. Gardner (04:14): So I will tell you, in my experience and in the literature, the places that scar poorly are the arm and you see how thin my skin is there. Whereas if you go to this side of my arm, the skin is very thick. And why is that? Well, because the skin on the inside of the arm, just like on the inside of the thigh is very thin because it's typically not under a lot of tension. Whereas the skin on the outside of the thigh or the back of the arm is very thick because the dermis provides a lot of support because those are areas of your body that there's a lot of tension. And so it has to do with the urinatomy. And the problem is, is that when you have very thin dermis, when you have an incision there, what happens is, and it's my understanding and the way I perceive it is that when you have an incision that's on tension, then what happens is your body is going to lay down more collagen to try to shore up that area under tension. (05:17): And so you tend to get a thick scar, but it also, that tension tends to widen the scar. So you get a thick wide scar and arms and thighs notoriously can scar poorly, not all the time, but they can. And so I would argue that the best way to try to prevent that is to eliminate the tension. And you do that with taping and why taping? Taping, when you pull those edges together, you apply tape along the incision. And what happens is you're basically, if you've got a four inch piece of tape over that incision, you're spreading the tension of that line, that incision line over that four inches. And so by spreading out the tension, you're going to take the tension off the incision, you're going to end up with a much better scar. So you combine that with the number two. It's the one, two punch, the taping and the compression. (06:10): And what does compression do? Well, compression helps prevent swelling. And if you can keep swelling at bay, now you're not going to eliminate swelling, but if you can minimize the swelling and keep the incision off tension by ... Because what happens when it swells? It swells, it pulls on the incision. So minimize tension by preventing swelling and taping, and I think you're going to get a much better scar. And I would do that for six to eight weeks as a minimum. And I tell patients, if you really want to try to improve it, then do it longer. But six to eight weeks is a long time, especially in the summer. But we use compression and we use fitted compression for arms and for thighs in the office. And then I love MeFix tape and I don't make anything from them. I just think it's a good product. It does have a little stretch to it, plus it's porous. So if they ooze a little bit, they can ooze through the tape and it's not going to cause any problems. Kirstin (07:09): Okay. One last question about this part, the cellulite question. Does a thigh lift address cellulite? Dr. Gardner (07:17): No. Well, I shouldn't say completely no. Cellulite happens for a couple different reasons. One, it has to do with the bands. There are these fibrous bands that connect the soft tissue to the skin. And what happens is you have these bands and they go up to the dermis and you'll have a long band and then you'll have a short band and you'll have a long band and a short band. And so you can get this undulating or these little divots that are caused by these bands. And so what happens is in women, and it's only in women because men don't have those, the bands are all the same length. And so men typically do not have cellulite. Now I'm not saying there's not a case where you could find a man that has some cellulite, but it's not typical. Men typically don't have that. And so a thigh lift is not going to solve that problem, but it will tighten the skin. And by pulling the skin tight, I would say you can improve the cellulite, but you're not going to get rid of it because you're not addressing that as a primary problem. Kirstin (08:22): I have literally never thought about the fact that men don't get cellulite. Yeah. That's unfair. Dr. Gardner (08:28): Well, it's just Dr. Koehler (08:30): Yep, life's not fair. Dr. Gardner (08:30): It's the burden that we live with. Kirstin (08:32): Oh, we. Dr. Gardner (08:34): Yeah. Kirstin (08:35): Okay. How about recovery? How does thighlift recovery compare to other body, well, you kind of touched on this with the thin skin and having to do some extra things to help with scarring, but as far as being kind of down for a couple weeks, is recovery comparable to other surgeries? Dr. Gardner (08:52): So typically after surgery, we say walk, walk, walk, right? You want to walk. And why do you want to walk? You want to walk because you're pumping that calf muscle and every time you just take a step, you're pumping that calf muscle, which is actively pumping the blood back to the heart. It's preventing blood from pooling. And we know that when blood pools, it clots. And so we can actively prevent blood clots by ambulation, just walking around your house, and it helps prevent pneumonia because when you're up, you're standing, you're expanding your lungs, and you're going to take deeper breaths. So we like it for those two reasons. The problem though, if you're too active, I think you're going to have issues with swelling, especially if you're not in good compression. And when I say good compression, we use a 20 to 30 graded compression, meaning that it's tightest at the ankle and less tight as it comes up the leg. (09:44): And I've been treating veins for years, and so it's something that we do every day, all day long. And so wearing good graded, meaning measured and fitted hose is going to really help with that. So yeah, that's what I would do. And as far as recovery, I don't like people to move a lot because they can swell more and swelling again delays recovery. And so think about it this way. When we talk about swelling, say you have a gymnasium and I ask you to run from one side to the other. That's easy to do, right? Now, if I fill up the gymnasium with four feet of water and I tell you to run from one side to the other, it's going to take you a lot longer to get to the other side. And so that's what- Kirstin (10:24): I don't know if I could make it to the other side, honestly. Dr. Gardner (10:27): Well, that's what swelling does. It doesn't matter where the swelling is. Swelling basically renders the normal function, meaning white cells can't get to where they need to, red cells can't get to where they need to, antibiotics can't get to where they need to, macrophages. There's all of these functions that we have. And if you have swelling, all those processes are not going to function correctly. And so the wound healing process is delayed with swelling. And so if we can eliminate or get rid of swelling or keep it at bay, you're going to heal up faster. So I don't like a lot of movement afterwards. And it's not that I don't like movement, but I want you to take it easy for a couple of weeks. Kirstin (11:06): So if you combine a thigh lift with another modality like Renuvion, does that ever change recovery? Does it improve at all? Dr. Gardner (11:15): And you're talking about Renuvion on the thighs? Kirstin (11:17): Yes. Dr. Gardner (11:18): Yeah. So I don't typically do that. And the reason is, is that I used to mess an anesthesia where I'm going to remove the skin because I'm going to lipo that area. So wherever I mark, I'm going to liposuction that area and I'm going to eliminate all the fat, and then I'm going to pull those edges together and cut out the skin in between. And we do that for a couple of reasons. One, we liposuction because we're trying to maintain as many of the vascular structures as we can, small arterials, veins or venules and lymphatics. And if we can just take the skin off and leave as many of those structures, then I would argue you're going to heal better and hopefully if you can maintain those structures, you're going to heal faster. So I don't like to do ... Because to do Renuvion, you have to add a lot of temescent anesthesia because you want to minimize the risk of burns and pain. (12:14): And so you have to expand the leg with that tumescent anesthesia. So what does that mean? If you blow the leg up and you liposuction it, you're not going to liposuction out all of the fluid, which means that when you try to pull those edges together, it's under a lot of tension. And one, it's harder to pull it together. And so I don't like to do that because I think that I pull it pretty tight anyways, and if I fill it up with fluid, I just don't feel like I can pull it as tight as I would normally like to. So I typically don't do circumferential thigh liposuction and a thigh lift at the same time. Kirstin (12:50): Is there a legitimate way to achieve thigh lift-like results without surgery? Dr. Gardner (12:57): No, not in my opinion. It depends though. I mean, what I'm saying by that is if you have a significant amount of skin, you can heat it up, right? There's three ways to tighten skin. You can heat it up, right? Renuvion, body tight, those modalities. You can cut it out or you can blow it up, meaning you can add volume like we do with breast. So how do you tighten up a breast? You cut out skin or you add volume with an implant or you try to heat it up and shrink the skin. And so yeah, I don't think you can do a whole lot with that. Kirstin (13:34): Okay. Are there any misconceptions about thighlifts that you wish you could correct? Dr. Gardner (13:40): I don't know if there's any misconceptions. I mean, if you think a thigh lift is an easy procedure, I don't think it's a terrible procedure, but when somebody comes in and they're a massive weight loss patient and they say, "Well, I want to do my thighs first." My first reaction is, "We'll do the thighs last." And what I mean by that is when you do a tummy tuck, you're going to pull up some of those anterior thighs and hips. When you do a buttock lift, you're going to pull up some thighs and hips. And so you're going to get some improvement there. And so I will typically put the thigh lift off to the last procedure because I want to see what kind of improvement you're going to get with the other procedures before we tackle the thighs. And I will tell you that I've gotten a lot of referrals for thigh lifts from other surgeons because they just don't like doing thighs and they don't like them because the recovery sometimes is not easy. (14:35): And sometimes you can get a wound dehiscence, you can have to deal with a chronic wound for a short period of time. So anyway, I think thighs can be tough and if you're doing that, it just depends on the patient. The mindset is everything. You have to come into it with the attitude that I'm going to do well. And if you don't, you might have some trouble. Kirstin (14:57): And I feel like, like you said, a thighlift patient is a specific type of patient. They're usually like massive weight loss. They've done their research. They already know what they want. They're coming to you having already done all the Googling, really. Dr. Gardner (15:11): Yeah. Kirstin (15:13): Googling and Facebooking. Okay. So for someone who's been quietly thinking about this for years, but hasn't said it out loud, what would be your best advice? Dr. Gardner (15:25): Well, like you said, do your research and just have some consultations. Come in, talk, have them explain, "Okay, what are you going to do? Where are you going to put my incision? Why are you going to do this? Are you going to do liposuction at the same time?" I don't think I've ever done a thigh lift without doing liposuction. Maybe I have early on, but I mean, almost always, same thing with arms. Even when it looks like there's not a whole lot of fat, I'm still going to liposuction it because I'm going to evacuate as much as I can and that way I can get more skin out. So I do the same with thighs. So I think just do your research and make sure that whoever does your surgery, you're comfortable with them because I was once told anybody can operate, but dealing with complications really defines good care. (16:10): And so if you can take care of somebody post-op when they have a bump in the road, and good thing is we don't deal with a lot of complications, but occasionally we do, right? Statistically, they happen. And you just want somebody that's going to be there for you and they're going to follow you up and it's not going to be a struggle. And that's what happens. If you have a bump in the road, we're going to take good care of you. Kirstin (16:33): I agree. I think Dr. Koehler would agree with that too. Dr. Koehler (16:37): Absolutely. Kirstin (16:38): Okay. Well, we're going to do our new segment that we introduced in the last episode, Get Off My Lawn. Okay. Let's have y'all talk about this. We've been seeing surgeons on social media especially claim to offer a scarless thigh lift. Is that actually possible? Dr. Gardner (16:58): Get off my lawn. I don't think so. I mean, Dr. K, what do you think? I mean, how many scarless thigh lifts have you done? Dr. Koehler (17:09): I haven't done any. I don't really follow the social media thing. So are they just talking about using Renuvion or something like that? Is that what they're talking about? Kirstin (17:19): I'm not really sure what the theory ... Maybe it's a secret. Maybe it's like a- Dr. Koehler (17:23): Well, like I said, I mean, if you've got loose skin, you only have so many options. And the non-surgical things, unfortunately, are limited in how much tightening they can give you and they don't ... Unfortunately, there's no magic wand. They've tried to do it with facelifts, right? Like thread lifts and other things to try to lift or tighten structures without removing anything, very difficult, if not impossible to do. So no, get off my lawn. Dr. Gardner (17:51): What do they call it? Psychic surgery where you just kind of hold your hand over. Kirstin (17:58): Yes. And some other things too. Dr. Gardner (18:01): You know how they pay for it? They rub their hand over their wallet like this. Kirstin (18:09): Oh, that's great. Well, anyways, what I was going to say might be offensive to some, so I'll just keep that to myself. But do you have a burning question for Dr. Gardner, Dr. Koehler, or me? We'd love to hear from you. You can leave us a voicemail on our podcast website at alabamathebeautifulpodcast.com. All right. Thanks, Dr. Gardner and Dr. Koehler. Dr. Koehler (18:32): Thanks, Kirstin. Have a good day. Dr. Gardner (18:33): Thanks, Kirstin. Kirstin (18:34): Go back to making Alabama beautiful. Dr. Koehler (18:36): All right. Bye. Announcer (18:39): Got a question? Leave us a voicemail at alabamathebeautifulpodcast.com. To learn more about Eastern Shore Cosmetic Surgery, go to easternshorecosmeticsurgery.com. The commentary in this podcast represents opinion and does not present medical advice, but general information that does not necessarily relate to the specific conditions of any individual patient. If you enjoyed this episode, please share it and subscribe to Alabama the Beautiful on YouTube, Apple Podcasts, Spotify, or wherever you like to listen to podcasts. Follow us on Instagram @EasternshoreCosmeticSurgery. Alabama the Beautiful is a production of The Axis, T-H-E-A-X-I-S.io.