LIPOSUCTION OF THE THIGH - 08/09/11
Résumé |
Women are frequently dissatisfied with the contour of their thighs; therefore, thighs are among the most commonly requested areas for liposuction surgery. By contrast, men rarely request liposuction of the thighs. Hetter noted that prior to liposuction surgery, there were relatively few procedures performed to remove prominent fatty deposits in the trochanteric area because they were difficult to improve surgically and left undesirable scars.13 Pitman also discussed the various surgical approaches designed to improve the saddlebag area. He also felt that there were relatively few individuals who were willing to accept the unsightly residual scars.19 As is true with most localized fatty deposits, those on the thighs are usually inherited and rarely respond to diet or exercise.
In addition to the dysmorphic changes resulting from localized or diffuse fatty deposits of the thigh, the skin of the female thigh is prone to irregularities resulting from cellulite, waviness, and poor skin tone—all of which impact the patient's perception of the overall problem. These factors also limit the degree of improvement that can be obtained by liposuction surgery.
Pitman defines three general types of thigh configurations. Type I individuals have localized fat and good skin tone and can benefit from liposuction alone. Type III individuals have virtually no fat and very poor skin tone. These women will not benefit from liposuction surgery, but would have to undergo a thigh lift to achieve the desired result. Type II patients have variable fat and skin laxity. Many of these individuals will benefit from liposuction surgery. Pitman further points out that liposuction surgery is the preferred treatment, but some Type II patients may also require surgical lifting.19
Cellulite is another common complaint of women who request treatment of their thighs. Cellulite is a term used to describe the irregularities of the skin, mainly of the thighs and buttocks of women (Figure 1). It is rarely seen in men. Although the origins of cellulite are not clearly understood, some investigators feel that it is a result of the attachment of fibrous bands from the dermis to the deep fascia, creating a quilting effect.19 Other investigators relate this to subdermal edema and liposclerosis.15 Draelos et al recently studied cellulite using ultrasound. She demonstrated projections of fat into the dermis and postulated that, at least in part, cellulite is a result of an inflammatory process involving the dermis and superficial fascia.6
Therapeutic recommendations abound for the correction of cellulite. These include weight loss,6 subscision of the fibrous bands, lipoinjection, mineral and dietary supplements, and massage.6, 15, 19 Contrary to early expectations, liposuction has not been successful in reducing cellulite.6, 15, 19 Indeed, Narins noted that occasionally liposuction can even appear to worsen the problem.17 It is important that patients who request liposuction understand that localized fatty deposits and cellulite are unrelated and that they can expect no substantial improvement of cellulite from liposuction. In addition, as previously noted, poor skin tone, either as part of the aging process, an inherited condition, or as a result of prior weight loss, can also result in suboptimal improvement following liposuction.
Large lateral thighs are part of the typical gynoid shape. Also, large disproportionate [lateral] thighs are not uncommonly present in women who have smaller upper bodies and legs (see Figure 1. Therefore, large thighs create a problem especially with tightly fitting dresses, pants, and jeans. This is demonstrated as a significant problem by the frequency with which liposuction is requested for the thighs, especially the lateral trochanteric areas. Pitman describes the ideal female form for the upper thigh and lateral and lower torso as a single smooth curve beginning at the waist, extending downward over the iliac crest and greater trochanter and then continuing down to the knee.19 The photographs published in fashion magazines and catalogues routinely demonstrate this ideal contour. Although not ordinarily understood by men, this deformity is an enormous problem for modern women who perceive themselves as living in a very competitive society.
The primary area treated for localized fatty deposits (lipodysmorphia) on the thighs is the trochanteric area of the lateral thigh or saddlebag area (Figure 2).19 The second most commonly requested area for liposuction treatment includes the upper portion of medial thighs with variable contributions from the adjacent anterior-medial or posteriormedial thighs (Figure 3). Occasionally the fatty deposition can extend along the entire internal medial thigh to the knee. These localized fatty deposits project medially from the upward sweep of the medial thigh and produce a proximal bulge, 1.0 cm to several centimeters below the crural fold.19 Functional problems also result from rubbing of enlarged medial thighs during ambulation. In addition, the thickened inner thighs generate tightness when women are wearing pants or shorts. The latter tend to ride up while walking, further aggravating the situation. Women who request liposuction feel that this condition is unsightly and uncomfortable. They desire legs with uniform linear contour of the medial thighs from the groin to the knee.
Anterior thighs often represent a problem of increased bulk that projects the anterior thigh forward. The fat of the anterior thigh is more diffusely situated rather than localized as in other areas.19 There is also the additional problem of fat in the suprapatellar area, which many women request treatment of separately from the rest of the anterior thigh. The skin tone of the anterior thighs, especially the suprapatellar portion, is often poor and associated with fine waviness. These changes aggravate the problem, especially when hem lines go up or when wearing shorts. They also affect the final result of liposuction surgery.
The posterior thigh is the area least requested for liposuction with the exception of the proximal infragluteal fold or so-called “banana fold.” In contrast to the rest of the posterior thigh, this fatty roll is a rather common problem (see Figure 3.
Overall, the contour of the thighs is a function of both the fat and the underlying musculature (Figure 4).14, 19 Women who exercise vigorously will often have prominent projections, especially of the medial and anterior thighs, which are a result of muscular hypertrophy rather than fatty deposits. These women will not benefit from liposuction surgery. In addition, bony irregularities resulting from scoliosis or inequalities in the length of the lower extremities will produce further asymmetry.14 It is difficult or impossible to compensate for asymmetries and bony irregularities with liposuction surgery. It is important that they be pointed out preoperatively and the limitation of liposuction in correcting these irregularities be explained to the patient.
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| Address reprint requests to Gerald Bernstein, MD, Bernstein Cosmetic Surgery Clinic, 1801 NW Market Street, Suite 107, Seattle, WA 98107 |
Vol 17 - N° 4
P. 849-863 - octobre 1999 Retour au numéro
Article précédent
- LIPOSUCTION OF THE ABDOMEN : An Analysis of Form
- David P. Clark
- LIPOSUCTION OF THE KNEES, CALVES, AND ANKLES
- Patrick J. Lillis
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