Thigh lift — the same trade as an arm lift, in a harder place

A thigh lift removes stretched skin from the inner thigh. It is done after substantial weight loss, or when skin has loosened with age.

This site already has an operation with the same structure — the arm lift. The two pages make the same point. It is not an operation of uncertain effect; the price is a scar. Cut the skin away and it is reduced.

But the thigh is a harder site than the arm. For four reasons.

One, it is always moving. Every step and every sitting puts the incision under tension. You can go days without using an arm; going without walking is harder.

Two, it rubs. The inner thighs touch each other. It is damp, and clothes chafe. The conditions for a wound to heal are poor.

Three, lymphatics run through it. The lymph of the leg collects at the groin. Dissecting widely there can leave lasting swelling of the leg.

Four, gravity pulls down. Which adds a problem the arm does not have: the scar migrating downwards over time. A line tucked into the groin crease comes down onto the thigh where it shows. That is why where and how it is anchored is the central technique of this operation.

The direction of excision sets the shape of the scar.

• horizontal (in the groin crease) — for a lesser degree of looseness. It hides substantially in the crease, but it can migrate.
• vertical (a line running down the inner thigh) — for a greater degree. The scar is long and cannot be hidden.
• both together — after large weight loss.

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The scar is this operation's largest problem. It is long, badly placed, and widening or thickening is reported more often here than elsewhere. Movement, friction and moisture all meet at this site. On scar care, see the silicone scar products page as well.

The scar can migrate downwards. This problem is specific to this operation. A line placed in the groin crease moves down over months and shows on the thigh. Ask before surgery where it will be anchored.

Wounds open here often. You cannot go without walking, and it is a place that folds when you sit. The end towards the groin especially.

Lasting swelling of the leg is possible. The lymphatics of the groin run through here. If anything has been done to the lymph nodes of your groin or leg, say so.

Fluid collection (seroma) is especially common at this site. That is why drains are used.

In women, the shape of the external genitalia can be pulled. A strong horizontal pull does this. This is sometimes left out of the explanation. Ask about it first.

Sensation can change. Nerves serving the inner thigh cross the operative field.

Infection is more common than at other sites. It is damp and subject to friction.

The two sides will not end up identical.

This is an operation for a stable weight. A large change afterwards alters the result.

First separate it from liposuction. If fat is the problem, suction alone reduces it. If skin is the problem there is no route but cutting it away, and removing fat alone can leave it looking looser.

Have the scar drawn on you before surgery. Look at where the line falls standing, sitting and walking. Checking it seated matters especially.

Ask whether it is horizontal or vertical. The length and the visibility are completely different.

Ask where the scar will be anchored. There are techniques for preventing migration. Asking the question is itself informative.

If anything has been done to the lymph nodes of your groin or leg, say it first. It is the most important part of the history here.

Check that your weight has settled. After large loss, it is better once it has held for some months.

Not smoking matters especially here. It bears directly on blood supply and healing along a long incision — more so at this site.

Put the period of restricted walking and sitting into your plans. It runs three to four weeks, and get instructions on how to sit.

Check in advance how long compression garments are worn.

The decision here, too, is not 'will it work' but 'can I accept the scar'. The same structure as the arm lift. But the thigh heals under worse conditions than the arm, and it adds the problem of the scar migrating.

Think about what you wear. It shows in short clothes and swimwear. Which bothers you less — visible sagging or a visible line — differs from person to person, and that judgement is yours.

Scars fade with time. But this site takes longer; give it a year before judging. And fading and migrating are different problems.

Whether your scars tend to widen changes the outcome a great deal. Talk through how previous operations or injuries healed on you.

Some people come back more than once. Revising the scar, or lifting a line that has migrated, is sometimes needed.

It cannot be undone. Skin removed does not come back, and the scar stays.

Whether to have it done is settled with a doctor, and it is better not to settle it on one consultation alone.