Summary

Performing procedures to reshape the thigh needs an understanding of the aesthetic thigh deformity and its causes. A thigh lift, liposuc­tion, and non-invasive body shaping may all be used for thigh shaping or contouring. Thigh liposuction is appropriate for younger patients with fatty collections and good skin quality. Liposuction treatment is often weighed against thigh-lift (thighplasty) with the possibility of a visible scar. An increasing number of transcutaneous energy delivery devices are currently available as an adjunct with surgical procedures or as a standalone device for patients who want slight improvement or who are unwilling or can not have surgery. They are classified according to the type of energy they deliver to their target—mechanical (e.g., suction, massage), radiofrequency, ultrasound, cryolipolysis, and laser. Realistic expectations on the part of patients and the appropriate application of technologies by surgeons are the key to achieving patients’ aesthetic goals.

The lower extremities, especially the thighs, are among the most typical surgery consultations in Egypt. Deformities in the thigh region vary according to age, degree of skin laxity, and adipose tissue distribution. Most patients with massive weight loss have a better-looking thighs shape because they look deflated and have poor skin tone. The surgeon’s primary challenge is how to restore the skin elasticity and reduce or redistribute the fat. The modern facility should offer several options to improve what can be obtained through surgery. Nonsurgical thigh shaping y involves several energy-based techniques; cryolipolysis, radiofrequency, ultrasound, or laser. The goal, in some cases, is to motivate the patient to a change in lifestyle.

Patients are often interested in contouring the leg, primarily in the inner and outer thigh, knee, and calf regions. The ideal patient for liposuction is the one who has localized areas of fat in the leg but is otherwise fit and does not have skin laxity. At the same time, the outer thigh has more fibrous fat and hardy skin. The inner thigh and knee both house softer fat and thinner skin.  Varicose veins will limit liposuction ability because of the risk of injuring veins causing bloody aspirate. Liposuction is not a proper method to treat generalized obesity.

These patients are typically women who are otherwise physically fit but may have upper thigh laxity, which they want to have tightened. These patients are candidates for superior or extended thigh lifting techniques depending on their scar preference versus tightening of the entire thigh. Individuals who have sustained massive weight loss through medical or surgical means form the most prevalent group seeking thigh-lifting procedures. While such patients prove functional issues, including rashes, pain, and an impact on knee and hip osteoarthritis, many massive weight loss patients pursue thigh lift to improve their self-esteem. Varicose veins may be prominent and need evaluation by a vein specialist before going ahead with a thigh lift. Superior or extended thigh-lifting techniques apply depending on presentation, goals, and scar preference.

The inner thigh fat is soft, and the skin is thin, making it easy to over-suction the inner thigh. Liposuction may lead to laxity and redundancy of the upper thigh skin, with unfavorable skin creasing after liposuction. Patients may also present deformities after a prior attempt at thigh lift elsewhere, with widened, visible scars, spread labia, asymmetry, and incomplete results. The inner thigh and knee are more challenging, with soft fat and thin skin, making postoperative contour deformity and skin laxity risky.

The lower body lifts surgical procedure tightens loose, sagging skin in the buttocks, posterior thighs, hips, outer thighs, and anterior thighs.  It utilizes incisions that pass from the back around the hips to the front of the thighs.  The loose skin and underlying fat tissue are removed from below the incision to allow suspension of the remaining tissues to stretch and smooth the lower body, especially the buttocks and thighs.  The surgery begins in the back and requires repositioning during the operation to address the hips and outer thighs and front of the thighs.  It can be combined with an abdominal skin tightening if needed.  If a previous tummy tuck (abdominoplasty) has been performed or is not required, I can extend the lower body lift to tighten the inner thighs. The incisions are designed to be hidden by clothing and sportswear or to lie in usually occurring anatomic folds.

An increasing number of transcutaneous energy delivery devices are currently available as an adjunct with surgical procedures or as a standalone device for patients who want slight improvement or who are unwilling or can not have surgery. They are classified according to the type of energy they deliver to their target—mechanical (e.g., suction, massage), radiofrequency, ultrasound, cryolipolysis, and laser. Realistic expectations on the part of patients and the appropriate application of technologies by surgeons are the key to achieving patients’ aesthetic goals.

Nonsurgical Fat Reduction

Unwanted local fat deposits negatively affect body shape and image. Diets, exercise, medications and/, liposuction, or gastric surgeries may effectively control obesity. Surgical or minimally invasive body shaping can dramatically improve the shape and proportion of your body, enhancing your appearance and boosting your self-confidence. For patients who require minor improvement or are unwilling or unable to undergo a surgical procedure, nonsurgical fat reduction is an alternative for surgical procedures. Nonsurgical and minimally invasive options for fat reduction use various modalities, including freezing, ultrasound, radiofrequency, infrared light, vacuum massage, and injectable medication. Realistic expectations on the part of patients and the appropriate application of technologies by surgeons are the key to achieving patients’ aesthetic goals.

Radiofrequency Skin Treatment

Minimally invasive procedures to tighten and lift skin give natural results with minimal risk and recovery time. Monopolar radiofrequency deliver a high-frequency electric current—tissue resistance to electrical current, results in volumetric heating to the deep dermis and underlying tissue. The resulting heat leads to immediate collagen contraction and a delayed wound healing response, with new collagen formation up to 4 to 6-month post-treatment.  The FDA initially approved monopolar radiofrequency (RF) devices to treat periorbital wrinkles. Since then, they have been used to treat laxity of the forehead, cheeks, nasolabial folds, marionette, lines, jawline, and neck. Although the results of RF are not as dramatic as a facelift, over 90% of patients obtain noticeable tightening of the treated areas, and it never looks “pulled.” Another benefit of radiofrequency is its ability to reduce fat and tighten the skin by directing energy to target collagen. For example, a patient with flabby upper arms may have more loose skin than fat in this area. In this instance, Prof Moawad might use radiofrequency to tighten the skin first and then remove excess fat. However, if he determines that there is fat primarily in an area, he will remove the fat first and then tighten the skin afterward. “Radiofrequency is a very versatile procedure that can be used on any area of the body – from large areas like the abdomen to minimal areas such as the chin – with the same degree of success.

Stretch Marks Treatment

Many things change after you have a baby: schedules, sleep time, and a sense of freedom, to name a few. Along with, there are many physical changes you’ll see. Chief among them is stretch marks. Stretch marks or striae are a form of scarring on the skin with an off-color hue. Stretch Marks are the result of the dermal tear, which over time may diminish, but will not disappear completely. Stretch marks are often the result of the rapid stretching of the skin associated with rapid growth or rapid weight changes. Stretch marks may also be influenced by hormonal changes associated with puberty, pregnancy, bodybuilding, hormonal replacement therapy, etc. Stretch marks formed during pregnancy, usually during the last trimester. It generally appears on the belly and commonly on the breasts, thighs, hips, lower back, and buttocks. For the treatment of red stretch marks, clinicians may consider the PDL, 1,064-nm Nd: YAG laser, and 532-nm KTP laser, which would likely improve the redness (vascular component) of red stretch marks. Recently, several emerging treatment modalities, including fractionated micro-needling RF, ultrasound, and PRP and micro-needling, have reported good clinical improvement of stretch marks.  Stretch marks prevention and treatment stay a clinical challenge. Physicians should set realistic expectations with patients seeking stretch marks treatment and informing patients that the appearance and texture of stretch marks may improve but will not completely resolve to be an integral part of setting these expectations.

Cellulite (dimpled skin) Treatment

The term cellulite refers to the ‘orange peel,’ ‘mattress,’ or ‘dimpling’ appearance on the thighs, buttocks, and sometimes lower abdomen and upper parts of the arms of otherwise healthy women. Approximately 85% of post-pubertal woman has a form of cellulite. This appearance is much more common in women than in men because of differences in how fat, muscle, and connective tissue are distributed in men’s and women’s skin. Although rarely observed in men, those men presenting with cellulite are commonly deficient in male hormones. The lumpiness of cellulite is caused by fat deposits that push and distort the connective tissues beneath the skin, leading to characteristic changes in the appearance of the skin. The causes of cellulite are not well understood. Theories include genetics, circulatory problems, inflammation, hormonal disturbances, tight clothing, and lifestyle factors. Although being overweight is not a prerequisite for cellulite, excess body fat makes cellulite more visible. The aging process can worsen the appearance of cellulite, as skin loses elasticity and is less able to resist irregular tension created by the fibrous bands. Despite many treatments available—all of which claim to work somehow—few do work, and many works with unpredictable results.  The new minimally invasive techniques of power liposuction (without suction) and fat transfer are rewarding to achieve acceptable results.