We hear all too often women complaining about the relaxation they feel in the area of the buttocks, inner thighs and lower limbs in general. We should first separate the cases of relaxation and completely distinguish them from the cases that experience sagging due to weight loss.
One of the most common areas where there is sagging is the inner thighs and buttocks. This relaxation can take the form of cellulite, hyperliposis, skin relaxation, or deep tissue relaxation. But what happens in each of these cases and how we can improve the problem.
Let’s take for example the area of the inner thighs. Many women feel that the skin at this point has sagged and in the examination we usually see some excess of tissue in the area, the thighs touching and rubbing against each other at that point and generally a feeling of looseness of the tissues like jelly. The first spontaneous thought is that the skin needs to be removed and stretched to correct the problem. However, if we examine the cause of the problem, we will find that the main problem is the fat that has accumulated in this area, which due to the weight it creates, recedes downwards along with the skin. In most cases, therefore, the solution is to remove fat with liposuction so that the skin returns to its place. The argument is “but if we do liposuction, won’t it relax further?”. In no case does liposuction cause relaxation, if performed correctly and in fact it is the best solution for these cases of relaxation of the inner thighs, because it leaves no scars and has an excellent result with minimal recovery.
Let’s also look at the example of sagging buttocks. We may indeed have real relaxation, as in large weight fluctuations, but usually we see a loss of volume in the upper and outer part of the buttocks, retention and cellulite in the lower part of the buttocks and centrally and in some cases loss of volume and relaxation in the crease below the buttocks, in the so-called banana rolls. The supposed relaxation is usually treated by restoring the loss of volume, either by transferring fat or using silicone implants, breaking down cellulite with the appropriate technique and adding volume to the fold under the buttocks.
Finally, an area that is often perceived as relaxation is the one around the knees. Here, too, there is either hyperliposis in the context of lipoedema above the knee that is treated with liposuction, or volume loss in very thin people that is usually treated with the addition of fat.
So is there real laxity? And when is a buttock or inner thigh lift operation is necessary?
The truth is that these procedures are very useful in people who have experienced great weight loss and the connective tissue architecture that keeps fat and skin in place has been damaged. In most cases, however, where there is no weight loss but a mild relaxation due to age or genetic predisposition, surgical correction of sagging with skin removal is an operation that should be the last option, as these are operations that stigmatize patients due to excessive and obvious scars, resulting in correcting one problem but creating another.
So, in the few cases where a surgical lift is needed to treat sagging, these are usually cases with great weight loss, or with real sagging of the skin and connective tissue.
Buttock and thigh lift techniques
In the case of minor to moderate sagging in the inner thighs, a portion of skin and adipose tissue is removed from the base of the thigh and is usually preceded by liposuction, which will remove excess fat and weight the inside of the thigh. Sometimes when the problem is very intense, we prefer to do the thigh correction in two phases. In the first, extensive liposuction is performed and after 6 months the thigh lift is performed. This strategy has the advantages that on the one hand the operation is not so burdensome, and on the other hand after the fat comes out and the swelling subsides, the weight of the flap is reduced and this significantly improves the final result. The scar that remains is circular at the base of the thigh and extends backwards to the lower fold of the buttock. Usually a good quality scar is made which is not visible.
In people who have lost an even greater amount of weight and the relaxation extends significantly towards the middle of the thigh, a dermadipose tissue excision is additionally performed along the thigh axis, so there is an additional scar perpendicular to the previous one. This solution allows us to pull the relaxation in two vectors and is even more effective towards the lower third of the thigh or knee.
When there is great relaxation after great weight loss, it is advisable to perform the so-called upper buttock lift, ie with an incision above and between the buttocks, which can be combined with abdominoplasty, ie the so-called lower body lift, ie the lifting of all loose skin of the buttocks, outer and back thighs up to knee level. This operation is part of the surgical treatment of weight loss patients.
In the lower pole of the buttock, when it is atrophied, we prefer not to remove the dermadipose tissue but to move it upwards in order to add volume to the missing area and perform a significant buttock lift. The incision is placed inside the fold so that it remains hidden.
Most of the time, when we want to achieve a buttock lift, the goal is not only to pull but also to refill the buttocks. On the upper buttocks we apply the Brazilian butt lift BBL. This is done without incisions, with the combination of liposuction and lipotransfer. With new fat grafting technologies we can collect significant amounts of fat and inject into the upper one, outer and lower third of the buttocks, to give the buttocks curvature again. In this way, an indirect buttock lift is performed, without scars and with a completely natural result.
Buttock lift can also be achieved by adding silicone implants of the buttocks, or use a hybrid method, combining silicone buttock implants with lipotransfer. This is the most successful method that corrects both the size and shape of the buttocks, while significantly eliminating sagging.
In case of cellulite of the buttocks, either fat can be added superficially to the lower and inner pole of the buttock, although many times it is enough just to “break” the cellulite mechanically with the technique of pulsating liposuction, without removing fat.
Recovery after buttock/thigh lift
In the case of Brazilian buttock lift with lipotransfer, or with the addition of silicone implants, a stay in the clinic is not required. Recovery includes sleeping in a prone position (face down) and abstaining from sports activities for 6 weeks.
If relaxation is treated only with liposuction, recovery is much easier and the return to daily activities and exercise is possible after 2-3 weeks.
In cases where skin removal is needed to treat sagging, recovery is more demanding and requires care of the areas for 10-15 days. Special elastic lastex is usually used to further enhance the aesthetic result and reduce swelling. It usually takes 1-2 weeks to abstain from work. Sports activities can resume 6-8 weeks later.
