Objectives: Know the different techniques to a medial thigh lift and their appropriate indications.

Introduction: The medial thigh lift is a standard procedure in post bariatric reconstructive surgery and also in aesthetic surgery. Still it is no easy surgery to perform with many pitfalls. We will present the different approaches to achieve the desired skin tightening, volume reduction and aesthetic contouring with minimal scarring and avoiding complications.

Materials / method: Different approaches to the medial thigh lift were tested in our specialized clinic for postbariatric reconstructive surgery and aesthetic surgery for more than 20 years. Each year around 50 to 65 patients were treated with a medial thigh lift. We used this experience to establish a reliable, efficient and effective algorithm to the medial thigh lift.

Results: Based on more than 20 years of experience in postbariatric reconstructive surgery and aesthetic surgery in our clinic and using different approaches to the medial thigh lift over the years, we found a reliable, efficient and effective algorithm to the medial thigh lift.

Conclusion: With the appropriate selection of techniques the medial thigh lift can be performed safe and deliver the desired results. Our standard algorithm and surgical tips are helpful guides for this procedure.

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Objectives: Selective neurectomy for calf reduction has been modified to be a stable and quick technique with satisfied results during two decades.

Introduction: Calf hypertrophy is of concern to Asians. Liposuction and muscle resection are often used with reasonable results. Traditional techniques of selective neurectomy developed by F.C. Tsai were to resect the nerves to medial gastrocnemius and soleus muscles (published in PRS 2008). However, the residual triceps surae muscle compensation often causes the partial calf circumference return. Thus, I revised the drawbacks of "partial" nerve resection to the complete "total" nerve resection of gastrocnemius and soleus muscle.

Materials / method: Between 1999 and 2020, 1800 patients underwent selective neurectomy with/without liposuction. Gait analysis was performed on six and electromyographic studies were performed on 30 patients.

Results: Reduction in circumference was 2.74 cm (range, 1.8 to 5.1 cm) at 14 months. Short-term disability was noted in 2.57 percent. Complications were noted in less than 5percent. Dissatisfaction was noted in 4 percent. Electromyography showed denervation of the medial gastrocnemius. Gait analysis revealed normal gait.

Conclusion: Selective neurectomy can offer an effective method of reducing calf circumference and improving contour.

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Objectives: In our work we were able to show that the skin quality and thus the skin's ability to retract, in MWL patients, should not be underestimated. As with patients with an aesthetic indication, common procedures such as lipoabdominoplasty can also be used in MWL patients to improve the end result and avoid the need of long scars, especially the visible vertical scar of and Fleur-de-lis-abdominoplasty.

Introduction: The number of bariatric procedures and thus also the number of post-bariatric operations has increased dramatically in recent years. Although long scars are common in post-bariatric surgery and accepted in favor of body shape reconstruction, we increasingly notice the wish for aesthetically pleasing results in addition to the desire for body contouring. The Fleur-de-Lis abdominoplasty (FdL), in particular, is viewed critically by younger patients after massive weight loss due to the visible vertical scar. Surgeons are also often bothered by the unsatisfying aesthetic outcome as wel

Materials / method: Retrospective analysis of 20 female patients who, after massive weight loss following bariatric surgery, received a lipoabdominoplasty instead of a Fleur-de-Lis abdominoplasty in the period from January 2019 to June 2020. Data analysis was performed using measurements of the preoperative vertical and horizontal excess skin and fat (Pittsburgh Rating Scale), the Body Mass Index, the surgical technique and the final result.

Results: 20 female patients with an indication for carrying out a FdL abdominoplasty underwent a combined radical liposuction of the abdomen with abdominoplasty. The original weight before massive weight reduction ranged between 100-168kg. The average weight reduction was 56.5 kg. The mean BMI was 27.3 kg/m². The average age of our cohort was 40 years. One patient (5%) had a major complication. This was an infected seroma which could be treated conservatively. Two other patients (10%) also developed an uninfected seroma as a minor complication.

Conclusion: On the basis of our data and work, we are able to show that lipoabdominoplasty can be safely and well performed also with patients after massive weight loss. It is possible to achieve good body contours without vertical incisions and with a high degree of patient satisfaction. The number of patients who have to undergo FdL-abdominoplasty can be successfully reduced by this technique.

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