Many massive weight loss (MWL) patients present with characteristic thigh deformity.  This includes: diffusely loose skin, saddlebags, and cascading rolls of tissue medially.  Almost all patients present with vertical laxity of their thigh.  In addition, some will also have circumferential (transverse) thigh excess.   The current mainstay treatment of thigh deformity after MWL is the vertical thighplasty.  This reductive procedure decreases the thigh circumference without correcting for the thigh descent.  Since 2005, we have been performing a modified upper medical thigh lift that we have termed the Spiral thigh lift. This procedure produces posterior, medial, and anterior thigh lift.  When performed with a lower body lift, the Spiral thigh lift provides circumferential thigh elevation.  The technique involves incisions that are made at the infra-gluteal crease and the upper posterior thigh markings in the prone position. The redundant upper posterior thigh tissue is then excised at the muscular fascia plane.  The posterior thigh is then suspended to the ischial tuberosity by multiple interrupted non-absorbable sutures.  Closure of the incision then recreates the infra-gluteal fold.  In supine position, the marked excess upper medial thigh is excised.  The lower incision of the medial thigh is extended to the thigh muscular fascia and Colles' fascia.  The anterior/medial thigh is then lifted in a vertical direction to the level of the groin crease with multiple non-absorbable sutures to the periosteum of the pubic tuberosity and the Colles' fascia.  This advances the anterior thigh incision to the planned groin incision level and closes the medial thigh defect.  The groin crease is then recreated. We have performed more than 102 lower body lifts with thighplasty in our practice.  On average, each patient underwent 4 procedures.  Every patient required a Spiral thigh lift.  About 34% of the patients also underwent simultaneous or staged vertical thighplasty in addition. The procedure has been very effective in correcting the vertical thigh laxity of our MWL patients.  We have noted a higher number of both minor and major wound complications with the thighplasty procedure than other procedures (Table 1). 

Complications	MWL patients (N=102)
Minor Dehiscence	48
Minor Hematoma	2
Minor Infection	3
Minor Seroma
% of Minor Complication/patient/ Procedure	12.9%
Major Dehiscence	14
Major Hematoma
Major Infection	2
Major Seroma
% of Major  Complication/patient/ Procedure	3.9%