In this episode of Carpools & Cannulas, Dr. Greer of Greer Plastic Surgery in Cleveland, OH, and Dr. Gallus of Restore SD Plastic Surgery in San Diego, CA discuss treatment options for the thighs. From the most extreme approach of thigh lift surgery to the noninvasive options of QWO and Cellfina to treat cellulite, they cover all the angles. And yes, we too wish there was a magic wand for cellulite!
Transcript
Dr. Greer: Hey, guys. It is Dr. Greer in Cleveland, Ohio, board-certified plastic surgeon. I am kind of in the midst of a pile of children and dogs right now. Okay, dude. Backup. Dr. Gallus from Restore Plastic Surgery in San Diego is here, and I’m gonna add her to us. I’m here in my house, my kids are in wind-down time. But once Dr. Gallus gets on… Hey.
Dr. Gallus: Hey, hey.
Dr. Greer: How are you?
Dr. Gallus: How are you? You’ve got a full house.
Dr. Greer: I’m literally in a pile of children eating bread because dinner is bread with ketchup.
Dr. Gallus: Oh, ketchup.
Wyatt: I’m eating an apple.
Dr. Greer: Yeah, my daughter loves bread with ketchup. That is literally like her favorite meal.
Wyatt: But I’m eating apple.
Dr. Greer: Oh, and Wyatt wants to point out that he’s eating apples. So…
Wyatt: That’s my midnight snack.
Dr. Greer: Yeah. So it’s good.
Dr. Gallus: That’ good. That’s healthy.
Dr. Greer: How’s your evening?
Dr. Gallus: Good. We haven’t eaten dinner yet because it’s earlier here on the West Coast. But my middle kid, for a while, ate cucumbers dipped in ketchup, which was truly disturbing.
Dr. Greer: Wyatt ate cucumbers, but he doesn’t dip them in ketchup.
Dr. Gallus: Yeah, he sounds a little snuffled there. Yeah. So because we give him carrots and cucumber sticks, you know, for…
Dr. Greer: Yeah. He would dip them in ketchup.
Dr. Gallus: Yep. Delicious. I was like, I don’t like ranch either. I just don’t like any…
Dr. Greer: Oh, really?
Dr. Gallus: Yeah.
Dr. Greer: Oh, I love ranch. I could just eat ranch. Like, oh, there’s a dog in front of me. The blackout was the dogs here coming over my phone. Yep.
Dr. Gallus: My puppy is too tired to come over here. She, like, lays around all day. It’s a hard life. Okay, so we were gonna talk about…
Dr. Greer: Thigh lift.
Dr. Gallus: …thigh lift.
Dr. Greer: Yeah. Which is one of my less common procedures, but I love doing them. They’re very satisfying.
Dr. Gallus: They are satisfying. Would you say…? What I’ve noticed is that more people are interested in thigh lifts now than in the… Like, in the past, I sort of relegated it to people who had had massive weight loss, which is, you know, 100 pounds or more. But oh, put your questions in then about…
Dr. Greer: Yeah, we’ll answer your questions. Absolutely.
Dr. Gallus: So yeah, I mean, I would say universally hated, most women don’t like thighs. You can come through here if you want. I have a interloper.
Dr. Greer: Of course.
Dr. Gallus: You wanna say hi? We’re on Instagram Live.
Juliana: Hi.
Dr. Greer: Oh, my kids are waving too.
Dr. Gallus: That’s Wyatt. This is Juliana.
Dr. Greer: Hi, Juliana.
Juliana: Hi.
Dr. Gallus: All right. Well, we were talking about thigh lifts, which I’m pretty sure you’re… Okay, yeah, not so…
Dr. Greer: Not interested…
Dr. Gallus: So yeah, massive weight loss, 59-year-old skin. No.
Dr. Greer: No, it’s not. And the great thing about thigh lift is you’re anchoring the skin to the underlaying fascia. So it doesn’t stretch with time and those scars stay high, which is nice.
Dr. Gallus: Yes. And the recovery and… Okay, so let’s talk about recovery. Because I feel like that’s a tough area to recover from. I will combine it with a tummy tuck, if indicated. I’m not saying that you need one. But I don’t like doing it in people who have multiple areas they want to tackle due to massive weight loss. I do not recommend doing it with your arms because arms and legs…
Dr. Greer: Then you can’t move any limbs.
Dr. Gallus: Yeah, yeah. So, what can you have done with a thigh lift? So I usually do it in conjunction with liposuction. You probably do too, right?
Dr. Greer: I do. Yeah, I actually…
Dr. Gallus: I feel like we lost you. There you go.
Dr. Greer: Yeah, my alarm went off. I set a timer so I would remember to log on. Yeah, then I hit Snooze, so it will probably go off again in 10 minutes. But yeah, I do lipo with it. And since doing the Hunstad avulsion technique for brachioplasty, which basically you liposuction very aggressively under the skin, which does your elevation and dissection for you, and then it’s called the avulsion technique because you make the incision and literally avulse the skin, you rip it off. Which is kind of gross. I took a video once, the nurses were all horrified. But I do that on thigh lifts now and it’s beautiful, because dissecting around a curve is a little trickier to stay in the same plane. And when you just elevate it with liposuction, it’s so much faster.
Dr. Gallus: Yeah, totally. I agree. So that’s one. So in terms of what you can do with a thigh lift, do you mean other procedures? I do recommend you can do a tummy tuck with a thigh lift, you can do breast surgery with a thigh lift. I just do…
Dr. Greer: Or like liposuction of the mid-section.
Dr. Gallus: But I just generally stay away from doing the arms, that would be my no-go for that.
Dr. Greer: Yeah, you just want to be able to actually, you know, get up. move, function.
Dr. Gallus: Yes. And in order… Because your legs are gonna hurt, you want to be using your arms to kind of get up. So yeah, so the Hunstad avulsion technique is great. It’s definitely good for people who have excess skin along the whole upper leg. So from the knee, all the way up to the groin crease. And you can kind of pull that skin together around your leg. I have also used the apex technique, which is an incision that’s kind of in…kind of like a bikini crease, like the bottom of a bikini, for people who just have…that lack that bit of laxity in the medial upper thigh.
Dr. Greer: Yeah, which is pretty common. That’s an area where there’s just kind of a little fat pad. A lot of people have… Well, I had that area lipod on myself. And I have like a little bit of crinkly skin, probably not enough that I bother with a thigh lift. But that’s a really common area just for a little laxity.
Dr. Gallus: Right. And that’s pretty effective. And then you don’t have the scar that goes all the way down the side of your leg. It just really depends. Somebody is saying hi to Wyatt.
Dr. Greer: Yeah, that’s our nanny Bridget. Hi, Bridge. I missed you today. Bridget is saying hi to you, buddy.
Wyatt: Hi, Bridget.
Dr. Greer: Oh, he said hi back.
Wyatt: Where is Bridget? Is Bridget on here? Is Bridget on too?
Dr. Gallus: Yeah, she I think she is.
Dr. Greer: Yeah, Bridget’s on here, dude.
Dr. Gallus: But you can’t see her.
Dr. Greer: Yeah, she’s just watching.
Dr. Gallus: I’m taking the screen away from Bridget, unfortunately.
Dr. Greer: Dude, let your sister pick TV for a little bit. Okay? Here, I gotta mediate.
Dr. Gallus: Every day.
Dr. Greer: Every day.
Dr. Gallus: So I do like to do circumferential thigh liposuction. Actually, if you don’t need a thigh lift in general, sometimes that is a good option, right? So you can do liposuction, you just have to be careful that the skin on your thighs is strong and has good elasticity. Because you don’t want to trade off thick thighs for thighs with sagging skin.
Dr. Greer: Sagginess. Yep, and I saw earlier… Oh, sorry. Go ahead.
Dr. Gallus: No, go ahead.
Dr. Greer: Oh, I was gonna say somebody had asked earlier about the types of thigh lifts. Because there are a couple, and we talked about the extended where it’s called, like, a hockey stick incision that goes down the leg. Depending on how much laxity, it can go all the way to the knee. And I’ve even taken it a little bit of past in people who’ve lost a lot of weight. And then there’s the spiral thigh lifts, which is a continuation of that along the outside of the thigh where tummy tuck incision would be. So you lift the lateral thigh as well.
Dr. Gallus: Yeah, so there’s as many dimensions as you can pull on a thigh as incision options. And then the one that goes up and around and behind your gluteal crease, the apex thigh lift. And you can do a short scar version of that too where you just come down the medial side of the thigh, and then tee it off. But I don’t know that that seems to be less popular these days with apex thigh lift. But yeah, I feel like liposuction in conjunction with that is a good choice in terms of kind of both the area that you’re going to resect and then the area that you’re not going to resect to kind of make the whole thigh smaller and then tighten.
Dr. Greer: Right.
Dr. Gallus: I would say though, I was saying at the beginning that it used to be in my mind of treatment for women or men who had had massive weight loss. But now I feel like there’s people who have lost maybe 10 or 20 pounds and then just want tightening of the skin because, you know, with aging, and sun exposure, and, I don’t know, gravity, things tend to fall and you really can just kind of, like, pick up on your leg a little bit and wonder why it isn’t where it used to be.
Dr. Greer: You can. And that laxity shows up, like, right above the knee. That’s where you get all that, like, crinkly skin. And with the medial thigh lift, you carry it up anteriorly a little bit to the groin crease, and it gives a little lift to that that’s nice.
Dr. Gallus: Yeah, and it’s a great area to… Yeah. Have you ever seen anybody…? I have seen patients who had direct excision right above the knee, and I don’t…
Dr. Greer: I’ve never seen that. That seems like a bad scar.
Dr. Gallus: Yeah, it’s not a great…
Dr. Greer: Which is very visible. Yeah.
Dr. Gallus: Yeah, because I’ve asked like what surgery that was.
Dr. Greer: “Oh, were you in an accident? Oh, cosmetic surgery. My bad.”
Dr. Gallus: I didn’t know ortho did that. And then I’m like, “Oh.” And I’ve seen somebody who had a similar incision above her elbow, same thing where someone thought, “You know, it would be a good idea. I’ll just take this little bit of skin.” And I’m like, “Oh, no.” So it’s not that effective. Although sometimes, you know, going right to where the problem is, seems like a good idea. You’re right, lifting the thigh within the groin crease will help with that skin that is sagging over your knee. The other thing I do is renuvion, which I know you don’t have that…
Dr. Greer: I don’t.
Dr. Gallus: I like that for additional tightening with the thigh liposuction. So if I’m doing thigh liposuction, I’ll add that device in to sort of shrink wrap and tighten the skin. And I’ve also done radio frequency micro-needling to the thigh to improve the collagen for people who just have, you know, milder laxity, crepey skin on their legs and, you know, they don’t…their legs are great, they don’t want to wear shorts or short skirts because they’re concerned about how their legs look. Although for most of us, we would be like, “Yeah, I would totally… I’ll be okay with that.” And then there are now skincare products that have less heavy doses of retinol or retinoids in them to also improve the collagen and skin on your legs.
Dr. Greer: Interesting. I have not seen these, although I use one for neck and chest. And it’s definitely a gentler formulation because that body skin is sensitive. I wonder, you know, because vitamin A is what, it’s fat soluble, so you can overdose on it. I wonder what happens if you start doing retinol on your entire body. Yeah, is there like a maximum dose?
Dr. Gallus: Yeah.
Dr. Greer: Sorry if my camera’s bouncing around. I have children, like, attached to me. Favorite part of the night.
Dr. Gallus: I have one coming in.
Dr. Greer: Okay. Guys, you just have to sit still. Okay?
Child: Can I bounce on you?
Dr. Greer: No, you cannot bounce on me.
Dr. Gallus: So yeah, I don’t know if it’s possible to overdose retinol. I know Alastin, which I don’t carry in my office, has a transformative cream that has retinol in it. And SkinMedica does, too. I think it has glycolic in it. And I feel like Topix makes one as well. But yeah, I just don’t have, you know, in the grand scheme of things, the patients for any of that. So I don’t do it. But I would say, for the younger people on this call, sun is not your friend. And so I highly endorse the fake tan. Like having those nice, lovely tan legs catches up with you later and that skin.
Dr. Greer: Yeah. And that’s where you get that sun damage creepy wrinkly. Yep. You know what, we should talk about that. I wasn’t actually thinking. We should talk about Qwo and Cellfina. Because when people think bias, they think cellulite. Which I just I want to tell you guys, public service announcement, cellulite is physiologic. It’s the little connections between the skin and the underlying muscle and then the fat puffs around it. I mean, it’s basically like upholstery with the buttons causing the indentation. My 2-year-old has cellulite. It’s cute on her little tush, but it’s normal. It’s not… I’m not going to close out Instagram to turn off the alarm, but the sleep timer will go off again in 10 minutes. Hey, dude, you just kicked your plate off the table. Please pick it up.
So yeah, people worry about cellulite a lot. Qwo came out last June. And everybody was really excited about it. And it’s made by the company that makes XIAFLEX, which is a collagenases, it breaks down collagen and it was used in Dupuytren’s contracture, which is basically where you get overabundant collagen formation in the hand. So you inject it and it breaks it up. So they thought, “Hey, we could do this for cellulite.” I have not used it, but I’ve heard a lot. Have you used it at all? Did you try it?
Dr. Gallus: I haven’t. I would not try it personally because…not because I don’t have cellulite, but because of my skin tone. So, you know, I’m a type 4. So my Hispanic origins, I tan easily. But also I’m prone to hyperpigmentation. And so one of those things that they’ve seen with these injections is that you get quite a bit of bruising. And with that bruising, you can get something called hemosiderin deposit, so that bruising deposits in your skin and turns it brown and then takes, I don’t know, years… it can be really…
Dr. Greer: A long time. And the thing is the bruising isn’t from the injection, the collagenase is actually disrupting the micro-vasculature. So the linings are on the blood vessels and they’re leaking. So I mean, it looks like you got run over by a car. It’s really dramatic.
Dr. Gallus: Right. And one would think that… Yeah, it’s really… So you think, “Oh, I’m going to get my cellulite treated. It’s going to break up these bands and I’m going to run off to the beach.” Nope, because you’re going to look like someone beat you up for about six weeks, eight weeks, maybe…
Dr. Greer: It’s a long time.
Dr. Gallus: And then you need to get multiple treatments like anything. So yeah, so I think that’s kind of…I feel like it’s falling into the Kybella trap of it seems like a really good idea. And then in practice, it’s not panning out.
Dr. Greer: Not worth it.
Dr. Gallus: What was I gonna say about… Oh, Stella’s on this call. She had neck surgery and had a huge amount of hemosiderin deposit. And I feel like she would attest to because she has Pacific Islander origins or Thai, I can’t remember, I should know that. Anyway, it looked like someone had strangled her for a long…like, a huge, just purple stripe across her neck. And it took a really long time to fade. So, you know, not that I would want it around my neck, but you definitely don’t want it on the back of your thighs. So we’ll see, you’ll figure it out. Yeah. Remember, it did take a long… Thai and Chinese. There we go. Thank you. Yeah, so I have not tried it. I don’t think I’d be a good candidate. I did laser like a small vein on my leg one time. And I feel like I can still see where the blood clotted. So I’ve traded off one thing for another. What about Cellfina? Any experience with that, the other cellulite magical…?
Dr. Greer: Yeah, I have not used it. I remember the rep came out and talked to us about it. And basically, it’s just a little gadget that allows you to cut the bands with a needle. It’s like $80,000 too, and I was like, “That is very expensive for a little plastic gadget.” And the rep looked at me and he’s like, “Well, yeah, I feel like what do you say to that?” But it basically just like stabilizes the area and then you come in at 90 degrees in two different vectors so that you can cut that band, and then you’re doing each little dimple. So I think it can get good results on the bigger dimples. But it seemed… Like, I wasn’t interested in getting it because it just looks so tedious and boring and I didn’t want to do it.
Dr. Gallus: Yeah, sometimes it’s not worth it for us.
Dr. Greer: Yeah. Like, there are procedures I don’t want to do. And that was one of them.
Dr. Gallus: Yeah, I don’t know. Again, I think the results are limited. It depends a lot on patient selection, and technique, and all of those things, unfortunately. I’m dying for them to come out with a cellulite cure.
Dr. Greer: That and stretch marks, we would be millionaires.
Dr. Gallus: Yes, stretch marks as well. So we can just talk about stretch marks for a second because you see them on the thighs as well. I always explain it to my patients is that it’s as if you had a cut in your skin, except it didn’t go through the top layer, the epidermis, it just cut in the dermis. And so the dermis that separated the epidermis is still together. And that’s what it is. That’s what the stretch mark…
Dr. Greer: Yeah, it’s like a tear. If you cut through the skin, it’s thinner there, much thinner. So it’s not like you can remove it, laser treatments…there have been so many laser protocols with, like, combination of fractional with BBL. And the thing about stretch marks, if they’re so red, you can fade them faster. But once they’re flat and white, there is nothing you can do except just remove that skin. That really works.
Dr. Gallus: You’d have to cut them out. I mean, the idea behind doing the laser treatments is to stimulate collagen in that area and try and thicken it up. But it is…
Dr. Greer: It’s very limited returns for the amount of work and effort you have to put in. I mean, we’re talking like 10 laser treatments for a very, very minor improvement.
Dr. Gallus: Right. It’s not going to disappear. It’s a scar and we are unable to make scars disappear. But yeah, crepey skin, speaking of the anterior thighs again, I have done micro-needling to stimulate collagen. I have been asked to do fractionated CO2 to the thighs, so to stimulate collagen. And all of those should theoretically work and thicken up the skin and help tighten it over time. It’s just not as dramatic as an actual thigh lift where you’re just sizing the skin and hauling everything up. And then the other thing I’ve done for that crepey skin around the knee is dilute radius, which has really well. I like that.
Dr. Greer: Yeah, done in upper arm skin. And it does thicken things up a bit.
Dr. Gallus: Right. And so that’s just another…it’s a filler product hydroxyapatite you dilute it in saline. You inject around those little wrinkles and it kind of fills it out, and also stimulates collagen in that area to soften up that wrinkling. I mean, it’s a little painful but not overwhelmingly and you’re, again, bruising. You’re not going to do it right before you need to walk the runway, but it’s totally doable. And so I’ve been pleased with how that’s worked. Those are kind of all the thigh trouble areas. What are we missing?
Dr. Greer: Yeah, I mean, that’s…
Dr. Gallus: I love our agenda for these things. Let’s just think.
Dr. Greer: Let’s talk about what we hate about our thighs and what we’re doing. Yeah. I mean, that’s… I mean, thighs are pretty straightforward.
Dr. Gallus: I started seeing more women who weren’t massive weight loss patients who wanted thigh lifts. And I called Michelle Shermak, who’s a great plastic surgeon in Baltimore and does a lot of body contouring. And I was like, “I don’t know. Do you think she needs a thigh lift? I mean, I can pick up the skin on my thigh and pull it up.” And she’s like, “I don’t know, Kat. Maybe get a thigh lift.” I was like…
Dr. Greer: Thanks, Michelle. We’ll come see you.
Dr. Gallus: Thanks for that. Okay, great. Yeah, maybe I do. Just because I can find skin I can exercise.
Dr. Greer: I can tell you all the procedures I need. Okay, I have a noodle in front of me. Lincoln, get down. Dude, ow. He’s not that small.
Dr. Gallus: Oh my gosh, that dog is big. What kind of dog is that?
Dr. Greer: He is a Schnauzer poodle mix, a Schnoodle. And he’s 20 pounds. He’s not huge, but he’s extra fluffy right now, because we haven’t clipped him because it’s winter. And he actually likes being brushed. So he’s like super fluffy. He just likes to snuggle. He’s like a boy.
Dr. Gallus: I kinda can’t see where his eyes are.
Dr. Greer: They’re like… There’s your face. Yeah, it’s kinda dark in here, too. Oh, hi, Wyatt. Wyatt’s back.
Dr. Gallus: So, yeah. So that’s kind of… Oh, what are you talking about recovery from thigh lift.
Dr. Greer: My spiel is pretty much the same for almost any procedure, like expect a week off work, I don’t leave drains, it’s going to be sore and tight. Dude, stop. No heavy workouts for four weeks. So no heavy cardio. No lifting more than about 15 pounds.
Dr. Gallus: Do you put people in a postoperative garment?
Dr. Greer: Yeah, I do. Yeah, I have them do…I do a compression garment with, like, above the knee. So it’s like shorts.
Dr. Gallus: Right. Yep, I do the same thing.
Dr. Greer: Yeah, although I think the swelling there is not awful, it goes down pretty fast.
Dr. Gallus: Yeah, I have them wear a compression garment, try to keep your feet up as much as possible during the healing process, which is hard to do. And then I do feel like thigh liposuction, there’s definitely a lot more swelling than actual surgery and can take a while for things to settle down. You’re like, “Did you actually take anything from my thighs because they’re bigger after you do the liposuction?”
Dr. Greer: You’re like, “I have pictures of the canister. It’s pretty full.” I like to liposuction the knee, too, whenever I’m doing the thighs. There’s just like a little bit of fat on the inside, makes all the difference.
Dr. Gallus: Yeah, absolutely. Awesome.
Dr. Greer: Yeah. What do you guys want to hear about next time? Let’s see. Oh, actually, in two weeks, I will hopefully be on a cruise in the Caribbean with my mom and my kids, providing everybody tests negative for COVID.
Dr. Gallus: Unless you’re…
Dr. Greer: Yeah. Well, I’ve had it twice, everybody else has had it once. So hopefully, it will be okay.
Dr. Gallus: Wow, that’s great. What cruise line are you gonna go on?
Dr. Greer: We’re going on Royal Caribbean.
Dr. Gallus: Okay. Nice. That will be fun.
Dr. Greer: A big ship. Yeah. I mean, there’s like an ice rink and a climbing wall. Like, we may not get off the ship. The kids will love it. Ice cream and pizza anytime they want.
Dr. Gallus: Right. Yeah, it’s hard to say no to that. That’ll be great. Yeah, so we’ll touch base about when we’re actually going to do this. Hopefully, it’s after your cruise, and you don’t have to tan. Wear sunscreen.
Dr. Greer: Have you seen me? I don’t have melanin. I just burn. Yeah, I wear so much sunscreen.
Dr. Gallus: Good. All right. Yeah. So if anybody has suggestions for what we should talk about, send them our way. Oh, browlift. Yeah, okay.
Dr. Greer: You know, that’s a good one, because I’ve actually changed… Did we talk about that recently? I don’t think we have talked about that one in a while. And I changed techniques this past year too. So that’s nice.
Dr. Gallus: I love it. Thanks, Stella.
Dr. Greer: Cool, appreciate it.
Dr. Gallus: All right. Well, I’ll let you get back to attending to the kids and I’m going to go…
Dr. Greer: Yeah, my pile of children. Awesome. Have a good night.
Dr. Gallus: All right. You too. Bye.
About Restore SD & Dr. Katerina Gallus
As the Director of Restore SD Plastic Surgery, board certified female plastic surgeon Dr. Katerina Gallus has over 15 years of experience helping San Diego women enjoy head to toe rejuvenation with face, breast and body procedures. After a successful career as a Navy plastic surgeon, Dr. Gallus founded Restore SD Plastic Surgery with the intention of creating a welcoming space for anyone seeking cosmetic enhancement.
Restore SD Plastic Surgery offers popular facial rejuvenation procedures like facelift & neck lift, facial fat grafting, and eyelid lift; breast augmentation with implants, breast lifts or breast reduction; body contouring procedures such as tummy tuck, liposuction, mommy makeover, and Brazilian butt lift (BBL), as well as aesthetician services, BOTOX, injectable fillers, and laser treatments.
