Postoperatively, the patient is placed into elastic compression garments to help minimize seroma formation in the lateral thigh region. These are to be worn 24 hours a day for a 4-week period. Patients are encouraged to resume light activity within 36–48 hours after surgery. Patients may return to light exercise within 2 weeks of surgery and vigorous exercise within 4–6 weeks.
Since beginning the technique in late 2010, 18 patients have undergone the procedure (Figures 5 and 6). Depending on their physical dimensions and desire for more volume in the lateral thigh regions, three different types of implants were placed in the subfascial plane (small, medium, and large). Only 1 patient suffered a complication: suspicion of compartment syndrome. A 35-year-old woman presented within 1 week of surgery with complaints of tightness over the lateral thigh region on the right side. The skin was dusky and several vesicles were noted. Because of a lack of obvious signs of limb compromise, observation with daily wound checks were performed. Within 4 days, the duskiness improved and the vesicles disappeared. We believe the surgery was a success; however, the subfascial pocket was too tight for the size of the implant that was placed. Although it is important to maintain a snug fit around the implant to prevent migration, it has been our practice in subsequent patients to perform a more generous pocket dissection to prevent this type of complication.
*INDIVIDUAL RESULTS WILL VARY. THESE RESULTS DO NOT CONSTITUTE A PROMISE OR REPRESENTATION OF ANY PARTICULAR OUTCOME OR EXPERIENCE.
The waist-to-hip ratio (WHR) is the ratio of the circumference of the waist to the circumference of the hips. In the realm of general health, the WHR has been used as a measurement of obesity; those that have a higher index are typically more obese and have a greater the potential for serious health conditions. Research shows that people with apple-shaped bodies (more weight around the waist) face more health risks than those with pear-shaped bodies (more weight around the hips). A WHR of 0.7 for women and 0.9 for men has been shown to correlate strongly with general health and fertility. Women within the 0.7 range have optimal levels of estrogen and are less susceptible to such major diseases as diabetes mellitus, cardiovascular disorders, and ovarian cancers.1 The WHR has been found to be a more efficient predictor of mortality in older people than waist circumference or body mass index.
Along with being a method of assessing general health, the WHR has long been used as a measure of attractiveness. Devandra Singh, an evolutionary psychologist at the University of Texas at Austin, has argued in multiple articles that the WHR is a significant measure of female attractiveness. Women who have a ratio near 0.7 are usually rated more attractive by men from European cultures.3 Icons of the silver screen such as Marilyn Monroe and Sophia Loren, long touted as pinnacles of beauty, had a WHR close to 0.7.3–5 Singh proposed a hypothesis to explain how WHR influences female attractiveness and its role in mate selection, citing evidence from studies of the WHR of Playboy playmates and Miss America winners over the past 30 years to support his work.4 In a 2010 article, Platek and Singh6 used functional magnetic resonance imaging to demonstrate that male participants looking at naked female bodies with an ideal WHR (approx 0.7) showed excitation in the anterior cingulate cortex, an area associated with reward processing and decision making. This further supports the premise that men appreciate curvy women and helps us understand the change in modern culture toward a more shapely and voluptuous woman.
Women have gone to great lengths in the past to alter their WHR. The corset was invented as a tool to reduce a woman’s waist size to make her more physically attractive. Some women have resorted to hip and buttock padding to increase the apparent size of the hips and buttocks. Female cosmetic patients routinely employ liposculpture to help redefine their waist area. Of late, buttock augmentation has been another means by which a woman can increase the curves in the lower pole of the body to help achieve a more aesthetically pleasing figure. The authors have developed a solution for women who wish to increase their hip size to better suit the remainder of her figure and perhaps improve her level of attractiveness.
The placement of a lateral thigh prosthesis is not only facile but relatively safe. Because of the paucity of major structures in the lateral thigh region, the surgery can be performed with little fear of injuring a vital structure. After the incision through the skin is completed, the tensor fascia lata is exposed. It is through this band of fascia that the posterior branch of the lateral femoral cutaneous nerve arises. The lateral femoral cutaneous nerve of the thigh is a nerve of the lumbar plexus. This nerve bifurcates into anterior and posterior branches. The anterior branch becomes superficial about 10 cm below the inguinal ligament, and then it divides into branches that are distributed to the skin of the anterior and lateral parts of the thigh as far as the knee. The posterior branch pierces the fascia lata and supplies the skin from the level of the greater trochanter to the middle of the thigh posteriorly. Careful dissection of the fascia lata and use of blunt dissection below the fascia allows for the creation of a pocket with minimal risk of injury to the cutaneous nerves supplying the thigh region.
Potential complications of this procedure include, but are not limited, to the following: infection, seroma development, bleeding, implant extrusion, asymmetry, scarring, muscle damage, nerve damage (lateral femoral cutaneous), and compartment syndrome. However, because of the superficial position of the implant, the potential for injury to major structures is minimal.
Infection is minimized through the use of perioperative administration of antibiotics, bathing the implant in betadine before placement, and minimal handling of the implant by surgical staff. Seroma formation is prevented by using compressive garments for 4 weeks after surgery. In performing various muscle augmentation procedures, notably triceps and biceps augmentation, patients who were noncompliant with compressive dressings had a higher incidence of seroma formation requiring intervention. Bleeding is prevented by meticulous hemostasis throughout the procedure and avoidance of injury to the muscles of the thigh. Implant extrusion is prevented by performing an adequate dissection below the fascia lata, but at the same time allowing for a snug fit of the fascia around the implant. Scarring is minimized by closure in layers and avoidance of tension in the area overlying the implant. Nerve damage and muscle damage are minimized by using blunt rather than sharp dissection to create the pocket for the implant (Figures 7 and 8). By using tools such as the spatula dissector and hockey dissector along with blunt finger dissection, one is able to avoid sharp dissection and inadvertent laceration of nerve structures in the operative field. Finally, compartment syndrome can be avoided with proper placement of implants that are not overly bulky and creating an adequately dissected pocket for the lateral thigh implant.
The curvaceous woman is back in vogue again. The demand for fuller, more curvaceous thighs has increased, and we have developed an implant to meet that need. Through a minimally invasive operation, women with minimal lateral thigh projection can be given a more curvy form to better mirror modern societal views of the eye-appealing feminine form.