Thigh lift: risks and complications from recent PubMed literature

How the PubMed evidence was selected

The literature search was limited to PubMed-indexed studies with a systematic review and meta-analysis design, giving priority to the most recent articles and those most closely related to thigh lift complications. Because meta-analytic literature specifically addressing thigh lift surgery is limited, studies were included across three levels of relevance: direct complications of the medial thigh region, body contouring complications and broader risk factors in aesthetic plastic surgery.

A 2024 meta-analysis compared seroma rates following procedures involving the medial thigh compartment, including medial thigh lift. Other recent meta-analyses evaluated smoking, obesity, surgical site infections and closed incision negative pressure therapy in plastic surgery.

General complication profile of thigh lift surgery

Thigh lift surgery is an effective procedure for correcting excess skin and tissue laxity of the inner or outer thighs, particularly after significant weight loss. However, it is also a procedure with a distinctive risk profile because the treated area is exposed to movement, moisture, tension across the suture lines and potential fluid accumulation. The most relevant complications include seroma, hematoma, wound dehiscence, infection, problematic scarring and delayed wound healing.

Available meta-analytic evidence relating to the medial thigh region indicates that seroma is one of the principal complications requiring consideration. Hematoma and wound dehiscence are also among the most important postoperative events that should be discussed during informed consent and surgical planning.

Seroma, hematoma and wound dehiscence: the most relevant complications

The main complications that should be considered in thigh lift surgery are:

Seroma: a collection of fluid beneath the skin after surgery. In thigh lift procedures, it may develop because surgery creates an internal space between tissue layers. The risk may increase because of movement of the area, tissue tension and inadequate postoperative incision management.

Hematoma: a collection of blood within the operated area. It may be mild and gradually resolve, but significant hematomas may require medical evaluation or specific treatment.

Wound dehiscence: partial separation of the surgical wound. This is a significant complication in procedures involving long or tension-bearing incisions, as may occur in thigh lift surgery.

The meta-analysis of the medial thigh region compared rates of seroma, hematoma and wound dehiscence between medial thigh flaps and medial thigh lift procedures, demonstrating that these complications should be considered a central component of informed consent and surgical planning.

Obesity and body mass index: a risk factor that should not be overlooked

Obesity is one of the most important factors in the assessment of surgical risk. In thigh lift surgery, this aspect is particularly relevant because many patients undergo the procedure after significant weight loss, often presenting with lax tissues, reduced skin elasticity and residual clinical conditions.

Meta-analytic evidence indicates that obesity is associated with a higher risk of complications and reoperations in plastic surgery compared with non-obese patients. This does not mean that every patient with an elevated body mass index is unsuitable for thigh lift surgery, but rather that risk assessment should be more rigorous.

Before surgery, current weight, weight stability, metabolic status, comorbidities and tissue quality should be carefully evaluated. This approach allows for a more accurate estimation of risk, safer surgical planning and a reduction in the likelihood of recovery-related complications.

Smoking and wound healing: why it increases risk

Smoking is an important surgical risk factor because it can impair tissue oxygenation, microcirculation and normal wound healing. In thigh lift surgery, this issue is particularly relevant because the incisions may be long and subjected to considerable tension.

Meta-analytic evidence indicates that smoking is associated with an increased risk of complications across several aesthetic surgical procedures. The main concerns include delayed wound healing, wound dehiscence, infection, problematic scarring and skin-related complications.

For this reason, smoking cessation and individual risk assessment should form part of preoperative preparation. A patient who smokes should not be evaluated solely from an aesthetic perspective, but also in terms of the tissues’ ability to heal properly after surgery.

Surgical site infections and prevention

Although infection is not the most common complication in every thigh lift procedure, it can have a significant impact on recovery, scar quality and the need for additional treatment. The risk may increase when factors such as obesity, diabetes, smoking, poor tissue quality, long incisions or difficulties in wound management coexist.

Meta-analytic evidence indicates that strategies for preventing surgical site infections should not be applied uniformly. Their effectiveness depends on the type of procedure, the patient’s risk profile and the clinical setting.

For this reason, thigh lift surgery requires a personalized approach, including careful preoperative assessment, appropriate skin preparation, proper incision management, scheduled follow-up visits and clear postoperative instructions.

Closed incision negative pressure therapy: a possible role in reducing complications

Closed incision negative pressure therapy is used in some surgical procedures to protect the wound and reduce the risk of local complications. In thigh lift surgery, its potential role is primarily related to the presence of long incisions, skin tension and the risk of fluid collections.

Meta-analytic evidence in plastic surgery indicates that this strategy may help reduce certain surgical site complications compared with standard dressings, particularly in patients at increased risk of wound-healing problems. This does not mean that it should be used routinely in every case. Rather, it should be considered an additional option for selected patients, for example, those with risk factors such as obesity, smoking, fragile tissues, extensive incisions or an increased likelihood of wound dehiscence and seroma.

High-risk population: patients after significant weight loss

Patients who have experienced substantial weight loss represent a distinct population. They often present with excess skin, lax tissues, previous scars, weight fluctuations, possible nutritional deficiencies and metabolic comorbidities. In thigh lift surgery, these factors may lead to increased tension across the incisions, a higher risk of seroma, delayed wound healing or wound dehiscence.

Meta-analyses on obesity, surgical site complications and smoking-related risk suggest that patient selection is an integral part of risk reduction. Assessing excess skin alone is not sufficient; stable body weight, smoking status, metabolic health, tissue quality and the patient’s ability to comply with postoperative recovery should all be considered.

Main predictors of risk identified in the literature

The selected meta-analyses identify several recurring predictors of risk:

• Elevated body mass index, associated with a higher risk of complications in plastic surgery;
• Smoking, associated with impaired wound healing and an increased rate of complications across many aesthetic procedures;
• Long or high-tension incisions, which are relevant to wound dehiscence and scar-related problems;
• Surgical dead space, associated with an increased risk of seroma formation;
• Post-bariatric status or a history of significant weight loss, requiring a more cautious evaluation;
• Postoperative wound management, including dressings, follow-up care and the possible use of advanced strategies in selected cases.

These factors do not act independently. The highest risk often occurs when several elements coexist, for example, a patient who smokes, has an elevated body mass index, requires a long incision and presents with tissues under considerable tension.

Thigh lift surgery: clinical implications for reducing risks and complications

PubMed evidence suggests that thigh lift surgery should not be presented as a simple aesthetic procedure for skin removal. It is an operation with predictable risks, particularly in patients who have experienced significant weight loss or who have uncontrolled modifiable risk factors.

From a clinical perspective, the main implications are:

• The risk of seroma and wound dehiscence should be clearly explained during the informed consent process;
• Smoking and obesity should be considered central factors in risk assessment;
• Infection prevention strategies should be tailored to both the patient and the procedure;
• Surgical incisions should be planned to minimize tension and reduce the likelihood of complications;
• Post-bariatric patients require a broader evaluation that extends beyond the aesthetic concern alone; 
• Postoperative management is an essential component of surgical safety and should not be regarded as a secondary detail.

Bibliography: Recent PubMed-indexed meta-analyses considered

Kilian KK, Panayi AC, Matar DY, et al. Similarity of Seroma Rate at the Medial Thigh following Free Flap Harvesting or Medial Thigh Lift: A Systematic Review and Meta-analysis. JPRAS Open. 2024. PMID: 38770115.

Bouhadana G, ElHawary H, Alam P, Gilardino MS. A Procedure and Complication-Specific Assessment of Smoking in Aesthetic Surgery: A Systematic Review and Meta-Analysis. Plastic Surgery. 2024. PMID: 38433792.

Gabriel A, et al. Closed Incision Negative Pressure Therapy Versus Standard of Care Over Closed Plastic Surgery Incisions in the Reduction of Surgical Site Complications: A Systematic Review and Meta-Analysis of Comparative Studies. Eplasty. 2023. PMID: 37187870.

Bigarella LG, Ballardin AC, Couto LS, et al. The Impact of Obesity on Plastic Surgery Outcomes: A Systematic Review and Meta-analysis. Aesthetic Surgery Journal. 2022. PMID: 35037936.

ElHawary H, Hintermayer MA, Alam P, Brunetti VC, Janis JE. Decreasing Surgical Site Infections in Plastic Surgery: A Systematic Review and Meta-analysis of Level 1 Evidence. Aesthetic Surgery Journal. 2021. PMID: 33693462.