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International audience; Background - Increasing obesity prevalence and development of bariatric surgery have led to the development of skin re-draping techniques. Several contouring techniques have been described for treating the circumferential excess of the lower trunk. Materials and methods - We performed a systematic review to summarize surgical indications, operative techniques, peri-operative management (nutritional supplementation, antibiotic prophylaxis, thrombo-prophylaxis), outcomes, complications, patient satisfaction, and impact on quality of life of circumferential contouring of the lower trunk procedures. A systematic review, based on the PRISMA criteria, was conducted using the Pubmed and Cochrane databases. Results - The review included 42 articles and 1748 operated patients. Two studies only were graded as level of evidence II; the others were graded as levels III to V. The most frequently reported indication was massive weight loss. All the described techniques derived either from belt lipectomy or lower bodylift. Belt lipectomy resulted in a posterior scar situated at the waistline and allowed a better correction of hip back rolls, whereas lower bodylift was more effective on buttock and lateral thigh ptosis. The most reported complication was wound dehiscence. Patient satisfaction and quality of life scores were high in all studies. Conclusions - This review included a majority of low-level evidence studies that limit extrapolability of the results. Future randomized prospective studies may generate stronger evidence, with a standardization of surgical indications and operative techniques. Level of evidence iii - This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Obesity is a major public health problem in Western societies. It may lead to difficulties in daily life that have an impact on quality of life and create psychological disorders. After failure of diet and exercise, patients can undergo bariatric surgery, but some obese patients are not motivated to undergo a bariatric procedure. For such patients, plastic surgeons can correct some excess fat to improve their quality of life. This report describes an original technique for correcting the excess fat at the medial part of the knees to regain a normal walking perimeter. A 68-year-old woman was admitted to the authors’ center for correction of a functional walking disorder. Indeed, her clinical examination found a static disorder, with a valgus knee morphotype related to a major excess of skin and fat in the medial part of the knees. She underwent a knee dermolipectomy to obtain a solely functional result. No complications were observed in the woman’s postoperative course. At this writing, the result is stable 18 months after the surgical procedure, with a minimal visible scar hidden in the internal face of the knees. The woman has experienced a loss of her genu valgum and regained a walking distance longer than 1 km. She also has lost 10 kg of weight. Knee dermolipectomy is a simple procedure with good results and few complications that improves the quality of life for obese patients. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

International audience; BACKGROUND: With the increasing incidence of obesity in Western societies, an increasing number of patients undergo bariatric surgery that leads to functional and aesthetic sequelae related to a rapid and massive weight loss, namely, skin and fat excess. The goal of surgical management after massive weight loss is to optimize the functional results obtained from bariatric surgery or diet by removal of the redundant skin folds. The authors report their experience with medial thighplasty after massive weight loss and identify factors predictive of postoperative complications. METHODS: This retrospective study investigated 53 patients who underwent surgery for medial thighplasty after massive weight loss. Data were collected through chart review and submitted to statistical analysis. RESULTS: The average weight loss before thighplasty was 43.5 ± 14.9 kg, and 39.6 % of the patients experienced at least one complication. The complications were seroma (9.4 %), wound dehiscence (20.8 %), scar migration (17 %), wound infection (5.7 %), and partial skin necrosis (1.9 %). The body mass index (BMI) before massive weight loss and the BMI before medial thighplasty were found to be risk factors for the development of a postoperative complication. CONCLUSION: Few guidelines exist for the optimization of care and safety in this complex patient population. The information from this retrospective study complements the current data from the literature and can help surgeons select patients eligible for medial thighplasty. This report shows that the BMI before medial thighplasty should be taken into consideration for patients willing to undergo a body-contouring procedure. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Obesity is a major public health problem in Western societies. After failure of diet and exercise, patients can have bariatric surgery. Weight loss causes excess skin on the body, including the thighs. This leads to difficulty walking and psychological disorders such as devalued self-image. Medial thighplasty is an intervention to reduce excess skin and fat in the thighs. The main complications are scar migration, scar infection, hematoma, lymphedema, gaping vulva, and, rarely, skin necrosis. We describe a case of flap necrosis after a reoperation of medial thighplasty. Treatment included debridement of necrotic tissue and healing of the wound by secondary intention (vacuum-assisted closure and dressings with calcium alginate). Complete healing was achieved in 4 months. As the patient refused any new procedure, skin grafting was not performed. The aesthetic results of plastic surgery procedures are often imperfect. Patients should be clearly prepared and informed about the results expected from the operation. Surgeons should know contraindications for reoperation.