Before discussing treatments for legs, let’s first define “legs”: For our purposes, “legs” are below the knees, and “thighs” are above the knees.

Common complaints for thighs are:

1. “Saddle-bags.” This is typically treated with liposuction if the only problem is excess fat.

2. Excess fat in the top of the inner thighs. This, too, can be corrected in most cases with liposuction. The skin in the inner thigh tends to sag, however, so tightening of the skin may give a better, tighter result. Renuvion or ThermiTight will tighten the skin and can be done simultaneously with the liposuction. Renuvion appears to be safer and tightens skin better and faster through the use of radiofrequency plus Helium.

3. Cellulite is treated with Cellfina, which severs the fibrous band pulling the skin in causing the dimples. This is most effective for true cellulite, which are isolated dimples of the buttocks, lateral thighs and front of the thighs. It can be combined with any of the other procedures mentioned in this article.

4. Multiple wrinkles and saggy skin of the thighs. This comes in many different forms and degrees and is often a result of weight loss. Some of these patients require liposuction, but most sagging is just from loose skin and not necessarily with excess fat.

To date, the most effective treatment to diminish thigh wrinkles is to use a liposuction cannula, called a basket cannula, to separate the fat from the surrounding fibrous bands, with or without liposuction, as needed. The basket cannula disperses the fat more evenly, spreading it out, creating a smoother thigh. Essentially, these are your own internal fat grafts without actually removing the fat from the thighs. The process is called equalization, and it results in smoother thighs.

Thigh dimples, irregularities, and lumpiness often include loose skin, so the basket cannula equalization is usually followed with the Renuvion to tighten the skin. If it is decided that the thighs would need even more tightening, an inner thigh lift can be performed at the same time.

5. Wrinkles above the knees. If these are fine wrinkles, the Renuvion or ThermiTight procedures usually will suffice. If more severe, either can be followed with a micro-needling device that emits radiofrequency at the same time to tighten the skin even more, such as the Pixel-8 or Vivaci.

6. Fatty inner knees are treated with liposuction. Generally, this is all that’s needed.

7. What about fatty ankles? These must be carefully liposuctioned so they are smooth and contoured looking from all angles.

Most of the above procedures can be performed with local or general anesthesia, according to the patient’s choice. The inner thigh lift and those procedures that involve the entire circumference of the thighs should be done under general anesthesia.

The procedures mentioned require compression garments for several weeks, according to the extent of the procedure.

E. Ronald Finger, MD, FACS is a board certified plastic surgeon with offices in Savannah and Bluffton.