With the variety of bariatric procedures available today, there is a steadily growing stream of massive weight loss patients. Although there have been major advances in upper extremity and upper and lower truncal contouring, the lower extremity often remains the most difficult to treat. Historically, thigh reductions were designed to treat minor medial thigh laxity. The technique described in this article is specifically designed for the massive weight loss patient who presents with extensive thigh deformity. For lesser deformities more traditional techniques should be used.