59. Buttock Augmentation



10.1055/b-0038-163183

59. Buttock Augmentation

Sammy Sinno, Constantino G. Mendieta

Background


1




  • Buttock augmentation rapidly increasing in popularity




    • 58% increase in 2014 in the United States according to the American Society for Aesthetic Plastic Surgery



    • Over 35,000 patients have had gluteal implants placed in the United States and Brazil.



    • Approximately 10,000 patients per year undergo buttock augmentation with fat grafting in the U.S.



    • Celebrity and social media attention to gluteal augmentation has attracted even more interest in the general population.



  • Three major methods of augmentation




    • Autologous fat grafting



    • Silicone implants



    • Autologous flap augmentation (in massive-weight-loss patients)



Indications


2 – 4




  • Ideal for patients in good health who desire improved gluteal shape and contour



  • Thin patients typically have very dramatic results.



  • Overweight patients require additional liposuction to improve contour.



  • Slightly overweight patients are excellent candidates for autologous fat grafting.




    • Excellent results seen for patients with excess sacral, lower back, and posterior triangle fat



Senior Author Tip:


The choice of operation, autologous fat grafting versus silicone implants for gluteal augmentation is typically based on amount of fat available. If the patient has enough fat, a fat grafting is performed. If not, a gluteal implant is performed. To date, no systematic reviews exist that compare overall safety and efficacy of these two strategies (particularly for implants)



Contraindications




  • Pregnancy



  • Neoplasm



  • Severe comorbid conditions



Preoperative Evaluation




  • Understand the anatomy of the gluteus maximus muscle (Fig. 59-1).




    • Origin along lateral sacrum and continues upward to posterior iliac spine



    • Attaches to superior iliac crest



    • Inserts into iliotibial tract and greater trochanter



  • Divide each buttock into four quadrants.

Fig. 59-1 Gluteus maximus muscle anatomy.


Tip:


Ideally, each quadrant should have equal volume




  • Understand key anatomic landmarks (discussed below).



Tip:


The lower inner gluteal fold ideally is diamond shaped




  • Evaluate the buttock laterally.




    • Presacral area should have a lazy-S shape.



  • Preoperative pinch test to evaluate donor fat areas



Senior Author Tip:


For autologous fat grafting, ensure patients have enough donor fat, because the amount of fat needed can range from 450-1800 cc or greater per side



Informed Consent




  • Fat grafting patients should be informed that lipoharvest, not liposuction, for removal is goal.



  • Silicone implant patients should be informed of risk of wound dehiscence, implant exposure, capsular contracture, infection, seroma, extrusion, and displacement.



  • Patients should be encouraged to avoid any medications that may promote bleeding before surgery.



  • Enema is given day before surgery.



  • Preoperative antibiotics are commonly given.



Senior Author Tip:


Keep in mind that aesthetic ideals for gluteal augmentation may vary between ethnic groups



Equipment



Autologous Fat Grafting


2 , 5




  • Large-bore cannula (4 mm and 5 mm)



  • Several techniques for processing, including centrifugation, can be used but are time consuming.



Tip:


A metal strainer can be used to irrigate and purify autologous fat




  • Large-volume syringes (60 cc), Autoinfusion systems do not exist.



Silicone Implants




  • Lighted retractors



  • Long instruments



  • Implant selection (silicone)




    • High cohesive gel-filled texturized



    • High cohesive gel-filled polyurethane surface cover



    • Elastomer solid implant



    • Can be anatomic, oval, or round shaped



Technique



Autologous Fat Grafting (Mendieta)


6 – 10




  • Conceptualizing the 10 aesthetic units of the posterior region is essential.



  • Respecting these aesthetic units is crucial to obtain a smooth contour (Fig. 59-2).



  • General or IV sedation



  • Patient marked standing; all zones



  • Landmark areas identified




    • Posterior superior iliac spine (marks gluteal muscle height)



    • Presacral “V” (superior point of intergluteal fold and posterior iliac dimples)




      • Zone 1



      • When liposuctioned creates desirable contour



    • Midlateral buttock contour




      • Ideally has no depression



    • Can give preoperative steroids for swelling, antibiotics, antireflux medications (patient will be in prone position)



    • Wetting solution injected



    • Supine position



    • Fat harvest through 5 mm cannula in deep layers and 4 mm cannula in superficial layers




      • Most fat in buttock removed from zones 1, 2, 3, and 4


Fig. 59-2 Mendieta’s 10 aesthetic units or zones. (1, Sacrum; 2, flank; 3, upper back; 4, lower back; 5, outer leg; 6, gluteus; 7, diamond zone: inner gluteal/leg injection; 8, midlateral buttock point C; 9, inferior gluteal/posterior leg junction; 1 0, upper back.)


Tip:


Typically, liposculpt zones 1 through 4, carefully liposuction in zone 5, and remember that fat transfer is difficult in zone 8 because of the paucity of muscle

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May 18, 2020 | Posted by in Aesthetic plastic surgery | Comments Off on 59. Buttock Augmentation

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