86 Buttock Augmentation: S-Curve®

Nathaniel L. Villanueva and Ashkan Ghavami

Abstract

The S-Curve® procedure is an effective and powerful way to enhance patients’ silhouette. Patient selection and preoperative planning are critical in achieving excellent outcomes. Execution of the procedure requires an understanding of gluteal aesthetics and anatomy. During the procedure selective release of ligamentous anatomy allows for intraoperative expansion and shaping of the buttock. The fat transfer should only be in the subcutaneous space to improve the safety of the procedure. Postoperatively, patients should be educated on key recommendations to improve graft survival and optimal trunk contour. Overall, this procedure provides an aesthetically pleasing S-shaped silhouette by narrowing the waist and augmenting the buttocks.

Buttock augmentation – S-curve – gluteal augmentation – fat transfer – Brazilian butt lift

86 Buttock Augmentation: S-Curve®

Key Points

Patient selection and management of expectations are important in achieving safe, good outcomes and patient satisfaction.
Preoperative planning and markings with a thorough understanding of the patient’s anatomy are critical to obtaining an aesthetically pleasing S-curve silhouette (Fig. 86.1).
Precise contouring of the waist and thighs with suction-assisted lipectomy are as important as the fat transfer to the buttocks in order to achieve ideal silhouette and transitions from back and thighs to buttocks.
Buttock fat transfer should be performed with small aliquots in the subcutaneous space only with continuous motion.
Overcorrection should be avoided because increased pressure may decrease graft survival and may create unwanted future buttock ptosis.

86.1 Preoperative Steps

86.1.1 Patient Selection

Ideal patients will have sufficient donor fat for gluteal fat transfer.
Thinner patients can also achieve dramatic results with modest trunk liposuction and fat transfer to select zones in the gluteal region.
Patients with insufficient donor fat can be instructed to gain weight with a diet targeted to increase fat lobule volume.
Patients with personal or family history of hematologic disorders (deep venous thrombosis, pulmonary emboli, bleeding diathesis, etc.) may be contraindicated for the procedure but should be evaluated by hematologist prior to proceeding.

86.1.2 Understand the Patient’s Anatomy

Knowing subcutaneous, neurovascular, muscular, and ligamentous anatomy is key to getting optimal results.
There are four general trunk and buttock shapes: A frame (desirable), V frame, H frame, and round (Fig. 86.2).