87 Safe Subcutaneous Buttock Augmentation

Ira L. Savetsky and Daniel A. Del Vecchio

Abstract

Gluteal fat grafting is the most rapidly growing cosmetic surgery procedure in the current era and is the most controversial in terms of safety. Simultaneous separation tumescence (SST) and expansion vibration lipofilling (EVL), combined with proper training in aesthetics and in technique, empower the properly trained plastic surgeon to perform buttock augmentation effectively and safely.

Gluteal fat grafting – Brazilian butt lift – simultaneous separation tumescence – expansion vibration lipofilling

87 Safe Subcutaneous Buttock Augmentation

Key Points

Fat can be safely placed in the subcutaneous space without inadvertent injury to the gluteus maximus muscle fascia.
Sufficient and reliable intraoperative expansion of the subcutaneous recipient site allows for adequate domal projection and aesthetics without the need to place fat into muscle.

87.1 Background

Simultaneous separation tumescence (SST) and expansion vibration lipofilling (EVL) are technically superior to obsolete Klein needle tumescence and syringe-based fat grafting techniques for large volume fat grafting on the basis of multiple attributes:
- Vibration allows ease of navigation in the recipient site, less fatigue, and better dispersion of fat.
- Roller pump eliminates thumb adduction to propel fat flow, resulting in less fatigue.
- Reduced fatigue allows surgeon to focus on location of cannula tip with every stroke.
- Canister versus syringe design makes volume documentation easier for staff.
- Canister design eliminates syringe transfers and is less time-consuming.
- Vibrating exploded cannulas disrupt fibroseptal network, allowing intraoperative subdermal manipulation of recipient site.

87.2 Setup

It consists of a double-barrel stand holding two canisters, a 3-L flat canister with a lid (suction canister), and a 3-L (“slant”) canister. The slant canister has a 1/4ʺ spigot at the bottom of the slant, completely eliminating all contents of the canister out of the spigot by simple gravity.
The canister stand is placed on a Mayo stand at the foot of the operating room (OR) table, but not over the table itself.
From the spigot of the slant canister 0.25-inch tubing is connected, and a loop of this tubing is passed off the sterile field to a roller pump, which is situated immediately adjacent to the Mayo stand. Returning to the sterile field, the end of the tubing is connected to a basket cannula on a Microaire PAL handle. This constitutes the vibratory inflow setup.
The flat canister (Medela Corporation, Highland Park, IL) containing a lid has two sets of tubing connected to it. From the canister, one tubing goes from the lid to a vacuum source, while the other tubing goes from the lid to a liposuction cannula, typically a 4 mm or 5 mm × 50 cm, 12-hole cannula (Wells Johnson, Tucson AZ) (Fig. 87.1).

Fig. 87.1 Instrumentation setup for expansion vibration lipofilling. Canister spigot, tubing, and cannula size are all of equal diameter to avoid any one area of high resistance and shear.

87.3 S imultaneous Separation Tumescence

During tumescence, solution is simply poured into the slant canister and simultaneous separation (basket) and tumescence (SST) is performed. The combination of blunt tipped basket cannulas, vibratory motion, and fluid head advancement results in minimal to no bleeding during this maneuver.
Liposuction is immediately commenced using manual cannulas and is collected into the flat canister. As each aesthetic is treated, the canister is changed out to guarantee equal removal in each side.
Once all fat is removed from a donor site aesthetic perspective, fat is allowed to separate from blood and crystalloid while equalization is performed to the donor site.
The harvested fat may be washed with Poloxamer 188 if the operator wishes (SurClens, Convatec Inc.) or simply divided into two equal volumes, placed into the slant canister, and grafted using EVL.