59. Buttock Augmentation

Sammy Sinno, Constantino G. Mendieta

BACKGROUND¹

■ 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

CONTRAINDICATIONS

■ Pregnancy

■ Neoplasm

■ Severe comorbid conditions

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

Fig. 59-1 Gluteus maximus muscle anatomy.

• 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.

■ Understand key anatomic landmarks (discussed below).

■ Evaluate the buttock laterally.

• Presacral area should have a lazy-S shape.

■ Preoperative pinch test to evaluate donor fat areas

AUTOLOGOUS FAT GRAFTING2,5

■ Large-bore cannula (4 mm and 5 mm)

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

■ 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).

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; 10, upper back.)

■ 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

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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5. Basics of Anesthesia for the Aesthetic Surgery Patient 17. Ablative Laser Resurfacing 35. Lower Blepharoplasty 53. Mastopexy Tissue Glues Nasolabial Fold

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