23 Buttocks
Summary and Key Features
• The gluteal region is an important component of body beauty
• There is an increasing search for techniques and products to enhance body shape and contours
• Autologous fat is abundant, easily collected, and promotes long-lasting results
• The donor area is chosen to contribute also to the final aspect of the buttocks: while liposuction models its shape, lipotransfer improves its projection
• The best areas to augment firmness and volume are the two upper quarters of the buttocks; the amount of fat tissue used is around 100–200 mL per side
• The hyaluronic acid used for body contouring is a large-particle gel called Macrolane VRF (Volume Restoration Factor)
• Indications include: correction of concave body deformities, trauma scars, and for shaping and augmentation of body areas, like calves, buttocks, chest, and breasts
• Advantages are the known safety record of NASHA™ (non-animal stabilized hyaluronic acid) products, no requirement of donor site, little downtime, reversibility, and performance on an outpatient basis
• The main disadvantage is cost when large amounts of the product are needed
Aesthetic characteristics of the buttocks
The shape of the buttocks is determined by anatomical structures such as the underlying bone component, gluteus maximus muscle, adipose tissue, and skin. Their combination and interaction give individuals their characteristic buttock shape. According to ethnic ideals, some characteristics of the gluteal region should be preserved, recreated, or corrected in order to enable a harmonious result in relation to the rest of the body. They are described here and summarized in Box 23.1.
Lateral depressions: formed on each buttock at the greater trochanter by the medius gluteus, external vastus, gluteus maximus, and quadratus femoris muscle insertions.
Gluteal augmentation with fat grafting
Fat may be obtained as a single process associated with regional or circumferential liposculpture, or combined with other procedures such as lipectomies. Table 23.1 describes the tumescent solution used for gluteal augmentation. Fat extraction is performed using 3–4 mm blunt-tipped cannulas to avoid the destruction of the adipocyte, with continuous negative aspiration at 0.5 atmospheres of pressure, collected in a sealed vial. For minor procedures 10, 20, or 60 mL syringes may be used.
Table 23.1 Tumescent solution used for gluteal augmentation
| 0.9% Saline solution | 1000 mL |
| 2% Lidocaine | 25 mL |
| 1/1000 Ephinephrine | 1 mL |
| 8.4% Sodium bicarbonate | 12.5 mL |
