Gluteal Augmentation and Remodeling

Fig. 17.1

Sciatic nerve anatomy. Reproduction of a lithograph plate from Gray’s anatomy (Henry Gray, Anatomy: Descriptive and Surgical)

The superior gluteal nerve originates in the pelvis and innervates the tensor fasciae latae muscles and the gluteus medius and minimus.

The inferior gluteal nerve is mainly responsible for motor innervation of the gluteus maximus muscle. It extends the thigh to execute activities such as climbing stairs.

All the cited nerves are placed deeply into the gluteus maximus.

The superficial branch of the superior gluteal artery enters the deep surface of the gluteus maximus and supplies the muscle anastomosing with the inferior gluteal artery. Numerous terminal branches perforate its tendinous origin to supply the superficial tissues covering the posterior surface of the sacrum.

The inferior branch of the gluteal artery descends in the gap between the greater trochanter of the femur and tuberosity of the ischium and is continued down the back of the thigh, supplying the skin. It anastomoses with branches of the perforating arteries.

17.2 Pitfalls

Accidental injuries to nerve and vessel of gluteal region can be avoided by introducing the injecting cannula in the subcutaneous layer, keeping the hedge superficial to the muscularis fascia of the gluteus (Fig. 17.2).

Fig. 17.2

The sciatic nerve is located in a deep plane. Reproduction of a lithograph plate from Gray’s anatomy (Henry Gray, Anatomy: Descriptive and Surgical)

17.3 Buttock Augmentation by Hyaluronic Acid

Buttock augmentation by hyaluronic acid is a simple procedure, performed in the office operating room under local anesthesia.

17.3.1 Indications

Improvement of gluteal contour.

17.3.2 Contraindications

The filler should not be injected in areas that lack sufficient blood supply or that have an infection or inflammation.

No injection should be done if the hand has been previously treated with liquid silicone or other permanent fillers because new injection could lead to inflammation or infection of the implants.

Any hypersensitivity to any components of the filler obviously constitutes a contraindication for the treatment.

17.3.3 Operating Time

The procedure usually takes 30 to 60 min.

17.3.4 Materials

Usually, the procedure is performed using 80 to 200 cc of hyaluronic acid and Macrolane VRF20 or Hyacorp 500 (40 to 100 cc injected in every buttock) (Fig. 17.3)