Buttock augmentation
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Buttock augmentation | |
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Specialty | plastic surgeon |
Gluteoplasty (Greek gloutόs, rump + plassein, to shape) denotes the
The corrective procedures for buttock augmentation and buttock repair include the surgical emplacement of a gluteal implant (buttock prosthesis); liposculpture (fat transfer and liposuction); and body contouring (surgery, liposculpture, and Sculptra injections) to resolve the patient's particular defect or deformity of the gluteal region.
Gluteoplasty has also been applied in the praxis of
Background
The functional purpose of the buttocks musculature is to establish a stable
Surgical anatomy of the buttocks
- Muscular origins and insertions
Anatomically, the mass of each
The
Like every pelvic-area muscle, the gluteus maximus muscle originates from the pelvis; nonetheless, it is the sole pelvic muscle not inserted to the
Innervation
The motor innervation of the gluteus maximus muscle is performed by the inferior gluteal nerve (a branch nerve of the sacral plexus) and extends from the pelvis to the gluteal region, then traverses the greater sciatic foramen (opening) from behind and to the middle to then join the sciatic nerve. The inferior gluteal nerve divides into three collateral branches: (i) the gluteus branch, (ii) the perineal branch, and (iii) the femoral branch. The first ramification—the gluteus branch—is a branch nerve that is very close to the emergence of the inferior gluteal nerve to the area, next to the inferior border of the pyramidalis muscle.[4] As it arises, the inferior gluteal nerve then divides into four or more fillets (bands of nerve fibres) that travel (in a crow's-foot configuration) between the gluteus maximus muscle and its (front) anterior fascia; the thickest nerve-bands are the superior-most and the inferior-most fillets. The superior-most fillet runs almost vertically, near the sacrum, and innervates the superior portion of the gluteus muscle; the inferior-most fillet, which has the greatest calibre, travels very close and parallel to the sacrotuberous ligament; the inferior-most fillet provides fine-gauge branch-nerve ramifications that innervate the gluteus muscle through its anterior (front) face.[citation needed]
In surgical and body contouring praxis, the plastic surgeon creates the implant-pocket—either for the gluteal prosthesis or for the injections of autologous fat—by undermining the gluteus maximus muscle with a dissection technique that avoids the
Vascularization
The superior gluteal artery, the inferior gluteal artery, the superior gluteal veins, and the inferior gluteal veins irrigate the gluteus maximus muscle with arterial and venous blood. The vascularization, the entrance of the blood vessels to the muscle tissues, occurs at the anterior (front) face of the muscle, very close to the sacrum. As the arteries and the veins enter the mass of the gluteal muscle, they divide into narrower blood-vessel ramifications (configured like the horizontal branches of a tree), most of which travel parallel to the muscle fibres.[citation needed]
In surgical and body contouring praxis, the plastic surgeon effects the implant-pocket undermining of the gluteus maximus muscle by carefully separating the muscle fibres to avoid severing the pertinent blood vessels, which would interfere with the blood irrigation of the muscle tissue. Therefore, to create an implant-pocket, either for a gluteal prosthesis or for lipoinjection, a low-angle muscle-dissection is performed in order to avoid the risk of severing any major branch—superior or inferior—of the gluteal artery, which travels very close to the sacrum and to the sacrotuberous ligament.[3]
Surgical procedures
Surgical therapy
While the resolution of the defects and deformities of the gluteal region can be realized surgically, the assessment of the degree of severity of the injury organizes treatment therapies into three types: (i) buttocks augmentation, (ii) buttocks reduction, and (iii) contour irregularity treatments that combine surgery and liposculpture (liposuction and fat-injection).[1]
Buttocks augmentation treatments
Gluteal implants
The augmentation of the buttocks is realized with a gluteal implant, which is emplaced under each
Lipoinjection
The augmentation and contouring of the buttocks with
Body contouring
The augmentation of the buttocks, by rearranging and enhancing the pertinent muscle and fat tissues of the gluteal region, is realized with a combined gluteoplasty procedure of surgery (subcutaneous dermal-fat flaps) and liposculpture (fat-suction, fat-injection). Therapeutically, such a combined correction-and-enhancement procedure is a realistic and feasible lower-body-lift treatment for the man and for the woman patient who has undergone massive weight loss (MWL) in the course of resolving obesity with bariatric surgery.[9][10][11] In the case of the man or woman who presents under-projected, flat buttocks (gluteal hypoplasia), and a degree of gluteal-muscle ptosis (prolapsation, falling forward), wherein neither gluteal-implant surgery nor lipoinjection would be adequate to restoring the natural anatomic contour of the gluteal region, the application of a combined treatment of autologous dermal-fat flap surgery and lipoinjection can achieve the required functional correction and aesthetic contour.[1]
Buttocks reduction treatments
The methods for reducing the size of the buttocks include the varieties of
Ultrasonic lipectomy
Ultrasonically assisted liposuction can quickly remove a large volume of
Superficial liposculpture
Reshaping the buttocks with liposculpture is performed with a small cannula (2 mm) specifically for contouring superficial body fat, the configuration of which (number of open ports) is determined by the type and the degree of gluteal correction to be realized. To sculpt rounded contours to square-shaped buttocks muscles, superficial liposculpture allows the plastic surgeon to control the injection-rate of the fat-volume. Moreover, superficial liposuction can be combined with other treatment methods for contouring the gluteal region to achieve the required functional, anatomic correction, and the aesthetic enhancement sought by the patient, such as reshaping the lateral area of the buttocks into an athletic form.[12][13] The study Contouring the Gluteal Region with Tumescent Liposculpture (2011) indicated that effective, gluteal-region contouring is best achieved by tailoring the liposuction-reduction and the lipoinjection-augmentation techniques to the anatomic topography of the body areas to be corrected.[14] Furthermore, the study Contouring of the Gluteal Region in Women: Enhancement and Augmentation (2011) indicated that natural contours of the buttocks and the thighs are effectively achieved with a combined gluteoplasty of selective liposuction and lipoinjection, which reduces the need for aggressive surgical procedures, decreases the risk of medical complications, abbreviates wound-recovery-time, and lessens post-operative scarring. Combined with any buttocks-correction method, superficial liposculpture facilitates the treatment of contour irregularities, the surgical revision of scars, and the correction of gluteal-region contour depressions.[15]
Surgical technique
Surgical contouring of the gluteal region
Pre-operative matters
To meet the functional requirements and the aesthetic expectations (
Intra-operative matters
Once the patient is atop the operating table, the surgeon positions him or her to best expose the pertinent gluteal-region area that is to be corrected or contoured, or both; the usual operative position is the prone (face down) position, but the patient can also be positioned laterally (on his or her side). The surgical correction plan can be delineated and marked to the patient's body when he or she is awake (before sedation or anaesthesia) or it can be delineated when the patient is on the operating table (already
Operative matters
Once the patient is in the operative position, the surgeon begins the liposuction correction by making incisions to the marks of the surgical-correction plan, and then infiltrates (injects) a solution of anaesthesia- and tumescence-inducing drugs, usually a combination of
For a lipoinjection augmentation, the surgeon first dissects and prepares the augmentation-pocket to which will be injected the autologous fat-tissue. The surgical creation (muscle dissection) of the augmentation-pocket avoids the gluteal innervation (
Post-operative matters
After completing the surgical corrections and the lipoinjection contouring of the pertinent area(s) of the gluteal region, the surgeon thoroughly examines the patient to ensure his or her general recovery from the operation; and examines each surgical incision to ascertain that it is correctly sutured and taped, in order to facilitate the uneventful healing of the gluteus-muscle tissues, without medical complications. The patient is advised to avoid exercise and strenuous physical activity until 3-weeks post-operative; how to properly care for surgical-incision wounds; and how to wear a compression garment that will keep in place the surgically corrected tissues, and so ensure their healing as a whole anatomic unit of the gluteal region.[1]
Follow-up and convalescence
The physician advises the patient who has undergone a surgical contouring of the buttocks with gluteal implants, that, although immediate results can be observed, the final, corrected body contour usually is observed at 6-months post-operative, and at 1-year post-operative, depending upon the tissue-healing capabilities of the patient's body. The liposculpture patient usually requires approximately 6 months, and occasionally 1 year before producing the final, corrected body contour. For both procedures, at approximately 1-month post-operative, marked aesthetic improvement is noticeable in the corrected body areas, as is the elimination of the initial, post-operative weight gain caused by the body's retention of the infiltrated,
Complications
Of the three general methods of gluteal augmentation procedures, including implants, flaps and fat graft, a 2019 systemic literature review with meta-analysis of 46 publications revealed fat graft with the least complication rate (7%) while implants associated with highest complication rate (31%).
Dangers
Like most medical procedures, buttock augmentation come with risks some of which can be life-threatening. A total of 413 Mexican plastic surgeons reported 64 deaths related to liposuction, with 13 deaths caused by gluteal lipoinjection. In Colombia, nine deaths were documented. Of the 13 deaths in Mexico, eight (61.6 percent) occurred during lipoinjection, whereas the remaining five (38.4 percent) occurred within the first 24 hours. In Colombia, six deaths (77.7 percent) occurred during surgery and three occurred (22.2 percent) immediately after surgery.[17] Secondary lymphoedema of the lower extremities has been reported as an unusual side effect of liquid silicone injection on the hips and buttock while thromboembolism, implant displacement and explosion has also been listed as some of the dangers.[18][19]
Unmet expectations
In the surgical praxis of body contouring therapy, the patient's body-image expectations can be different from the contoured body that is the outcome of the performed surgical operation. Such unmet aesthetic expectations can be avoided at the pre-operative consultation stage, whereby, with informed consent, the physician and the patient jointly establish a realistic and feasible surgery plan to achieve a mutually satisfactory corrective outcome (functional and aesthetic) of the operation to the gluteal region, the buttock- and thigh-areas.[1]
Contour problems
Contour problems of the corrected gluteal region can be prevented with the operational use of small-gauge cannulas (ca. 2.0 mm) specifically for superficial liposuction; and with the application of cross-pattern harvesting of the excess body fat, to avoid removing too much
Drug complications (anaesthetic and tumescent)
The infiltration of a solution of
Numbness (paresthesia)
Post-operatively, local areas of numbness (paresthesia) might occur in the contoured portion(s) of the gluteal region, and might perdure for a long time after the surgery. Hence, the patient is advised to facilitate the re-sensitizing of the numb area(s) with applications of gentle massage, to prevent the development of a neuroma complication, and to alleviate pain. Nonetheless, depending upon the tissue-healing capabilities of the patient, he or she can recover in full at 2-years post-operative.[1]
Outcome
The outcome of a buttocks-contouring procedure depends upon the specific defect or deformity that can be effectively corrected with liposculpture,
Non-surgical procedures
While surgical buttock enhancements are popular, there are minimally invasive alternatives. One such alternative is Sculptra, which is an injectable solution made of Poly-L-lactic acid particles. By stimulating the body's own collagen production, the injected area begins to expand over the course of 1 – 2 months.[20]
References
- ^ a b c d e f g h i j k l m n o p q r s Buttocks Contouring at eMedicine
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- ^ "Butt Augmentation Surgery". 14 February 2019.
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- ^ "Butt Augmentation Surgery NYC | Butt Lift Westchester NY". www.drberan.com. 14 March 2013. Retrieved 2018-09-06.
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- ^ "Six Dangerous Side Effects of Buttocks Augmentation and Implants - Public Health". 29 July 2017.
- S2CID 46474822.
- ^ "Clinical Trial of Poly-L-lactic Acid (Sculptra Aesthetic) for the Treatment of Cellulite of the Buttocks and Thighs". Clinical Trials Database. April 5, 2021. Retrieved June 25, 2023.