A New Technique for Gluteal Lifting Using Deepithelialized Dermal Flaps

Abstract

In this article, Handschin et al. [1] promote several modifications to the inferior buttock lift techniques previously described by Gonzalez [2] and Huemer et al. [3]. The main modifications include the division of the deepithelialized infragluteal crescent into upper and lower segments. The other adjustment is the subsequent anchoring of the deepithelialized flaps into the gluteal fascia instead of the ischial periosteum in order to recreate the inferior gluteal fold and provide the buttock lift. The authors describe the procedure in a series of eight patients with very good aesthetic results by postoperative analysis and patient satisfaction report and no recorded complications after a 2month follow-up. The inferior gluteal lift is a very powerful and effective tool in the appropriate candidate. It improves the inferior gluteal fold and the skin and subcutaneous tissue of the superior posterior thigh. The procedure is indicated in patients with mild buttock ptosis with excess skin and subcutaneous tissue in the inferior gluteal fold or ‘‘banana fold.’’ It can also be used to improve a double infragluteal fold, to correct infragluteal fold asymmetry, or to shorten a long buttock when combining it with an upper buttock lift. It is indicated when the maximum point of buttock fullness is at the mid to upper portion of the buttocks, which should coincide with the level of the pubic symphysis [4]. If the maximum point of fullness falls below this line, then a superior approach and/or augmentation should be contemplated [5]. Furthermore, the inferior gluteal lift technique is contraindicated when the excess skin and subcutaneous tissue extends laterally toward the trochanteric area because this would force the incision to extend laterally, resulting in a long infragluteal fold. It has been widely accepted that one of the features of aesthetically pleasing buttocks is a short infragluteal fold that does not extend past the union of the semitendinous muscle with the biceps femoris, which is medial to the midaxial line of the thigh [4]. The postoperative results depicted in the article demonstrate a successful creation of an inferior gluteal fold and improvement in the contour of the inferior buttock and posterior thigh skin. Yet, the resulting inferior gluteal fold is long and extends into the trochanteric area. Unfortunately, only one patient was depicted in the postoperative images. We agree that avoidance of anchoring the dermal flaps to the periosteum of the ischial tuberosity would result in less postoperative pain as described by the authors. We routinely extend horizontal medial thigh lifts posteriorly into the inferior gluteal crease to create an improved infragluteal fold and lift the skin and subcutaneous tissue of the medial posterior thigh. In our experience with inferior gluteal lifts and horizontal thigh lifts, we have avoided scar migration and recurrence of ptosis by anchoring the superficial fascial system of the lower skin flap to the ischial periosteum with satisfactory long-term results [6]. We are concerned with the ability of the gluteal fascia to withstand the gravitational and muscle pull over a period of time. In their study, the patients were followed postoperatively for 2 months. It would be interesting to know whether the authors have experienced sustained long-term results without scar migration or ptosis recurrence. S. O. Sozer (&) F. J. Agullo Department of General Surgey, Texas Tech University Health Sciences Center, 4800 Alberta Avenue, El Paso, TX 79905, USA e-mail: doctor@elpasoplasticsurgery.com