Dynamics of Gluteal Cleft Morphology in Lower Body Lift: Predictors of Unfavorable Outcomes.

Abstract

The number of lower body lifts is increasing with the increase in post-bariatric surgery patients. An undesirable result of the lower body lift is elongation of the gluteal cleft. The authors assessed their patients for gluteal cleft elongation to determine predictors of this unfavorable result. Lower body lift excision patterns were classified based on their relationship to the gluteal cleft. Type I patterns were superior to the gluteal cleft; type II were central, partially incorporating the superior portion of the cleft; and type III were characterized by the cleft spanning the entire height of the pattern. Postoperative deformities were classified as cleft unchanged (grade 1), moderate cleft lengthening (grade 2), or severe cleft lengthening (grade 3). Gluteal autoaugmentation was also determined. Eighty-six patients were included (average age, 46.4 ± 9.0 years). Thirty-two patients (37 percent) had type I excision patterns, 30 (35 percent) had type II, and 24 (28 percent) had type III. Seventeen (19.8 percent) had grade 1 clefts, 43 (50 percent) had grade 2 clefts, and 26 (29.9 percent) had grade 3 clefts. Age, sex, change in body mass index, and gluteal autoaugmentation were not significantly associated with postoperative cleft grade. Type I patterns were significantly less likely to cause postoperative cleft elongation (p = 0.001). Two patients (2.3 percent) desired correction achieved by excision and direct closure. Although lower body lift patterns may be based lower for better contour of the buttocks, there is an increased propensity for gluteal cleft elongation. This often occurs in patients with significant horizontal length discrepancy between the upper and lower incisions. Careful planning and markings can reduce the risk of this unfavorable result. Excision and direct closure provides a reliable solution.