Gluteal Augmentation Research Articles

Concepts in Hip Implant Body Contouring: Patient Evaluation & Implant Fabrication

Introduction: One of the most requested aesthetic procedures is body contouring using liposuction. Adjunctive procedures using fat grafting can provide enhancement in most body areas, commonly used in both gluteal and hip augmentation. Performing processing and enrichment to optimize fat transfer survival can avoid the use of body implants. When there is insufficient fat for the desired degree of augmentation, silastic implant placement is an alternative treatment. Much has been written in the medical cosmetic literature regarding gluteal and breast implants, but nothing in terms of hip silastic implants. Material and Methods: Hip implant patient selection, the body frame analysis, associated enhancing body contouring procedures, implant design and fabrication, and implant surgical placement are analyzed. In 3 different cosmetic surgery practices, methods of patient analysis and the process of creating a custom hip implant is presented. Techniques and protocols in the use of fat grafting in association with both gluteal and hip implants are elucidated. Results: The minimally manipulating fat maneuvers to increase fat survival are detailed. This paper defines the process of planning, designing, and fabricating a custom hip implant with significant patient input. By definition, patient-specific or custom implants can be any shape, size, and projection. The patient and surgeon provide the implant fabrication company a paper tracing of the surface area of the proposed implant along with the maximum projection. Engineering creates a 2-dimensional drawing using a computational software for intelligent system design or CAD. The implants are fabricated with input from the surgeon on silastic durometer, implant alterations to lower weight and enhance ease of folding for placement, and shape. Caveats and pitfalls in surgical planning, implant design, fabrication, and surgical placement are identified. Discussion: Body contouring using ultrasound liposuction may provide the desired aesthetic result. When augmentation is requested, fat transfer is the preferred initial procedure. If there is an insufficient volume of fat to augment both the buttocks and hip area, hip fat grafting is preferred to avoid a hip alloplastic implant. The reason for this treatment recommendation is to avoid the hip implant with a higher risk profile. Once the indication for the hip implant is confirmed, usually because of either inadequate presence of fat or a desired maximum hip projection that cannot be attained by fat grafting alone, the body shape analysis is finalized. Conclusion: Custom silastic hip implants are designed, fabricated, and surgically placed to provide the patient desired cosmetic hip augmentation.

A Dynamic Anatomic Study of Parasacral Perforators: Mapping, Perforasome, and Applications for Buttock Enhancement.

Due to the lack of knowledge about parasacral artery perforators, flaps from this region cannot be used with complete confidence in their security and effectiveness. Knowledge of the clusters and perforasome of these perforators could help in the design of more reliable flaps and extend the range of applications. This study aimed to identify the location, number, and density of perforators, and to subsequently analyze the perfusion flow and linking vessel distribution. Five fresh cadavers were harvested and dissected. For the mapping, after injecting lateral sacral arteries with colored latex, perforators with a diameter of >0.5 cm were examined in 5 sacral regions. All data were collected on the suprafascial plane, with an orthonormal coordinate system placed on iliac crests and median lines. For perforasome analysis, 5 perforators and 3 three sacral flaps were injected with radiopaque dye. A dynamic (4-dimensional) computed tomographic angiography completed the analysis. A mean [standard deviation] of 8.4 [1.36] perforators per corpse, with a mean diameter of 0.72 [0.14] mm, were identified. There was a higher density of parasacral perforators close to the median line and 7.6 cm above the iliac crests. This pattern was not a random distribution (P < 0.05). The perfusion area was preferentially in the superior gluteal region. Perfusion flow was permitted by the dominant direct-linking vessels towards adjacent lumbar perforators, oriented diagonally upward and outward to the midline. Parasacral perforator flaps appear to be a useful procedure in reconstruction and in aesthetic surgery, especially in gluteal augmentation. Their reliability depends on sound anatomic knowledge, with accurate preoperative perforator mapping.

Autologous Gluteal Augmentation with Parasacral Perforator-Pedicled Propeller Flaps

De-epithelialized flaps have been used in gluteal contouring over the last three decades, but most improve the projection rather than the upper quadrants. The authors provide a detailed description of their method of gluteal augmentation using parasacral perforator-pedicled propeller flaps. This technique achieves a volumetric increase and maximal buttock projection at the midlevel and in the medial half of the buttocks. Between January and December of 2019, a series of 18 patients on whom a lower body lift with a parasacral perforator-pedicled propeller flap had been performed by the senior author (F.B.) were prospectively evaluated. Postoperatively, the satisfaction rate was assessed using a 10-point analog scale (1 = unsatisfied, 10 = very satisfied) by the patient and by two independent surgeons based on photographs taken 1 year after surgery. Eighteen patients underwent this procedure. Their mean age was 32.2 ± 5.6 years (range, 24 to 40 years). The mean flap length was 20.3 cm, their mean width was 10.4 cm, and the mean thickness was 3.4 cm. The authors noted only two minor complications, one seroma and two skin dehiscences that healed without surgery. The rate of satisfaction as assessed by the patients was 8.3 out of 10 (±1.1), and by surgeons, 7.9 and 8.1. This article describes a gluteal autoaugmentation flap technique using parasacral perforator-pedicled propeller flaps to increase projection and volume in the inferomedial gluteal region after lower body lift. Therapeutic, IV.

Brazilian Buttock Lift for the Weight-Loss Patient

Introduction: Performing optimal gluteal augmentation using traditional methods in moderate to severe weight-loss patients poses a surgical challenge as such patients typically present with (1) significant skin redundancy, (2) soft tissues containing higher density of connective tissues, and (3) buttock ptosis. Materials and Methods: Excess skin redundancy and buttock check ptosis require consideration of supplemental excisional tucking to achieve optimal results. In addition, subcutaneous tissues that maintain more connective tissue pose difficulty with fat removal using traditional liposuction techniques. As such, we present a novel surgical technique to optimally augment and shape the buttock in patients who have undergone weight-loss. Results: This procedure uses a modified lateral thigh and buttock tuck excision not only to lift the buttock cheek complex but also to create a dermal fat flap that is transposed into the upper buttock pole to achieve upper buttock fullness. The remainder of the excised tissue undergoes novel ex-vivo liposuction, which allows for simultaneous repair of the created excision line while fat is being harvested. Discussion: We present a new Brazilian buttock lift (BBL) procedure for weight-loss patients using a novel modified lateral thigh and buttock tuck with a dermal fat flap as well as ex-vivo liposuction and fat transfer. The described ex-vivo liposuction technique provides several advantages that include (1) limiting operative time, (2) allowing for maximal fat removal while avoiding unnecessary trauma to the patient, and (3) providing improved quality of fat that is less blood tinged. The lateral thigh and buttock tuck with dermal fat flap is used to eliminate buttock ptosis and augment the upper buttock. The ex-vivo harvested fat to the middle and lower buttock to complete buttock augmentation for the Brazilian buttock lift in a seamless fashion. Conclusions: In summary, we present a novel Brazilian buttock lift technique to augment the buttock in weight-loss patients that maximizes both patient safety and efficacy.

Buttocks Volume Augmentation with Submuscular Implants: 100 Cases Series.

Permanent aesthetic augmentation of the gluteal region can be achieved with fat graft and/or implants. Implant-based augmentations have been proposed since the late 1960s. Buttock implants can be placed in four different planes according to distinct surgical techniques: subcutaneous, subfascial, intramuscular, and submuscular. In this retrospective analysis, a 100 case series of patients seeking volume and shape amelioration of the gluteal region were studied. All of them had primary gluteoplasty performed with a submuscular implant placement by first author (F.P.) with a new technique, as described in the article. Data on surgery time, implant volume selection, and postoperative complications were collected. The most frequent complications were delayed healing of the incision and implant flipping. Submuscular implant positioning is a safe and reliable technique for buttock augmentation with implants. Whatever the implant volume, submuscular gluteal augmentation carries the benefit of perfectly covering, protecting, and hiding the implant, making it almost impalpable and invisible. Therapeutic, IV.

LL body contour technique-A new way of gluteal contouring and augmentation with hyaluronic acid filler.

Enhancing and altering body contours has increasingly been the focus of new technologies and techniques in aesthetic treatments. The buttocks are seen as a symbol of beauty, sensuality, and attraction. The authors described a technique for female and male gluteal augmentation. It uses a special marking, a safe plan, and a specific product. The patients chosen for this technique wanted to have an augmentation or projection effect on the buttocks, but were not willing to undergo surgery. The product used was Sofiderm Subskin Aeskins. The plan of injection was the subcutaneous as no major blood vessels were found. The authors report good aesthetic results with the proposed technique. The patients reported a high degree of satisfaction. The product chosen has a high G prime and a larger molecule size, which accounts for resistance to deformation and a high lifting power. Thus, result can be visible in a large body area. As the anatomy between male and female buttocks are different, different techniques were used for each gender. The LL body contour technique for gluteal augmentation proved to be a minimally invasive technique, with quick results, without major risks and downtime.

Management of a Large Quantity of Permanent Gluteal Copolyamide Fillers (Aqualift/Activegel): Literature Review and Algorithm.

Buttock augmentation is a commonly performed aesthetic surgery. Several methods have been described, but only the use of implants or autologous fat is consensually deemed safe and effective. Synthetic fillers in gluteal augmentation have been described despite potential severe long-term complications, both medical and aesthetic. The aim of this study is to report a series of 2 consecutive cases who underwent buttock and hip augmentation with large volumes of permanent copolyamide filler requiring surgical removal due to significant complications. Based on these cases and a review of recent literature, a management algorithm is proposed. The authors conducted a retrospective chart review of 2 consecutive cases of failed copolyamide filler augmentations in the gluteal and inguinal regions. The authors conducted a literature overview using PubMed (National Institutes of Health, Bethesda, MD) and Google Scholar (Google, Mountain View, CA) to include all articles concerning the removal of large quantities of permanent copolyamide fillers. Based on the physical properties of copolyamide, resection of the filler was performed by percutaneous aspiration with liposuction cannulas, with varying infiltration protocols. Both cases showed successful removal of major parts of the filler; however, residual material tended toward migration, requiring a secondary intervention. Hydrated low-pressure aspiration can manage nonintegrated gluteal copolyamide filler but will achieve only partial resection. Literature shows that radical excision is possible, however, with major drawbacks in function and aesthetics. Moreover, in acute inflammation and infection, an open approach should be preferred.Level of Evidence: 5

High-Definition Liposuction Body Scale: Expanding Indications for High-Definition Liposuction

High definition liposuction (HDL) has been coined to identify liposuction results that are superior to traditional liposuction. HDL results are appreciated when body contours are transformed with the ultimate goal of achieving a near perfect 9 or 10 body. High definition liposuction is considered a “game changer” in the body contouring arena as it gives plastic surgeons the ability to precisely sculpt the patient’s body in a 360 degree circumferential manner to previously unattainable results. Until recently, indications for high definition body contouring were reserved for patients with minimal fat excess and skin redundancy. Several factors must be accounted for to achieve high definition liposuction results, and these include appropriate patient selection and a customized and strategically sound operative plan. We introduce the High definition liposuction (HDL) body scale that assigns body scores ranging from 2 to 10 by taking into account degree of fat excess, amount of skin redundancy, as well as quality and extent of skin texture changes. The HDL body scale was created to expand indications for a larger patient population by assisting surgeons to establish preoperative start points, guide patient selection, design a customized, sound surgical plan, and objectifying outcomes. The HDL body scale and subsequent surgical algorithm, and case studies are presented. Using the HDL body scale, surgeons may improve and expand patient populations who can benefit from HDL outcomes.

Cosmetic tourism during the COVID-19 pandemic: Dealing with the aftermath

BackgroundDespite government restrictions during the coronavirus (COVID-19) pandemic, cosmetic tourism continued to occur. The authors present the impact of cosmetic tourism on their plastic surgery unit.MethodsRetrospective case note review of two cohorts was performed: COVID-19 (March 2020–April 2021) and a pre COVID-19 comparator (January 2019–February 2020). Patients presenting with complications from cosmetic tourism were included and their hospital notes were reviewed.ResultsSeven patients were identified in the COVID-19 cohort compared with four patients in the comparator. In the COVID-19 patient group, six underwent their procedure overseas. The final patient was operated on in the UK by a visiting surgeon. Cases consisted of two abdominoplasties, two breast augmentations, two gluteal augmentations, and the final patient had a hernia repair. The most common presenting complaint in the COVID-19 cohort was a post-operative wound infection (n = 5), of which two had deeper associated collections, with two further wound dehiscences. In the pre-pandemic group, four patients underwent their procedure overseas. Cases consisted of an abdominoplasty, a blepharoplasty, a breast augmentation and a gluteal augmentation. Two patients presented with a wound infection, and two with simple wound dehiscence.ConclusionCosmetic surgery tourism is a growing industry with an increasing number of patients presenting with complications to NHS services. These patients are a potentially vulnerable group who exhibit risk-taking behaviours, such as going abroad amidst a pandemic and acceptance of not having appropriate follow up care.

Reducing Complication Rates of Fat Grafting in Gluteal Augmentation

INTRODUCTION: Gluteal augmentation via autologous fat grafting is an increasingly popular procedure used in body contouring. However, concerns remain about the patient safety of the procedure due to reported high complication rates in numerous countries around the world. METHODS: The author reports on a retrospective analysis of a 181 patient database who all had intramusular and deep subcutaneous gluteal augmentation via autologous fat grafting following liposuction. Average age, body mass index, tumescent fluid volumes, aspirate, fat volumes grafted, and operating room times are analyzed along with complication rates in the 181 patient cohort. Triple antibiotic solution was added to the grafted fat after four of the first 31 patients developed an infection. Patient positioning after fat grafting in the prone position was changed to the right lateral decubitus position for extubation after three of the first 51 patients developed clinically significant fat embolism in supine position. Statistical analysis using Fisher exact test is performed to determine if these changes in protocol result in better patient safety. RESULTS: Data from 181 patients reveal an average age of 38.6 years, average BMI of 28.4, average tumescent fluid injected 4078 cm3, average aspirate 4962 cm3, average right buttock injected 790 cm3, and average left buttock injection is 790 cm3. Mean operative time was 4 hours and 8 minutes. Fisher exact test was used to analyze two changes in buttock augmentation protocol consisting of adding a triple antibiotic solution to the harvested fat and extubating the patient in a lateral decubitus position on the recovery room bed. Four of the first 31 patients developed an infection but after adding triple antibiotic solution of gentamycin, ancef, and bacitracin to the aspirate, no infections were seen in the next 150 patients. The P value is 0.0008 for infection, which is statistically significant. Three of the first 51 patients experienced a clinically significant fat embolism, which required supplemental postoperative oxygen and hospital admission. The extubation protocol after general anesthesia was changed to position the patient in the right lateral decubitus position on the recovery room bed for extubation and no patient out of the next 130 experienced a fat embolism despite intramuscular injections. The P value is 0.0229 for this change in protocol. Other complications include abdominal seromas requiring serial aspirations, cubital tunnel syndrome from lying prone for 2–3 weeks postoperatively, and one patient with a pulmonary embolism and death. CONCLUSIONS: Fat embolization in gluteal augmentation can be greatly reduced by positioning the patient in the lateral decubitus position for extubation after injecting the fat in a prone position. Infection rates can be reduced by mixing a triple antibiotic solution with the aspirate prior to grafting. Since the popularity of gluteal augmentation is increasing, we must develop protocols in performing the procedure that maximize patient safety and minimize risks of complications. The buttock augmentation patient is at a higher risk of DVT/PE because they do not ambulate normally; so prophylactic lovenox may be of benefit. Further studies are required.

A CASE OF BRONCHIECTASIS AFTER SILICONE GLUTEAL AUGMENTATION

TOPIC: Lung Pathology TYPE: Medical Student/Resident Case Reports INTRODUCTION: Bronchiectasis is a chronic condition with pathogenic airway dilation and bronchial wall thickening that has been associated with many different causes. One of the less studied causes is silicone exposure. CASE PRESENTATION: This is a 33 year-old female with a history of supraventricular tachycardia, chronic respiratory failure due to bronchiectasis, and pulmonary hypertension group 3 presented with increased work of breathing and lethargy. She appeared uncomfortable with tachypnea and hypoxia requiring an increase of her baseline home oxygen. ABG was consistent with acute hypercapnic respiratory failure and thus she was placed on Bi-level with improvement in hermental status. Chest radiograph showed hyperinflated lungs and diffuse bronchiectasis bilaterally. Computed tomography showed extensive severe bilateral cystic bronchiectasis. She had multiple recurrent admissions for hypercapnic respiratory failure due to progression of her bronchiectasis with superimposed bacterial pneumonia and colonization. She had an extensive work up to assess for an underlying etiology for her bronchiectasis which began at age 18 with mild disease. Full rheumatologic evaluation was unrevealing. Her pulmonary function tests revealed a severe mixed defect with an FEV1/FVC of 58, FEV1 0.57 (22%), and FVC 0.98 (33%), TLC 4L. However, her respiratory status declined rapidly after she had a silicone gluteal augmentation surgery in 2015 which was "botched." She was treated with steroids and intravenous antibiotics and was discharged home on home oxygen. DISCUSSION: In recent years there has been a rise in cases of silicosis due to modern industries; however, a less studied phenomenon is that of lung disease as a complication of silicone breast and gluteal implants. The pathogenesis of silicosis is due to sIlica particles deposited in the distal airways, engulfed by alveolar macrophages leading to an upregulation of pro inflammatory and pro fibrotic pathways. Further silica ingestion by the macrophages leads to autophagy and release of intracellular silica thus attracting more macrophages with the release of cytotoxic antioxidants, proteases, and inflammatory cytokines. This leads to fibrosis and alveolitis. Bronchiectasis results from the destruction of connective tissue due to proteases with chronic inflammation leading to a host susceptible to recurrent infections, leading to further inflammation and progression of bronchiectasis. CONCLUSIONS: This case highlights the need for physicians to be aware of the potential adverse pulmonary effects, although rare, of silicone implants. This particular patient most likely suffered progression of bronchiectasis with both a restrictive and obstructive disease due to silicosis from the gluteal implants. REFERENCE #1: Barnes, Hayley, et al. "Silica-Associated Lung Disease: An Old-World Exposure in Modern Industries." Wiley Online Library, John Wiley & Sons, Ltd, 13 Sept. 2019 REFERENCE #2: King, Paul T. "The Role of the Immune Response in the Pathogenesis of Bronchiectasis." BioMed Research International, Hindawi, 18 Mar. 2018 REFERENCE #3: Schierbeck, Juliane, et al. "Silicone Implant Incompatibility Syndrome (SIIS) in a 57-Year-Old Woman with Unilateral Silicone Breast Implant." BMJ Case Reports, 2017, doi:10.1136/bcr-2016-218709 DISCLOSURES: No relevant relationships by Nourhan Kika, source=Web Response No relevant relationships by Nisha Patel, source=Web Response No relevant relationships by Anthony Saleh, source=Web Response

Submuscular Gluteal Augmentation and Lipoplasty for Buttock Beautification.

Background:The number of gluteal augmentation procedures with implants has increased in the last years. However, due to high complication rates related to the placement of the implants, surgeons have started to avoid using implants. The objective of the present study was to describe the details of the submuscular gluteal augmentation technique together with lipoplasty techniques and to increase the prevalence of its use.Methods:All methods are complementary to each other rather than being superior to each other. That is why the author has used submuscular gluteal augmentation with implant technique and lipoplasty together during the surgeries. The complication rates are lower with this easy-to-learn technique described in this article. Eighty-six patients aged 20–46 underwent surgery. The follow-up period was 6–24 months. The implants used consisted of round cohesive silicone, with the most commonly used size being 330 cm3. The average volume of infiltrated fat was 514 cm3.Results:The sciatic nerve is well protected by the surrounding anatomical structures, indicating that submuscular technique can be used safely. Partial wound dehiscence was noted in 1 patient, implant malposition in 5 patients, and seroma in 2 patients. All patients reported that they are highly satisfied with the results of the procedure.Conclusions:The author advocates that the combination of lipoplasty with the submuscular technique described is safe, easy to perform, has a short operative time and low complication rates. It can be preferred in buttock beautification as a simple and safe technique.

US Public's Perceptions of Online Transformation Photos.

Although many plastic surgeons seek to optimize their online presence and reach a broader patient base, no studies to our knowledge have evaluated the general public's perceptions of one of the most valued informational tools: transformation photos. The aim of this study was to evaluate the general public's preferences for viewing transformation photos online. Respondents representative of the US public, crowdsourced through Amazon Mechanical Turk, answered a survey assessing perceptions of the posting of before-and-after photos. One thousand respondents completed the questionnaire. Ninety percent (905/1000) of respondents are willing to view online before-and-after photos. Sixty-three percent (634/1000) would consent to online posting of before-and-after photos of at least 1 body area, with comfort levels highest for facelift (36.4%), nonoperative facial rejuvenation (31.9%), liposuction (24.9%), and abdominoplasty (23.2%). Breast reduction (12.4%), breast reconstruction (10.9%), gluteal augmentation (14.0%), and vaginal rejuvenation (4.4%) are considered least acceptable for public posting. Respondents are significantly more opposed to online viewing of genitals than any other body area (P < 0.0001). Of those willing to have their own transformation photos posted online, 74.0% would allow posting on professional practice websites, 35.1% on Instagram, 26.6% on Facebook, 17.2% on Twitter, and 10.7% on Snapchat. Significantly more respondents prefer their transformation photos reside only on professional practice websites rather than on a social media platform (P < 0.0001). The public considers aesthetic facial procedures and body contouring most acceptable for showcasing transformation photos online. Although most respondents prefer viewing these photos on professional practice websites, Instagram is the favored social media platform. The majority of the public seek transformation photos when choosing a plastic surgeon for a cosmetic procedure.

Migration of liquid silicone, an emerging contraindication of neuraxial anesthesia

The illegal use of liquid silicone products or biopolymers in gluteal augmentation procedures is giving rise to multiple complications, with a significant negative health impact, both in the short and long-term. The migration of polymers to the sacral and lumbar region represents a major limitation to conducting neuraxial anesthesia procedures. This silicon migration is unpredictable through the superficial tissue as is widely described in the literature. Caudal, spinal and epidural anesthesia may cross the silicone in the fascia and contaminate the neural axis with substances that are highly capable of causing inflammation, edema and tissue necrosis. In order to improve the safety of neuraxial anesthetic procedures and avoid the potential risk of dissemination and contamination of the neural axis, this complication must be ruled out, or be considered an emerging contraindication for these anesthetic procedures.

Perception of Risk Among Aesthetic Plastic Surgeons.

With continuous innovation in plastic surgery, new procedures are constantly being introduced. A number of these procedures are generally safe but have the potential for rare yet serious complications. Many surgeons steer clear of these procedures due to safety concerns. The aim of this paper was to survey the membership of The Aesthetic Society to elicit perception of risk of several novel or less mainstream procedures. A 24-item survey was sent out to members of The Aesthetic Society. The survey focused on surgeon experience and attitude towards 3 procedures: filler rhinoplasty, gluteal augmentation with fat grafting, and submandibular gland excision. In total, 189 completed surveys were returned. Of the responders, 50%, 49%, and 89% of surgeons said they do not perform filler rhinoplasty, gluteal augmentation with fat grafting, or submandibular gland excision in their practices, respectively. The majority of those who do not perform the procedures selected "danger to the patient" as the primary concern for each of the 3 procedures. Surgeons overwhelmingly reported not learning these procedures in training. Additionally, surgeons perceive the risks of more common procedures such as abdominoplasty and breast augmentation-mastopexy to be significantly lower and more acceptable than those of the studied procedures. When comparing the perceived complication rates with data published in the literature, particularly when looking at rates of serious or life-threatening complications, plastic surgeons overestimate the risks of procedures with which they are less familiar. This perception of risk, accompanied by the lack of exposure to novel techniques in training, may contribute to surgeons avoiding these procedures.

Improving supragluteal contouring using curved liposuction cannulas introduced through a single midline port

Aim: The definition of beauty has changed in the last 10-15 years where women seek more a highly defined curved body regarding buttocks in relation to the waist and thighs. The supragluteal area needs a long learning curve to have a smooth transition between the back and gluteal region. In our study we adopted a single port liposuction for this technically difficult region using a curved liposuction cannula instead of the usual three port site incisions and a straight cannula adopted by many surgeons.Method: From 2017-2020, 94 Female patients had gluteal augmentation using fat grafting and liposuction of the lower trunk, age ranging from 22 - 54 with a mean age of 32.Studying the use of a single incision in the intergluteal crease for liposuction of the supragluteal area using the curved shaft liposuction cannula size 3 mm and size 4 mm to reach the desired contour instead of adding another two paramedian supragluteal incisions. The main goal is to reach the upper lateral supragluteal region.Results: The transition zone between the lower back and buttocks was greatly achieved with a very high surgeon and patient satisfaction in more than 85% of the cases. (80 cases), There was no any major aesthetic complication in terms of Step-off’s , irregularities, over-resection or musculanization.Conclusion: Curved liposuction cannulas can greatly contribute to minimizing unnecessary extra incisions to reach various areas in the body specially the technically challenging upper outer supragluteal region as mentioned in our study.Level of Evidence: Therapeutic, V.

Gluteal Augmentation with Fat Grafting: Literature Review.

The buttock is the second sex feature of the human body, and the graceful buttock curve gives people confidence. Although the safety of gluteal augmentation with autologous fat grafting is still controversial, the proportion of operations is increasing year by year. To provid a comprehensive and detailed review of the literature on gluteal augmentation with fat grafting. A comprehensive review of the published literature through September of 2020 was performed in PubMed database, with the search terms "gluteal augmentation," "buttock augmentation," "Brazilian buttock lift," "fat grafting," "fat transfer," "gluteal AND aesthetic," "gluteal AND anatomy." A total of 64 articles were included. On the basis of the information obtained, surgical recommendations are proposed to achieve buttocks as close as possible to aesthetic standard and improve surgical safety. With a good grasp of the anatomical structure of the buttocks, complications can be reduced. At the same time, based on the theoretical basis of buttock aesthetics, better postoperative results can be obtained. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Poly-L-Lactic Acid for Gluteal Augmentation found to be Safe and Effective in Retrospective Clinical Review of 60 Patients.

Poly-L-lactic acid (PLLA) is a well-established biostimulator that induces neocollagenesis, allowing for volume loss correction. Although PLLA is FDA approved to treat mid-to-lower facial wrinkling, it has grown increasingly popular as a nonsurgical, minimally invasive procedure for soft-tissue volume augmentation of other extremities. However, research detailing PLLA buttock injections is still lacking. The purpose of this study is to determine the safety and efficacy of PLLA for buttock augmentation. A clinical retrospective review of 60 patients (ages 23-54 years) were followed for 2 years by 2 investigators. Patients underwent 1 to 3 treatments, spaced 4 to 6 weeks apart, and received 2 to 12 vials per session (based on the patient budget). Pretreatment and post-treatment photographs were assessed by the primary and secondary investigator in blinded and double-blinded surveys, respectively. The Global Aesthetic Improvement Scale was used to quantify improvements in volume, skin texture, and cellulite dimpling. Poly-L-lactic acid allows for visible volume amplification, improved skin texture, and softened cellulite dimpling in the buttocks when at least 20 vials are used. Poly-L-lactic acid is safe and effective for overall aesthetic enhancement of the buttocks if used in adequate quantity (minimum 20 vials) for all women, independent of age or the number of sessions.

Gluteal projection and augmentation using polycaprolactone-based filler: a promising new indication

Buttock improvement and augmentation have become a whole new challenge to the medical aesthetics field. Nowadays, besides surgical options, the only available non-surgical treatment for gluteal augmentation is the injection of biocompatible fillers. Nevertheless, these minimally invasive treatments have their own limitations. In the quest to find a better option to treat this specific area, the idea of using polycaprolactone (PCL) to enhance the gluteal area emerged. The case of a 26 year-old female patient who desired a non-surgical buttock enhancement is presented. She was treated with PCL-based filler to achieve such an improvement. The clinical photographic results were outstanding, with a nine out of 10 overall satisfaction subjective score. In conclusion, using PCL could become a new alternative to non-surgical gluteal enhancement. Due to the collagen biostimulation property of the filler, the treatment will also enhance the skin quality, giving the buttocks an overall improvement.

A Multimetric Health Literacy Analysis of Online Information for Gluteal Augmentation With Fat Grafting.

According to the American Society of Plastic Surgeons the number of gluteal augmentations with fat grafting, colloquially known as the "Brazilian buttock lift" (BBL), doubled from 2014 to 2018. Recent studies have demonstrated that gluteal augmentation with fat grafting has a higher mortality rate when compared with other esthetic surgeries. We hypothesize that online patient-directed information for gluteal augmentation are overly complex, written at an elevated reading grade level, with incomplete or no information regarding associated surgical risks. To perform an objective appraisal of the most popular online patient education materials for gluteal augmentation surgery and explore potential interventions for improving material quality. An online Google search using the term "Brazilian butt lift" was performed and the top 10 websites providing relevant information were identified. Readability for each website was determined using Readability Studio. Understandability, actionability and cultural sensitivity was assessed with validated tools by 2 independent raters. The top 10 websites were written at a mean reading grade level of 13.0, appropriate for a high school graduate. No website was written at the American Medical Association and the National Institutes of Health recommended 6th to 8th grade reading level. Mean understandability and actionability scores of 51% and 18.9%, respectively, suggest significant room for improvement. The average cultural sensitivity assessment tool score was 2.30, below the recommended threshold for acceptability of 2.5. Ninety percent of all websites did not meet the threshold for cultural acceptability. Online patient education materials for gluteal augmentation with fat grafting were written at an inappropriately elevated reading grade level and were overly complex, did not promote reader action, and were not sensitive to the needs of the target demographic.