Gluteal Augmentation Research Articles

Imaging of cosmetic plastic procedures and implants in the body and their potential complications.

Cosmetic plastic surgery procedures, as well as implants, are increasingly being performed. These implants are often encountered on routine imaging examinations, and radiologists are often asked to evaluate for complications or evidence of failure. Pectoral augmentation, gluteal augmentation, body lift and abdominoplasty, and penile and testicular prostheses are reviewed in this article. The typical appearance of common cosmetic implants and cosmetic techniques used in the human body is presented, along with the imaging spectrum of their potential complications.

Purtscher-Like Retinopathy and Diffuse Alveolar Hemorrhage Caused by Soft Tissue Injection for Gluteal Augmentation.

PurposeTo describe a rare occurrence of acute vision loss and diffuse alveolar hemorrhage following a treatment of injectable gluteal cosmetic filler.Patient and methodsA 20-year-old female underwent a cosmetic injection of unknown components for gluteal augmentation. Within hours she developed progressive shortness of breath secondary to diffuse alveolar hemorrhage. She presented to ophthalmology 6 weeks later with a history of bilateral decreased vision. Clinical examination revealed cotton wool spots and retinal hemorrhages. Fluorescein angiography demonstrated macular vascular pruning and an enlarged foveal avascular zone.ResultsThe patient was observed and vision did not improve after 8 months of follow-up.ConclusionThese findings were attributed to a Purtscher-like retinopathy secondary to systemic inflammation induced by the filler and/or direct microembolization of the injected material or fat. To the best of the authors’ knowledge, this is the first documented case of diffuse alveolar hemorrhage and ischemic bilateral vision loss in a patient undergoing gluteal augmentation with dermal filler.

Satisfaction and complications after lower body lift with autologous gluteal augmentation by island fat flap: 55 case series over 3 years

Major weight loss causes body deformities. Lower circumferential dermolipectomy with autologous gluteal augmentation by a fat island flap can restore a part of the body contour, but this procedure is associated with a high incidence of complications. The aim of this study was to analyse the benefit/risk ratio and the patients' satisfaction. All patients who underwent this procedure at the Nancy University Hospital over a 3-year period (between January 2010 and 2013) were reviewed; the complications were analysed and the patients' satisfaction rated. A total of 55 patients were included with a mean age of 41.0 years. The average body mass index of the patients was 28.2kg/m² with a mean weight of 76.8kg at the time of the procedure and a mean weight reduction of 49.6kg. The mean operative time was 4.85h. The average hospital stay was 6.1 days. The average haemoglobin loss was 3.0g/dl, and 12 (21.8%) patients required a blood transfusion. Of the total number of patients, 22 (40%) developed at least one complication, including six (10.9%) major complications. Fifty-two patients answered the questionnaire; 49 (94.2%) patients would go through this procedure again. The overall satisfaction was rated as excellent by 29 (55.8%) patients and as pleasing by 22 (42.3%). The outcome was judged as excellent or pleasing for the abdomen by 29 (55.8%) and 20 (38.35%) patients, respectively, and for the buttocks by 17 (32.7%) and 29 (55.8%) patients, respectively. The quality of life was rated better after than before the intervention by 49 (94.2%) patients. Despite a high complication rate, the majority of patients confirmed that they would opt for this procedure again, showing an improvement in their quality of life with an aesthetic and functional benefit. III.

Determining the Safety and Efficacy of Gluteal Augmentation

Determining the Safety and Efficacy of Gluteal Augmentation

Reply

Sir: In response to questions raised by Dr. Swanson in his letter to the Journal, we submit the following. Although we found several of his points to be only tangentially relevant to the subject matter within the original article and others to be fully explained within the article itself, we have elected to respond to both. It is understood on the basis of communication with Dr. Swanson that he has had a limited and unsuccessful experience with gluteal augmentation with silicone implants.1 The authors do not advocate the performance of this procedure without adequate training and advance study. Resources to assist the surgeon interested in learning this technique are available through both textbooks and teaching courses at national meetings of the American Society of Plastic Surgeons and the American Society for Aesthetic Plastic Surgery. Success with this procedure is highly dependent on both technique and perioperative care, as would be the case with nearly all procedures that plastic surgeons perform. As we state in the first paragraph of the original article, leaner patients that desire the addition of greater volume to the gluteal region are not candidates for fat grafting procedures.2 Dr. Swanson’s recommendation that we stop trying to improve on gluteal augmentation techniques using implants and limit ourselves presumably as a specialty to suction lipectomy and fat grafting procedures ignores the obvious. Patients without adequate autologous donor fat to achieve the results desired in gluteal volume are not candidates for fat grafting procedures. With respect to his concerns about the scar location within the intergluteal cleft and that analogous breast scars would not be tolerated, even when wound separation has occurred, these typically heal remarkably well and in most cases so well within the cleft that, to most untrained eyes, they are hardly even identifiable as scars. The need for scar revision after gluteal augmentation is so rare that we did not even identify the occurrence within the study. Scars associated with other aesthetic procedures of the face, breast, and trunk seem to be of much greater significance than those associated with gluteal augmentation. Procedural statistics available through our national societies are heavily reliant on surgeon participation. At this time, based on the relatively small numbers of cases reported by member surgeons of the American Society of Plastic Surgeons for buttock augmentation procedures, it is unlikely that small relative changes can be relied on entirely as indicative of overall popularity. The most recent statistical reporting available by the American Society for Aesthetic Plastic Surgery for 2012 reveals that more than 7000 buttock augmentation procedures (not stratified for implants versus fat grafting) were performed by member surgeons, representing an increase of 40 percent over 3 years.3 It is the impression of the surgeon authors of this study that buttock augmentation with silicone implants has increased significantly in popularity over the past 5 years. The overall complication rate reported by this study of 38.1 percent should be interpreted relative to the complication rate associated with other aesthetic implant procedures. Breast augmentation is widely regarded as a safe procedure with a high patient satisfaction rate despite an even higher 45 percent complication rate studied over a 7-year period.4 To suggest that somehow breast augmentation surgery using implants should be an accepted procedure yet gluteal augmentation with implants should not seems an arbitrary judgment. We believe that Dr. Swanson’s response misses the point of the study. The intent of the study was not to promote the procedure but to address physician preference and broadly identify complication rates. Decisions about whether an individual patient should be a candidate for the procedure should be determined by well-trained surgeons familiar with the body of literature on the subject and in the course of an informed consent discussion with the patient. DISCLOSURE Dr. Gonzalez receives royalties from the sale of his book, Buttocks Reshaping (Rio de Janeiro, Brazil: Indexa Editora Ltda; 2006). Dr. Mendieta receives royalties from the sale of his book, The Art of Gluteal Sculpting (St. Louis, Mo.: Quality Medical; 2011). The remaining authors have no other relevant financial disclosures. M. Mark Mofid, M.D. Constantion G. Mendieta, M.D. Douglas M. Senderoff, M.D. Division of Plastic Surgery University of California San Diego San Diego, Calif.

Buttock Augmentation with Silicone Implants

Enhancement of buttock volume with gluteal silicone implants has been performed by surgeons for over 30 years, but no studies have examined complication rates or outcomes of more than single-surgeon experiences. Numerous technical differences in how gluteal augmentation surgery with implants is performed also exist, and to date, surgeon preferences for implant plane, incisional access, implant type, and drain use have not been quantified. A 10-question survey was sent to 83 targeted members of the American Society of Plastic Surgeons requesting information about number of cases performed, duration of surgeon experience, implant placement plane and incisional access, implant type, length of typical surgery, use of drains and antibiotic irrigation solution, surgeon satisfaction and surgeon assessment of patient satisfaction, and number of complications experienced. Nineteen respondents (25 percent response rate) provided data on 2226 patients. Thirteen respondents (68.4 percent) favored the intramuscular plane of dissection over the subfascial plane. Preference for incisional access was nearly equally divided between a single incision in the gluteal cleft (10 respondents) and two incisions separated within the cleft (nine respondents). The total number of complications reported was 848 (38.1 percent). Gluteal augmentation with silicone implants has gained popularity in the last decade. Despite this, no previous studies have examined multisurgeon experiences with this procedure to determine complication rates or surgeon technical preferences. The authors present data from a survey sent to experienced gluteal augmentation surgeons. Advances in technique and implant options are needed to improve complication rates experienced with this procedure.

Intramuscular Technique for Gluteal Augmentation

New surgical techniques for gluteal augmentation have improved final results. It is estimated that more than 35,000 patients have undergone augmentation gluteoplasty using implants. The authors sought to determine and quantify the presence of muscle atrophy, and to evaluate implant positioning using the intramuscular technique. Twenty-three female patients were selected prospectively for this study and underwent intramuscular gluteal augmentation using gluteal implants of a round or oval base. Computed tomographic scanning and three-dimensional volumetric reconstruction were used to investigate muscle atrophy and implant position, with comparison of the results between the preoperative scan and scans obtained 3, 6, and 12 months after surgery. Three-dimensional reconstruction and volumetric analysis showed muscular atrophy. After 12 months of follow-up, 34 gluteal muscles (17 patients) were analyzed, with 4.3 percent atrophy remaining on the right side and 2.6 percent on the left side. Twenty-three patients were studied regarding position (46 gluteal implants). All oval base implants introduced in a vertical direction (seven patients) turned to an oblique direction, following the direction of muscle fibers by 3 months after surgery. Two patients showed rotation of the implant. The presence of a gluteal implant caused muscle atrophy. However, it did not lead to clinical or physical limitations. It is not important whether the implants are positioned vertically or obliquely, provided that they are symmetric. The technique proved to be safe in maintaining the intramuscular position of the implant, with good satisfaction for the patients. Therapeutic, IV.

Surgical Pocket Location for Gluteal Implants: A Systematic Review

The safest pocket location for gluteal augmentation surgery using implants still is unknown. This study conducted a systematic review to derive evidence-based recommendations concerning the safest type of pocket location (sub-muscular, subfascial, intramuscular, or intramuscular XYZ method) for silicone implants in terms of acute and long-term complication rates. Articles from medline that met predetermined criteria were included in the study. The outcomes of interest included wound dehiscence, wound infection, seroma, hematoma, implant asymmetry, and capsular contracture. Pooling of statistical data was performed when possible. The authors reviewed 30 articles regarding five different types of pocket locations for gluteal implants described since 1969. The most common complications after gluteal augmentation surgery using implants are wound dehiscence (10.29%), seroma (2.49%), wound infection (1.12%), and hematoma (0.24%). Fulfilled expectations after surgery were assessed differently among studies and could not be compared. The pocket locations for gluteal augmentation surgery with implants that have the lowest complication rates are the following: intramuscular XZY method (13.18%), sub-muscular (17.60%), intramuscular (18.05%), and subfascial (54.84%). 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 .

Remodelage fessier esthétique par transfert graisseux

The most common surgical techniques performed for gluteal augmentation employ gluteal implants. Gluteal augmentation is today a consultation request for many patients. The results can be interesting, but this surgical procedure can provide some complications. Fat grafting is reliable technique to remodel the buttocks. The aim of this study is to describe our experience for buttocks remodeling with fat grafting. A prospective study has been performed, including patients that have been operated for buttocks remodeling with fat grafting in our department during one year. We have recorded the average age and body mass index of each patient, the total volume transferred for each patient, and the postoperator complications (infection, hemorrhage, seroma, fat embolism). The end result was evaluated by the patient and the surgical team using four criteria: very satisfying, satisfying, fair and poor. A prospective study including 24 cases of buttocks remodeling corrected with fat grafting. The average age was 43 years (30 to 65 years) and the average body mass index was 20.4 (18 to 24,2). The average volume transferred for each patient was 280cm(3) (from 140 to 440cm(3)). The patients and the surgical team were very satisfied or satisfied in 87,5% of cases. In this series we had no complications (infection, hemorrhage, fat embolism). We only had one seroma. Fat grafting is a reliable technique, simple and safe procedure. Fat grafting is an excellent indication for moderate buttocks remodeling. Surgery for correction of the buttocks may involve more than projection and volume. However, these must be in a balanced proportion with the rest of the body.

Reducing Wound Complications in Gluteal Augmentation Surgery

Over the past 30 years, many techniques have been proposed for gluteal augmentation with implants. The intramuscular technique provided greatly improved results and a consequent increase in the number of such procedures performed in Brazil. However, the data available in the medical literature reveal high rates of wound complications, mostly seroma and dehiscence. The aim of this study was to present changes in the management of the wound of augmentation gluteoplasty with silicone implants in an attempt to reduce the rates of postoperative complications. Twenty female candidates for augmentation gluteoplasty were selected prospectively and submitted to the procedure with a modified technique. The incidence of wound complications was compared with the data of the authors and of the literature. In the comparison between homogeneous groups of patients, the modified technique reduced the rate of wound complications from 35 percent to 5 percent. The most frequent complications were seroma and dehiscence. The combination of liposuction of the flanks was not a risk factor for the occurrence of these complications. Reduction of the undermined subcutaneous area, application of adhesion stitches, and maintenance of good vascularization in the sacral region are the keystones of the authors' proposal. The modifications of the technique presented here are simple and easy to perform, and have proved effective in reducing complications during augmentation gluteoplasty with silicone implants. Therapeutic, II.

Région fessière : analyse sémiologique et application pour le remodelage par lipofilling

Gluteal augmentation is a consultation request for many patients. The most common surgical techniques performed for gluteal augmentation employ gluteal implants. However, the results can be frustrating. Liposuction is one of the most common surgical procedures in aesthetic surgery. This surgical procedure can provide some complications. Fat grafting is an effective and predictable way to remodel the buttocks. To get better results, it's important to understand gluteal compartments with a descriptive study. The aim of this study is to describe gluteal semiology for buttocks remodeling with fat grafting. We have described gluteal semiology with our review of literature. We have analyzed fat compartments of gluteal region: volume, links between every compartments, connections with major gluteal muscle and with the skin. We have also analyzed shape and volume of the buttocks. We have described 11 aesthetic subunits, the volume and the shape of the buttocks, and the skin laxity. We did an important literature review to understand the most important gluteal zones to improve for patients' satisfaction. Our gluteal semiology description is very useful to understand liposuction/lipoinjection of gluteal areas. Fat grafting may be a reliable technique, simple and safe procedure. Surgery for correction of the buttocks may involve more than projection and volume. However, these must be in a balanced proportion with the rest of the body.

Gluteal Augmentation

Silicone implants have been used for gluteal augmentation for the past 40 years. Several techniques have been described for cosmetic purposes, but many plastic surgeons do not feel that performing the operation is safe. In this article, a technique is described to reduce the complication rate, improve the final results, and develop an easy way of understanding and learning this procedure. Based on surgical simulation involving 10 fresh cadavers, the authors have determined the goals for making the operation simpler and safer. One hundred three patients have undergone the operation performed by the staff or by the plastic surgery resident under supervision. There was seroma in 3.88 percent, dehiscence of the sutures in 5.8 percent, infection and removal of the implant in one case (0.97 percent), and no hematoma. The patient satisfaction rate was high. Anatomical dissections allowed the authors to gain experience and confidence regarding the plane of undermining, avoiding damage to the sciatic nerve, and the placement of the prosthesis, keeping it in place. The technique is easy to understand and learn.

Body Contouring

After studying this article, the participant should be able to: 1. List patient selection factors for body lift surgery. 2. Describe operative approaches for brachioplasty, upper body lift, abdominoplasty, lower body lift, and thigh lift. 3. Identify complications and pitfalls related to body lifting and describe how to avoid them. The author discusses the preoperative assessment, surgical treatment plan, postoperative management, outcomes, and possible complications for a comprehensive spectrum of body-contouring surgical procedures. Preoperative planning includes medical history and physical examination, along with an open discussion with the patient. Surgical procedures for brachioplasty, upper back lift, abdominoplasty, lower back lift, gluteal augmentation and thigh lift are discussed. Postoperative management pearls are shared, as well as pitfalls to be avoided.

Thickness and tension of the gluteal aponeurosis and the implications for subfascial gluteal augmentation

The aim of this study is to elucidate the thickness and tension of the gluteal aponeurosis (GA) as related to subfascial gluteal augmentation. Twenty buttocks from 10 Korean fresh cadavers (age range: 69-92 years, five men and five women) were dissected. Five radial lines were made from the greater trochanter (GT) to the highest point of origin of the gluteus maximus muscle (GM), the posterior inferior iliac spine (PSIS), the piriformis line (P), the coccyx (Co) and the ischial tuberosity (IT). The upper four lines were intersected by three curvilinear lines that divided them by a quarter, half and three-quarters ratios, and the lowest line was divided by a third ratio and a two-thirds ratio. At the 14 intersecting points, the force needed to break the 6 mm width of the GA was measured. The thickness of the GA was also measured with a digital caliper. The GA was widest at the GT-Co line (161.7±15.8 mm), and it was narrowest at the GT-IT line (106.5±21.2 mm). At most of the points (12 among the 14 points), the breaking strength of the GA was greater than 20 Newtons (N). The breaking strength of the GA did not vary significantly according to the locations (P=0.568, anova). The breaking strength of the males (22.8±6.6 N) was significantly greater than that of the females (20.3±7.5 N, P=0.003, t-test). The thickness of the GA varied according to the locations (0.4±0.2 mm to 0.7±0.3 mm). The thickness of the GA of the upper part (GT-GM line: 0.64±0.24 mm; GT-PSIS line: 0.66±0.23 mm; GT-P line: 0.66±0.24 mm) was significantly greater (P=0.040, 0.017, 0.018, respectively) than that of the lower part (GT-IT line: 0.49±0.18 mm). The GA of the males (0.70±0.23 mm) was significantly thicker than that of the females (0.53±0.21 mm, P<0.001, t-test). We conclude that the GA is capable of holding gluteal implants in the proper position, as the average force to break up the 6 mm width of the GA in females was greater than 20 N.

Gluteal Reduction: A New Technique With Tightening, Lifting, and Reshaping Effects on the Buttocks

Currently, patient demand is increased for procedures to improve the form and size of the gluteal region. Although gluteal augmentation and lifting are the most common aesthetic requirements for the gluteal area, some patients need gluteal reduction. Most surgeons reduce the gluteal volume only by liposuctioning the buttocks. This procedure, however, is inadequate when patients do not have good skin quality. Very few techniques have been described for gluteal reduction, and all of them leave noticeable scars that are unacceptable to most patients. The author presents a new technique to reduce, lift, and tighten the gluteal region using well-hidden incisions. Five female patients who requested gluteal reduction were included in this study. Two of these patients had primary gluteal lipodistrophy, and two had excessive gluteal volume as a consequence of liquid silicone injections in the buttocks. The remaining patient had previously undergone gluteal implants, but after pregnancy ended up having very big buttocks and wanted to reduce the gluteal volume. Gluteal reduction was performed using bilateral incisions that began from the sacral triangle and proceeded downward slightly off the gluteal midline to continue along the infragluteal fold. A flap involving the whole gluteal area was dissected superficially to the gluteal fascia. Excess tissue was removed, and wound closure was performed in multiple layers. The mean operating time was 210 min, and the volume resected ranged from 550 to 640 g in each of the gluteal areas. No major complications or infections occurred. One of the patients presented with wound dehiscence bilaterally, limited to the central area. This case required wound care for 1 month, after which the wound was closed satisfactorily with the patient under local anesthesia. In all the patients, the gluteal area was reduced, reshaped, and tightened satisfactorily. All five patients were extremely satisfied with the new gluteal shape, the degree of the gluteal reduction, the quality and location of the scars, and the lifting effect associated with this gluteoplasty technique. A new technique for gluteal reduction that effectively reduces, tightens, and reshapes the buttocks is presented. Patient acceptance of this surgery is very high because unlike previous gluteal reduction techniques, this procedure leaves well-concealed scars that can be hidden even with the small type of swimsuits used currently. 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 at www.springer.com/00266.

Reconstrução do sulco interglúteo: relato de caso

INTRODUÇÃO: O conceito de beleza feminina tem mudado ao longo dos anos, porém a forma e a projeção das nádegas permanecem como símbolos de máxima feminilidade. A exposição corporal, especialmente da região glútea, tem proporcionado aumento da procura pela cirurgia de gluteoplastia. OBJETIVO: O propósito deste relato é demonstrar a correção cirúrgica de uma deformidade do sulco interglúteo, utilizando a preservação do ligamento sacrocutâneo. RELATO DO CASO: Paciente do sexo feminino, com queixa de deformidade do sulco interglúteo e nádegas hipoplásicas. O tratamento cirúrgico consistiu na reconstrução do sulco interglúteo por meio de preservação do ligamento sacrocutâneo, implantação de prótese de silicone glútea no plano intramuscular e lipoaspiração das ancas. CONCLUSÃO: O entendimento dos princípios da técnica XYZ, em particular do ligamento sacrocutâneo, possibilitou a correção da deformidade do sulco interglúteo e o remodelamento do contorno posterior da paciente.

Bidirectional Barbed Suture Migration: A Unique Complication After Intracuticular Closure

One of our body-contouring patients recently experienced a complication not reported previously for this type of procedure and closure. After gastric bypass, a 29-year-old woman desired body contouring aimed at the lower trunk and inner thighs. She underwent a 360 body-lift, posterior flap gluteal augmentation, and bilateral vertical thigh-lift. As part of the closure, an intracuticular 2-0 Quill SRS Monoderm (polyglocolide-poly-e-caprolactone copolymer; Angiotech Pharmaceuticals, Vancouver, BC) was used. Approximately 2 weeks postoperatively, the patient experienced isolated cellulitis and wound breakdown on a portion of the left vertical thigh-lift incision, which resolved with antibiotics and topical Silvadene. The patient resumed her exercise routine 6 weeks postoperatively but noted pain and a cordlike structure at the medial aspect of her knee. This was suspected to represent inferior migration of the monoderm intracuticular suture (Fig. 1). The suture was removed with the use of local anesthesia and consisted of approximately 7 cm of unidirectional barbs (Fig. 2). The patient’s symptoms resolved, and she resumed her exercise routine. Bidirectional barbed suture was developed to remedy the disadvantages of traditional suturing techniques using knots. These disadvantages include increased foreign body reaction, ‘‘spitting,’’ increased operating room time, and tissue strangulation [1–8]. Early bidirectional barbed suture was noted to cause visible or palpable threads, skin dimpling, ecchymosis, and even suture migration and extrusion in face-lifts [9–13]. These problems have not been reported for the Quill SRS series. The cause for suture breakage and migration in the reported case may have been due to the resumption of exercise or to the previous episode of cellulitis. Increased inflammatory cells may have led to more rapid degradation of the suture in an isolated location. Because factors contributing to this complication are not entirely avoidable, we present this case as a cautionary note for other surgeons. As new wound closure devices are developed, they must be examined to ensure that their advantage extends to patient outcomes and not merely to time savings or novelty. Although bidirectional suture has the potential to improve operative time and offers a theoretical advantage in wound healing, long-term data are limited. We hope future reports will elucidate the frequency of complications with this product.

Autologous Gluteal Lipograft

In the past 25 years, several different techniques of lipoinjection have been developed. The authors performed a prospective study to evaluate the patient satisfaction and the rate of complications after an autologous gluteal lipograft among 351 patients during January 2002 and January 2008. All the patients included in the study requested gluteal augmentation and were candidates for the procedure. Overall satisfaction with body appearance after gluteal fat augmentation was rated on a scale of 1 (poor), 2 (fair), 3 (good), 4 (very good), and 5 (excellent). The evaluation was made at follow-up times of 12 and 24 months. The total amount of clean adipose tissue transplanted to the buttocks varied from 100 to 900 ml. In nine cases, liponecrosis was treated by aspiration with a large-bore needle connected to a 20-ml syringe, performed as an outpatient procedure. Infection of the grafted area also occurred for four patients and was treated by incision drainage and use of antibiotics. Of the 21 patients who expressed the desire of further gluteal augmentation, 16 had one more session of gluteal fat grafting. The remaining five patients did not have enough donor area and instead received gluteal silicone implants. At 12 months, 70% reported that their appearance after gluteal fat augmentation was "very good" to "excellent," and 23% responded that their appearance was "good." Only 7% of the patients thought their appearance was less than good. At 24 months, 66% reported that their appearance after gluteal fat augmentation was "very good" (36%) to "excellent" (30%), and 27% responded that their appearance was "good." However, 7% of the patients continued to think that their appearance was less than good. At this writing, the average follow-up time for this group of patients has been 4.9 years. The key to successful gluteal fat grafting is familiarity with the technique, knowledge of the gluteal topography, and understanding of the patient's goals. With experience, the surgeon can predict the amount of volume needing to be grafted to produce the desired result. Although the aim of every surgeon is to produce the desired augmentation of the gluteal region by autologous fat grafting in one stage, the patient should be advised that a secondary procedure may be needed to accomplish the desired result.

Additional References Document the History of Gluteal Augmentation With Cryopreserved Fat

We are writing regarding the recent article titled “Gluteal Augmentation With Cryopreserved Fat” ( Aesthetic Surg J 2010;30:211-216), in which the authors describe the injection of fat to improve the gluteal contour. The authors inject cryopreserved fat grafts for delayed gluteal augmentation and conclude that their method can reduce costs and morbidity for patients. Although we would like to congratulate the authors for their strong results and for advocating the placement of grafts …

Gluteoplasty: Anatomic Basis and Technique

Although the placement of implants for gluteal augmentation is becoming more common, the procedure still faces strong resistance from patients and some surgeons as a result of unsatisfactory outcomes in the past. The authors describe easily-identifiable anatomic reference points that can assist the surgeon in the performance of gluteoplasty, making the procedure simpler and safer. Based on a literature review, an anatomic study was performed of dissections of the gluteal region in seven formalinized and fresh cadavers. This study allowed the authors to observe anatomic details and propose bony reference points to guide gluteoplastic surgery. Between July 2006 and February 2009, 105 patients underwent gluteoplasty according to the guidelines resulting from the cadaveric study. All patients were female, ages 22 to 50 years. The surgical procedure, once refined, resulted in a low complication rate. In the final 50 patients in the series, there was only one seroma, one wound infection, and no cases of dehiscence. Bruising on the side of the thigh was encountered in four of the total 105 cases (3.8%). The clinical photos demonstrate the positive aesthetic results of this technique. When gluteoplasty is performed utilizing a systematic strategy based on bone anatomy references, it can be a predictable procedure with reproducible results and minimal complications.