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23 Buttocks

The gluteal region is one of the main components of the body beauty, occupying a preponderant position in the physical ideal. Universally pleasing features include fullness, smooth convex contours, and homogeneous skin tone and texture. In recent years, the search for procedures to improve buttock volume, firmness, and / or shape has been increasing. Traditional treatments (massages, exercises) are still in use, while surgical techniques are being refined and new energy-based (lasers, radiofrequency, infrared) treatments are expanding. No one type of procedure will achieve improvement in all aspects and multiple modalities are necessary to obtain the highest patient satisfaction. This chapter will address volume augmentation through autologous fat grafts and correction of gluteal contour deformities with hyaluronic acid gels.

Aesthetic characteristics of the buttocks

The shape of the buttocks is determined by anatomical structures such as the underlying bone component, gluteus maximus muscle, adipose tissue, and skin. Their combination and interaction give individuals their characteristic buttock shape. According to ethnic ideals, some characteristics of the gluteal region should be preserved, recreated, or corrected in order to enable a harmonious result in relation to the rest of the body. They are described here and summarized in Box 23.1.

Gluteal augmentation with fat grafting

For gluteal augmentation, the majority of investigators believe that autologous fat can be considered the ideal filler as it is abundant, easily available, of low cost, and easily and repeatedly collected. The donor area is selected to contribute also to the final shape of the buttocks; thus, the alternative sites would be the supragluteal, paralumbar, subgluteal, and trochanteric regions (thigh bulges). In this way, while liposuction models the shape of the buttocks, lipotransfer improves their projection.

Fat may be obtained as a single process associated with regional or circumferential liposculpture, or combined with other procedures such as lipectomies. Table 23.1 describes the tumescent solution used for gluteal augmentation. Fat extraction is performed using 3–4 mm blunt-tipped cannulas to avoid the destruction of the adipocyte, with continuous negative aspiration at 0.5 atmospheres of pressure, collected in a sealed vial. For minor procedures 10, 20, or 60 mL syringes may be used.

Table 23.1 Tumescent solution used for gluteal augmentation

0.9% Saline solution 1000 mL
2% Lidocaine 25 mL
1/1000 Ephinephrine 1 mL
8.4% Sodium bicarbonate 12.5 mL


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