Buttock Augmentation Isn’t a New Procedure Per Se.

M. Vincent Makhlouf, MD, FACS

Article by
Chicago Plastic Surgeon

Thirty years ago, physicians were placing breast implants in the buttock area in order to increase fullness and projection.  Unfortunately, this procedure was fraught with complications; some directly related to the implant itself (rupture of silicone, limitations in shape and size of the implant design) and some due to the technique and location of placement.  The implants were placed subcutaneously and frequently resulted in an unacceptable shape because of the scar tissue that would form.

As plastic surgery evolved, silicone became available as a soft solid with different shapes and sizes, and liposuction and fat grafting have become popular.

Our aesthetic goals have evolved over time and include the whole area of the lower back, buttock and upper thighs addressing proper projection and fullness. The maximum projection should be at the level of the pubic hair when viewed from the side.  The maximum fullness from the back is not in the middle of the buttock when viewed straight back, but in the middle of the buttock when viewed from a 45 degrees angle to the back.  The scar has to be inconspicuous.  We need to incorporate the buttock with the flank and hip areas in our evaluation, and we have to take into account the trochanteric and thigh areas and decide if they will require special attention.

Until a few years ago we were able to offer only liposuction for this area of the body. Today along with liposuction we can add either an implant or the fat. When fat is used it is harvested through liposuction and then introduced in the buttock area through small cannulas.

In order for the fat to survive, it has to be injected in very minute quantities so that the surrounding tissues can provide nourishment for these cells.  If a large volume is injected in any one location, the central part of this imaginary ball of fat and fluid would not be in direct contact with the tissues and not have access to oxygen and nourishment; the fat cells would then die.  Because of this limitation, multiple tracts are created in the tissues of the buttock in order for the surgeon to be able to deliver the amount needed. Extreme care with regard to sterility of the procedure must be maintained. Antibiotics are a central component of this procedure.  The first limitation for fat injection (grafting) is the amount of fat that any individual patient has available for use. The second relates to the fact that less than 50% of what is aspirated can be used in the augmentation, and the third is that 30-50% of that added volume might be lost over time.

If buttock augmentation is going to be achieved with a silicone implant, the procedure is done through a very specialized incision in the fold between the buttocks.  It is designed to prevent separation of the tissue and to prevent accumulation of fluid between the two buttock cheeks that could lead to problems with healing.  After this incision is made, a pocket is dissected to the exact size and shape of the implant.

As mentioned earlier, the implants we use today are specific for the buttocks and proper anatomic placement is crucial. Earlier in the learning curve the implants were placed subcutaneously often resulting in the previously mentioned problem.  Subsequently, the implants were placed underneath the muscle, but that position suffered two setbacks.  The first was that the implants were riding higher than aesthetically desirable and when the surgeon tried to bring the pocket a little lower, pressure on the sciatic nerve was a potential complication.

Today we place the implant in one of two ways. One is within the gluteus muscle itself.  The other is underneath the fascia of the muscle.  This is the location that I use because it provides me with the flexibility that I need and minimizes the discomfort. The patient is marked before surgery in the standing position with the help of a sizer and dissection adheres strictly to the markings. We inject the area with a long acting pain medication at the onset of the procedure. This seems to help the patient significantly with postoperative pain.  A garment is placed at the conclusion of the procedure. Care is simple and within two weeks scar tissue has formed around the implant keeping it in position.

Now that we are beyond the learning curve, I am able to offer a reliable procedure with very few risks, little discomfort and a short downtime. It has been rewarding both for me and the patients who walk away with an increased confidence in their transformed appearance.