Contrary to what one would think, most women want their buttocks enlarged, not reduced.  Most people think of breasts when talking enlargement, but increasingly, a demand for buttock enlargement is being seen.  Attractive norms vary on the basis of ethnicity.  Women with larger buttocks have always been deemed desirable in the African American and Hispanic populus.  The media’s recent fascination with more curvy women, particularly those with a large derrière, has also fueled an interest in options patients may have that give that appearance.

The purpose of this article is to educate patients about buttock enhancement.  This operation is not one that patients would normally or routinely ask their family physicians about or a referral for.  Most do research on-line and, with an opportunity to review before and after photographs, can get a good idea of what is a desirable buttock and who is providing those operations. 

Currently two options exist for buttock augmentation.  The first is autologous augmentation wherein the patients own fat is harvested from another area of the body, washed, and then injected into the buttock.  To be a candidate for this option, one needs enough fat in other areas.  Advantages of this technique include liposuction of the donor sites; the patient’s own tissue is used reducing the risk of infection or extrusion, and the postoperative feel is very natural.  Small single stitch incisions are used.  The biggest limitation of this procedure is the amount of donor tissue available.  When fat is harvested, some of the cells do not survive the harvesting process or the transfer process.  Consequently, in patients desiring a significant change, a repeat procedure might be necessary to achieve the desired outcome.  In some patients, there is simply not enough fat in donor sites to provide for an adequate volume increase.

Most patients want a noticeable enlargement and in patients who have insufficient donor sites, an alloplastic implant is the best option.  Buttock implants are reasonably soft and blend nicely if properly placed.  They come in varying sizes and are made of semi-solid silicone.  Being semi-solid, there is no risk of rupture.  Ideal placement is subfacial or intramuscular in the gluteus maximus muscle, which extends from the sacrum to the outer aspect of the thigh.  Using these placement locations, the risk of migration (moving around), infection, wound breakdown, or exposure of the implant is significantly reduced.  Advantages of implants include single site surgery without pain at the donor sites.  The volume of the implant is constant and larger sizes can be obtained.  There is no subsequent reduction in the size of the implant after buttock augmentation with an alloplastic implant. 

I frequently use a combination of implants and fat grafting.  Recovery is fairly short (approximately one week) and discomfort is minimal.  Contrary to popular belief, we sit on our ischial prominences and posterior thighs rather than on our buttocks.  We use antibiotics perioperatively when using implants, diminishing the risks of infections.  Drains are placed to prevent fluid or blood accumulation around the implants and are usually removed within three to five days.  Pain meds are prescribed upon discharge and a girdle is applied at the end of the procedure for comfort and support.  The girdle is worn as tolerated over the first two weeks.

The goal of this operation is to create a buttock as described by the country singer Trace Adkins as a budonkadonk.  The operation is not a treatment for cellulite.  Enlargement of the buttock will improve aesthetics associated with drooping or sagging of the buttock but is not the same as a buttock lift wherein a longer incision is made across the top of the buttock and the skin and sagging fat are lifted.  The incisions used for augmentation with an alloplastic implant are in the intergluteal cleft and thus not visible.

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Jackson Plastic Surgeon