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Concerns regarding the buttock are excess, sagging, or deflation. Mild to moderate excess fat can be corrected with conservative buttock liposuction, but aggressive liposuction can lead to significant sagging. In the right patient, liposuction can have a dramatic result with imperceptible scars and simple recovery in an outpatient procedure without the need for observation overnight. Significant excess requires excision of skin and fat, a buttock dermal lipectomy, or elevation, a “buttock lift” or “fanny tuck,” which includes mobilization and suspension of lower buttock tissue.
The scar can usually be placed where it will be hidden by underwear and a bathing suit. An upper buttock lift requires an incision at the belt line and is usually performed as a circumferential lower body lift. The procedure must be performed with the patient on their side or belly so general anesthesia is usually employed for safety. After the procedure, overnight observation may be necessary, as are drains and limitations on activities to protect the suture line. Pain can be controlled with prescribed medication but may last 1 to 2 weeks. Deflation can be corrected with implants, fat injection, or elevation of thigh tissues.
Implants
Gluteal augmentation with a buttock implant is often performed with a solid silicone implant placed under the fascia of the gluteus muscle with an incision over the tailbone. Sub-fascial placement reduces implant risks, such as migration, fluid collections, infection, and extrusion without the added morbidity from submuscular placement. Gluteal augmentation with fat injection includes harvesting fat with liposuction which is then prepared and reinjected in significant volume, usually in the gluteal muscles. Large volumes are needed to create significant change. Gluteal auto-augmentation mobilizes excess soft tissue from the posterior or superolateral thighs under the buttock skin to serve as an implant. There are advantages to avoiding an implant, but the “implant” flap may not survive which can lead to infection or gradual dissolution. All of these techniques are uncomfortable and preclude sitting or laying on the buttock for 1 to 2 weeks and mobility is encouraged but must be guarded.
All of the descriptions for the various procedures are condensed from the text of the upcoming textbook written by Dr. Christopher Park and Dr. Malcolm Marks and are copyrighted, "The Artistry of Plastic Surgery: Exploring the Experience” . |
