Today, women seek an athletic look with well-defined curves for the breast and buttock area. Standards of beauty include a well-projected gluteal area and a uniform line that on the frontal view makes a natural curve from the waist to the knee.
● Young patients with an athletic build with little or no ptosis.
● Morbidly obese patients are not candidates for this surgery unless they lose weight, after which
the laxity of tissues converts them into good candidates if they undergo excisional procedures to correct the back and gluteal regions.
● Those patients who lack projection of the gluteal region and desire to improve the shape of the gluteus.
● The implants used today minimize the risk of displacement, having a textured surface, or a polyurethane foam cover that minimizes the occurrence of capsular contracture.
● Patients must be informed preoperatively about restrictions for sitting in the postoperative period, in which they will be limited to sitting only when going to the bathroom for the first month postop.
If these instructions are not followed, the chance of wound dehiscence and other complications is elevated.
Techniques for gluteal augmentation have progressed through four anatomic planes: subcutaneous, submuscular, intramuscular, and subaponeurotic. I prefer ıntramuscular plane in my practice.
Another anatomic space described for gluteal implants is the intramuscular space which was developed by disrupting the gluteal muscle fibers. This can help to minimize risk to the sciatic nerve, but it may produce some incidence of seroma.
This procedure employs small anatomic implants for gluteal augmentation, as well as bigger implants for larger patients who want a better contour of the gluteal region. Gluteal contour is gained by insetting anatomic implants. The anatomic decision making system designed for this operation consists of templates for the preoperative skin markings, sizers for transoperative measurement.
Implants have a textured surface with the maximum soft- ness available; these implants are highly cohesive gel–filled with texturized surfaces and/or a polyurethane cover.
Patients are instructed to consume a low-fiber diet 3 days in advance of the procedure and to suspend any aspirin, vitamin E, or other medications that promote bleeding during surgery. Patients are admitted to the hospital the night before the operation and skin markings are performed.
Patients are given an enema and started on an antibiotic.
Knowing in advance the exact measurements of the implant pocket, as well as the patient’s expectations for augmentation, it is easy to determine the implant size.
With the patient in the upright position, skin markings are made using a custom-designed template.
When evaluating a gluteal augmentation candidate it is important to take into consideration the following aspects:
1. Skin quality of the lower back, gluteal region and flanks.
2. Length or cephalocaudal distance of the buttocks.
3. Presence and grade of ptosis.
The Basic Surgical Technique
1. Skin approach in the intergluteal fold.
2. Subcutaneous undermining over the sacral region.
3. Intramuscular dissection where the template area is marked.
4. Placement of the implants so that they fit loosely in the pocket.
5. Closure of the different spaces with care to ensure that the subfascial space is waterproof.
6. Approximating of the subcutaneous dissection over the sacral bone.
7. Closing the incision so that the intergluteal fold is recreated.
The most frequent procedure done simultaneously with gluteal implants is liposculpture of the gluteal area including the lower back, posterior thighs, and lateral thighs. By combining these procedures, the results of gluteal augmentation are positively enhanced. Liposuction of the lower back enhances the gentle curve produced by the implants in the upper part of the buttocks.
Patients are taken to the recovery room in a supine position, with a comfortable pillow above and below the buttocks; they are instructed to start moving their legs and feet as soon as possible. A compression garment is worn for 1 month after the operation, and sitting will be restricted to when going to the bathroom.
On the first day after the procedure, patients are instructed to stay in bed with the compression garment on and move their legs and feet. Patients can lie on their side or in a prone or supine position. For the next 2 weeks, patients are able to stand, lie in bed, or crouch on their knees; however, sitting is restricted to when going to the bathroom. Drains usually are left in place for 7 to 10 days and removed once the drainage is less than 30ml per day.
Once the surgical incisions are mature and strong enough the patient can renew sitting for limited amounts of time (no more than 2 hours at a time), and once 30 days have passed normal activity can begin.
Normal activity resumes at 2 weeks. Driving and exercise as well as steam baths are to be avoided. Shower is preferred for the first 3 weeks. Exercise can be started again at 2 months to prevent the wound incision from expanding; it is advisable to take good care of the scar for the next 3 months.
The incidence of infection for the cosmetic procedures is 1%, and this required temporary removal of the implant. Seromas and hematomas are prevented by using meticulous technique, but if they do occur they must be evacuated. If herniation of the implant is observed, surgical re-approximation of the fascia should be performed as soon as possible. Sensation to the gluteal region is lost during the first 6 weeks, and recovery of normal sensitivity may take up to 4 months. Patients have cited the following positive changes: visually improved appearance in clothing, enhanced self-esteem, and improved physical appearance beyond expectations.