New Orleans — The number of buttock augmentation procedures performed in the United States increased 533 percent in 2003, rising from 614 procedures performed in 2002 to 3,885 in 2003, according to the American Society for Aesthetic Plastic Surgery (ASAPS). In 2004, there was a 45 percent decrease to 2,141 procedures performed, still well above the number performed in 2002. The ASAPS did not collect data about this procedure before 2002. Thomas Roberts, M.D. expects the desire for this procedure to continue.
"There's a lot of pent up demand," says Dr. Roberts, associate clinical professor of surgery at the Medical University of South Carolina in Charleston, S.C. "Women have known they could do breast augmentation for years but are just learning they can do buttocks too."
Various magazines, including Vibe, are beginning to elaborate on surgical options for women who feel inadequate in the buttocks department. While Vibe is a magazine aimed at black readers, Dr. Roberts is seeing a cross-cultural selection of women.
He notes, "I'm doing research with a psychologist and cultural anthropologist. We've found at least 18 cultures from primitive African to modern European that value large buttocks."
According to Thomas Roberts, M.D., the universal gold standard for buttocks size is 1.4 times the circumference of the waist. Photos: Thomas Roberts, M.D.
In describing beautiful buttocks, Dr. Roberts says there is a universal gold standard: buttocks about 1.4 times the circumference of the waist. Beyond that, concepts of beauty tend to diverge along ethnic lines. Asian women want small but shapely buttocks. Some Caucasian women like small, athletic-looking buttocks with a lateral hollow and medial fullness; others seek rounded, lateral buttocks without extension of that fullness to the lateral thigh. Hispanic women prefer full buttocks with moderate fullness in the lateral thigh. Black women request significant fullness, both in the buttocks and in the lateral thighs.
Dr. Roberts notes, "Generally, the patient will come in with a photo of Serena Williams, Jennifer Lopez, Beyonce or a photo from my Web site. I can't make a 230-pound woman look like a 120-pound gal, but whatever their shape, I can improve it by sculpting in the lower back, abdomen and hips, adding cleavage between the buttocks, and increasing fullness wherever they want it."
The procedure is labor-intensive, requiring one surgeon and three to four scrub nurses for a period of four to seven hours. Women who are thin, have had liposuction in the past, or want a dramatic increase in buttocks size take longer to operate on.
Dr. Roberts warns: "Success is technique-sensitive from the standpoint of minimizing infection and maximizing fat survival. I urge people to take a course before trying the procedure."
Rise in cosmetic buttocks surgery
Implants versus microfat grafting
Dr. Roberts has performed more than 220 buttock augmentations over the last five years. He has two basic approaches: microfat grafting and implants.
Ninety percent of women opt for grafting. Of the rest, some choose implants to save money; others find it's the only viable option because they haven't enough fat and do not gain weight easily.
When performing microfat grafts, Dr. Roberts makes three small incisions in each buttock and threads droplets of fat through tissue in a fan-like pattern at differing depths. He starts just above the bone and sculpts out a deep sacral "V," augmenting the upper medial edges of the buttocks to emphasize the superior gluteal cleavage.