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Gluteal, dermal fat flaps help restore buttocks contour after lower body lift

Article-Gluteal, dermal fat flaps help restore buttocks contour after lower body lift

El Paso, Texas — Because surgeons remove soft tissue and suspend remaining tissue during the lower body lifts, female patients often emerge with flatter, less contoured buttocks.

In almost every total body lift case, surgeons can correct the problem with the use of autologous buttock implants, according to Sadri O. Sozer, M.D., a plastic surgeon in El Paso, Texas.

Dr. Sozer has performed the gluteal flap in circumferential torsoplasty procedure on 30 patients, and says patient satisfaction is high.

Not only are massive weight loss patients candidates for the lower body lift and autologous flap procedure, but also patients who are moderately overweight (30 to 35 pounds) and those who are thin but have bulky legs with a lot of cellulite.

Dr. Sozer's series includes patients who are being treated for multiple body contour deformities, involving the abdomen, thighs and buttocks. He treats these female patients surgically with a circular lipectomy, with lateral thigh and buttocks lift and liposuction of the back and thighs.

"We started with the bariatric patients because they were so deformed, but, as we gained experience with it, I started to think this provides excellent results with cosmetic patients, as well. I started to use it in moderately overweight patients. I would take a patient, and I would reduce that patient 30 to 35 pounds in one operation," he says.

But he noticed that after pulling up the buttocks some three to four inches, he would lose the buttocks' feminine curvature.

"The majority of my patients are Hispanic and the buttocks is very important for them," Dr. Sozer says. "I thought about how I could fix the problem and noted that there were other flaps defined in the literature, but all had their shortcomings."

Dr. Sozer referred to a flap described by French plastic surgeon J. F. Pascal that involves not excising a crescent shaped tissue just superior to buttocks that usually would be excised during a lower body lift. But the approach only gives fullness in the upper portion of the buttocks and not in the more important mid portion.

Dr. Sozer instead designed the gluteal flap that he uses from supragluteal tissue that he would have normally thrown away after surgery.

Step-by-step approach

The technique applies knowledge gained in local myocutaneous advancement flaps for repair of lumbo-sacral defects.

Preoperative markings are crucial to getting the desired cosmetic outcome from the flaps, according to Dr. Sozer. He marks patients preoperatively in standing and decubitus positions. Dr. Sozer has the patient abduct the thigh while in a decubitus position to assess lateral mobility; then, he evaluates incision symmetry while the patient is standing. He marks an ovoid dermal fat flap from in the medial half of the regularly excised supragluteal tissue and individualizes the size of the flap according to each patient's contour.

He performs liposuction where necessary, then positions the patient for resection.

Dr. Sozer places the patient on a beanbag in the supine position; later, turning the patient to the left lateral decubitus position to ensure that the waist and knees are bent. He abducts the thigh, rests the knee on a Mayo stand with a pillow and places an axillary roll.

"The beanbag is then hardened and the patient is prepared once again and draped. We de-epithelialize the flap after making the circumferential incision," he says.

Dr. Sozer designed this flap in such a way that he dissects the flap to the fascia obliquely, undermining the superior and inferior border.

"Think about it as a cylinder: the top of the cylinder is cranial; the bottom is caudal," he says.

The next step involves dissecting the flap to the fascia, obliquely, undermining the superior and inferior border. By retrieving the base of the flap more inferiorly than from the surface, Dr. Sozer allows for greater inferior mobility and a longer, more mobile dermal flap.

He then creates a pocket in which he inserts the flap. Dr. Sozer undermines the buttock above the fascia and extends that sufficiently to reach the inferior gluteal crease, which allows for better movement of the buttock tissue over the flap. He rotates the flap caudally 180 degrees into the pocket and anchors it to the fascia with sutures.

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