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Too thin not 'in'

Key iconKey Points

  • Gluteal augmentation is growing in popularity
  • Various approaches, including autologous fat transfer and several types of silicone implants, find favor with surgeons based on patient selection and device availability

Pre- and post-operative photos of two patients who underwent buttock augmentation utilizing solid silicone gluteal implants. Photo credit: Douglas Senderoff, M.D.
INTERNATIONAL REPORT — It's no longer hip to minimize your gluteus maximus.

Though demand for the procedure has not yet approached that of procedures such as breast implantation and liposuction, according to the American Society for Aesthetic Plastic Surgery there were 2,361 buttock augmentations performed in 2005 in the U.S. — up some 284 percent since 2002. Overwhelmingly, buttock augmentation patients are women, but men are having the procedure done as well.

Interestingly, some U.S. surgeons are finding themselves playing catch-up to their counterparts in Mexico and South America to learn the technical intricacies and artistry of the procedure. The American Society of Plastic Surgeons recently held an instructional course on this topic at its annual meeting, bringing together international practitioners of the procedure.

EX-U.S. OPTIONS These gluteal augmentation experts tell Cosmetic Surgery Times that a device availability gap exists between practitioners in the northern and southern hemispheres. This, in part, has contributed to a difference in augmentation approach between U.S. surgeons and those based in Mexico and South America. American physicians generally opt for autologous fat transfer while their peers south of the border often choose silicone implants.

Specifically, Mexican and South American surgeons have silicone gel implants as an option, which have not been approved by the U.S. Food and Drug Administration. These silicone gel implants are softer, more pliable and more easily compressed. The implants available in the U.S. are solid silicone, have a hard shell and are more challenging to place in the body — also requiring larger incisions.

"There can be significant complications with silicone elastomer implants," cautions Robert Centeno, M.D., a plastic surgeon in private practice with Body Aesthetic Plastic Surgery and Skincare Center in St. Louis, Mo. "There may be a problem with the positioning of the implant, the visibility of it, palpability, as well as wound dehiscence."

But for Raul Gonzalez, M.D., a plastic surgeon in Sao Paulo, Brazil, using implants is the ideal option because they produce more shapely buttocks.

"The best way to achieve a round shape and good projection is to use implants," says Dr. Gonzalez. "Using fat grafting or fat transfer does not improve the appearance of the buttocks as well as implants."


Dr. Senderoff
Dr. Gonzalez notes that he also performs the gluteal volume restoration and reshaping procedure on AIDS patients who sometimes suffer lipodystrophy as an adverse event from their medications.

While the silicone implants, particularly the gel versions, carry a risk of rupture and are more difficult to manage if a complication such as fluid collection occurs, Dr. Gonzalez indicates that complications have not been a concern with the silicone gel implants in Brazil.

OPTIMAL POSITIONING Dr. Gonzalez notes that about half of his patients are younger, 40 and under, and do not like the shape of their buttocks. The other half are women 40 and older whose upper buttocks are somewhat ptotic mainly due to sedentary lifestyle.

"The upper buttocks need a lift," he explains. "I use an intramuscular method of implantation to reshape and rejuvenate the buttocks."

Surgeons have explored various implant positions to see which approach optimizes the appearance of the buttocks, notes Dr. Centeno.


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