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Buttock suspension provides a complete 'gluteoplasty'

Article-Buttock suspension provides a complete 'gluteoplasty'

Key iconKey Points

  • Suspension performed in two phases, a month apart, under local anesthesia
  • During first month following first phase, sufficient fibrosis has developed to resist solicitations in this area
  • Physician finds that using horizontal and vertical vectors at the same time and performing surgery in two steps

In contrast to traditional methods of firming and lifting the buttocks, Roberto Pizzamiglio, M.D., and his colleagues are performing a technique to lift and compact the adipose tissue using polypropylene threads with absorbable cones. These cones are soft and hydrophilic and are absorbable by hydrolysis. Additionally, they generate new collagen formation, and 50 percent of the volume of the cones is absorbed by the body within approximately five months after placement.

TWO-PHASE SUSPENSION The procedure is performed in two separate phases a month apart, and both phases are performed under local anesthesia. The first phase consists of placing sutures without creating traction. In the second phase, an incision is made, and the proximal parts of the sutures are tied, creating suspension. Preoperative marking is performed in the orthostatic position.

"During the first phase, only infiltrate the incision and the exit points with local anesthesia. After the incision, the presacral fascia is identified. Continue introducing the guidewire of the Silhouette suture into the subcutaneous tissue, maintaining the level closest to the muscular fascia. If the patient notices any pain, we are probably pinching the muscular fascia, and we are aiming at an area that is too deep. In this case, go backwards and seek the correct, more superficial area. Take care not to be too near the surface," explains Dr. Pizzamiglio, who is in practice in Marbella, Spain.

Once the suture has been placed, pierce the presacral fascia with the proximal curved needle to keep the pairs of sutures in order and to facilitate the search for the corresponding sutures during the second phase of the procedure, he says.

First part of the procedure, during which the sutures are introduced (left). Then a test is done to see the traction and the compression of the fat tissue (right). Next, the wound is closed until the second step, which takes place three months later. Photos credit: Roberto Pizzamiglio, M.D.
To help differentiate the right-hand sutures from the left-hand sutures, he recommends attaching the proximal part of the suture with numbered Klemmer forceps, while waiting to introduce the one corresponding on the other side. "In this way, we will have, for example, the pair of No. 1 sutures, right and left, attached to the presacral fascia and knotted with a simple knot, without the risk of them getting confused or mixed up with the other sutures," he explains.

The sutures should be rolled in pairs. Then, four are rolled together to ease the introduction into the wound while waiting for the second phase of the surgery. Finish off the first phase of the procedure by closing the wound with flat stitches, he says. After dressing the wound, Dr. Pizzamiglio recommends using a short liposuction girdle.

A patient after the second step of the procedure is completed (left), then eight months post-op.
After at least a month, the second phase of the procedure, which consists of suspension of the gluteus using the sutures previously placed, is performed. "During the month after the first phase, enough fibrosis has developed to resist the solicitations in this area. Infiltrate just the area of the incision with local anesthetic. Remove the old scar and recover the proximal part of the Silhouette sutures used during the previous phase," he says.

Dr. Pizzamiglio then recommends the following steps: Having isolated all of the sutures in pairs, start to tie them. For each pair, determine the direction of the suture, and while the assistant is pushing the center of the gluteus, tie the sutures with six opposing knots. When all of the sutures have been tied, close the wound with flat stitches. The post-liposuction girdle should be worn for two weeks.

INITIAL EXPERIENCE According to Dr. Pizzamiglio, the use of Silhouette sutures for buttocks suspension was first performed by Dr. Fernando Urrutia approximately two years ago in Mexico. "The initial results were strange. Some patients had a visible elevation, while others lost the suspension a few days after the surgery. Of course, the mechanism was that the cones lost support and traction on the adipose tissue," he says.

He decided to do an empiric evaluation of the reactions of the gluteal area during the more common movements of the legs and the body.

"In five patients, we painted some reference lines, and we recorded the changes during movement. The result was that, with the first preoperative marking, the sutures were mainly in the areas that have the largest increase in length during movements. So, when the fibrosis was not strong enough to resist, the cones lost traction," he explains.

He then changed the preoperative marking to a more horizontal position, making compression of the fat more stable. However, this only increased volume in the upper area of the buttocks. "So, we finally decided to use horizontal and vertical vectors at the same time (with six sutures on each side) and to perform the surgery in two steps. This provides a fibrous reaction around the sutures and the cones. This has given us stable results," he says.

Dr. Pizzamiglio has performed this procedure on 36 patients, with up to one year of follow-up.

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