Interest in buttocks enhancement surgery appears to be increasing among Americans, but as surgeons consider offering these procedures to meet rising consumer demand, they need to understand the risks and limitations of augmentation using implants and fat as well as the aesthetics of beautiful buttocks, says Daniel Del Vecchio, M.D., M.B.A.
Speaking at the 2011 Cutting Edge Aesthetic Surgery Symposium, Dr. Del Vecchio reviewed the critical anatomy, patient selection factors and surgical considerations for minimizing risk and maximizing success. He also noted the need for additional research to further improve outcomes.
"Some surgeons have completely dismissed buttocks augmentation surgery because of concern about potential complications. However, that is probably a short-sighted decision because with appropriate patient selection and careful technique, it is possible to minimize serious adverse events," says Dr. Del Vecchio, private practice, associate clinical staff, Massachusetts General Hospital, Boston."Now, if more surgeons begin to adopt safer techniques, report good results and patient demand increases, I think more surgeons will begin to include buttocks augmentation into their cosmetic surgery armamentarium, but they must approach it in a thoughtful and gradual way," he says.
KNOWING THE ANATOMY Rare, but life-threatening, complications of buttocks augmentation include injury to the sciatic nerve, injury to the superior gluteal vessels and possible fat embolism. These problems can be avoided by marking the patient to identify the location of these structures, Dr. Del Vecchio says.
The marking is done using three topographic landmarks — the sacral hiatus (SH), posterior superior iliac spine (PSIS) and the greater trochanter (GT). An A is created by drawing lines from the GT to the PSIS and from the GT to the SH.
The cross-line of the A is drawn by dropping a line perpendicularly from the midpoint of the top line to the midpoint of the lower line. The vessels lie at the intersection of the top line and the cross line; the sciatic nerve lies where the cross-line bisects the lower line, Dr. Del Vecchio says.
PATIENT, PROCEDURE SELECTION Even with meticulous technique, there is a relatively high risk of complications with buttocks enhancement surgery, and particularly with implant procedures. Careful patient selection is a fundamental consideration in terms of excluding at-risk patients or those who the surgeon senses will be difficult to manage through a complication, Dr. Del Vecchio says.
"Implants are not meant to support a person's body weight, and so people who spend eight hours a day sitting in a desk chair are not good candidates for an implant procedure," he says.
Although patients may come in specifically seeking implants, since the likelihood of postoperative problems is higher for implant procedures than with autologous fat injection — and because the implant procedure is tolerated less well by patients — Dr. Del Vecchio says he prefers to perform fat transfer whenever possible. In patients who do not have sufficient fat to allow buttocks augmentation by fat transfer alone (or in those who are seeking significant projection that is unachievable with fat alone), however, Dr. Del Vecchio performs a "bilamellar" technique, placing the implant into the muscle and then injecting fat superficially to smooth the contours.