"Beware that certain injectable materials used in other countries for buttock reshaping are illegal in the U.S. and have been associated with complications, including necrosis and granuloma formation," says Dr. Pelosi, chairman of obstetrics and gynecology, United States Section of the International College of Surgeons, and associate director, Pelosi Medical Center, Bayonne, N.J. "Fat or preformed silicone implants are the only safe methods for buttock augmentation, but considering ease and ability to control the final outcome, fat is clearly the superior product."
LAYING THE FOUNDATION Aggressive liposuction to remove tissue that is competing for attention in the buttock region followed by careful planning to determine the area of augmentation are the first steps to achieving a good result. Liposuction concentrating on the mid- and lower flanks and the midline immediately above the buttock crease narrows the waist and improves the flow of the sacral curve into the buttock. By itself, the liposuction enhances the appearance of buttock size and contour, Dr. Pelosi says."Removing a triangular-shaped fat deposit that is often present above the buttock crease sculpts a 'V' shape emanating out of the buttock apex and produces a cleavage type of effect with a sharply defined curvature from the top of the buttock outward," he says. "This goes a long way toward creating a visual impression of upper buttock roundness that is a good starting point for achieving a nicely flowing contour with the augmentation."
To define the perimeter of the area for the fat injections, Dr. Pelosi identifies the edges of the gluteus by palpation while the patient is standing and marks a preliminary template that he then views from across the room.
"Patients should be standing for the assessments, because that is the position in which they will look at themselves to decide their satisfaction, and to fully appreciate the expected outcome, the surgeon needs to make the initial assessment by taking a long versus close-up view," Dr. Pelosi says.
He says he often takes digital photographs of the marked patient and views them on the computer to refine his plan about shape.