William Callaghan. MD (gluteal-implants Surgery)
Another term that can be used to define glueal enhancement is gluteoplasty. Gluteoplasty essentially is the repair of any deformity of the buttocks whether acquired or for aesthetic purposes.
In today’s aesthetic surgery of the buttocks gluteal enhancement is a very popular procedure. The most common techniques involve micro-fat transfer, gluteal implantation, or a combination of the two. Frequently, to improve the enhancement of the buttocks liposuction is very frequently a necessary procedure.
To understand the shape of the buttocks a brief understanding of the anatomy is required. The major components, which contribute the shape of the buttocks, are the gluteus maximus and medius muscles, and the overlying layer of fat held in place by fibrous connections. The fibrous connections of the buttocks are very important in gluteal enhancement surgery.
The shape of the buttocks is also formed partly by the shape and the fat distribution of the hips and lower back (pre-sacral area). All of these anatomic areas must be considered as part of the overall buttock when one is considering its enhancement.
It is very important for the reader to realize that these are highly specialized procedures that have potential for severe complications and a patient must determine the background of the surgeon. In the USA they MUST be board certified by the American Board of Plastic Surgery. Even this does not necessarily mean that the surgeon is qualified. They must have prior experience in these types of procedures.
The augmentation of the buttocks can be done with the use of implants. These are solid (soft) implants, which are placed in this location. There are several places, which have been described in the literature and are currently by plastic surgeons.
The implants may be placed under the gluteus maximus fascia, between the layers of the gluteus maximus muscle (intra-muscular approach) or under the muscle (sub-muscular approach).
The gluteal fascia is not very well defined in most patients, and the sub-muscular approach has the potential for movment and possible impingement on the sciatic nerve. Therefore, the intra-muscle approach is probably the best approach.
Lipo-injection (Micro-fat graft)
This approach has become very popular. The patient undergoes liposuction (lipo-sculpture) and the harvested fat is injected into the buttocks. The process of fat transfer is a highly technical procedure especially when injected in large amounts. Again, the Board certified plastic surgeon must be experienced in order for the results to be optimal.
The correct amounts to be grafted will depend on the experience of the surgeon and the availability of fat. Liposuction is performed in the same manner as in tumescent techniques. Other methods (ultrasound and laser are still under study).
The recovery mainly depends on which procedure was performed. The gluteal implant procedure tends to be very painful initially (1-2 weeks); however, the once the initial period has concluded there is a fairly rapid recovery. The micro-fat graft approach is not generally as painful as the implant approach; however, there is a longer recovery because of the liposuction.
One of the important points to remember is that the body absorbs some of the fat. The percentage varies but roughly 1/3 is absorbed and 2/3 stays, if performed correctly. Sometimes more than 2/3 stays! Another important part of the recovery process is that the patient must not put pressure on the grafted fat. That means no sitting for at least 2 weeks.
Infection, and hematomas are common to all procedures and gluteal enhancement is not an exception, though they are rare.
Whenever an implant is placed in an individual’s body the possibility of implant malposition or movement exists. Contour irregularities from the fat grafting or liposuction also are not too uncommon.
Gluteal implantation also has a very rare possibility of a compartment syndrome. This is a very dangerous development, which needs immediate attention. It generally occurs when the combination of extreme edema (swelling) and hematoma occur. This development can be fatal.
Impingement of the sciatic nerve can also occur and is most likely due to over aggressive dissection, or direct implant pressure on the sciatic nerve.