Background: The size and shape of the buttocks is an important part of the aesthetics of one’s body. The importance of size and shape varies amongst different cultures and ethnic groups. This has led to the popularity of buttock augmentation procedures, using either the insertion of an intramuscular implant or fat injections. Fat injections, known as the Brazilian Butt Lift, is the more popular due to its use of one’s own body tissues and the generous availability of donor material in most patients.

But regardless of one’s ethnic or racial background, a completely flat buttocks is not viewed as aesthetically desireable. Such a flat buttocks, and sometimes even an indented one, is prone to occur in those that are thin and lean. To no surprise, a thinner overall fat distribution in one’s body can lead to minimal fat over the buttocks as well. While the gluteal muscles are not small, much of buttock volume comes from the amount of fat between the skin and the muscles.

In the thinner woman who desires a buttock augmentation, specifically a Brazilian Butt Lift technique, the lack of sizeable donor material is a limiting factor. For very thin women, this procedure is an impossibility and an implant is the only treatment option. But moderately lean to average-size women may have a fat injection buttock technique if they recognize that the buttock size obtained will be more modest and always less than they ideally desire.

Case Study: This 31 year-old female had long been bothered by her flat buttocks. She had tried to build up her buttock size through different exercises but without success. She did have some excess fat on her stomach and around her waistline and wondered if this would be enough for a Brazilian Butt Lift. On feeling her stomach and flanks, it was felt that maybe a liter of fat aspirate could be obtained but not much more. She wanted to proceed with surgery as she did not want to have synthetic implants.

Under general anesthesia she first underwent liposuction harvest of the entire abdomen and flank regions in the supine position. A total of 1,150cc of aspirate was obtained after initial Hunstad infiltration. She was then turned over into the prone position where additional liposuction was done across the top of the buttocks, in the sacral triangle and below the buttocks in the infragluteal fold. This brought the fat aspirate to 1,275ccs.

The fat aspirate was processed by passing it through a sieve and draining off the excess fluid. This brought the concentrated fat amount to 450cc. Using an injection cannula, 225cc of the concentrated fat was injected into each buttock. The injection amount combined with surrounding buttock liposuction fat reduction gave her a visible amount of buttock enhancement.

When seen at her three month follow-up, her final result showed a slightly more rounded buttock shape and size. Her overall buttock shape was more pleasing even if it was not dramatically bigger.

An important question when considering the Brazilian Butt Lift is how much fat will end up being injected into the buttocks. As a general rule, expect only 1/3 to ½ at best ending up being the concentrated amount of fat available for injection. This means that one has to have at least a mimimum of 1,000cc to 1,200 available for removal. It is better that 1,500cc to 2,000cc can be harvested. When only 150cc to 250cc of fat is available for each buttock, the patient needs to appreciate that the buttock size gain will be modest. Some improvement will also come from the buttock sculpting obtained by the liposuction. It is the combination of both that creates the final result. In thinner women, the Brazilian Butt Lift is more of an overall buttocks reshaping effort than exclusively an augmentation outcome.

Case Highlights:

1) The results of fat injection buttock augmentation is limited by the size of the donor harvest areas. These come primarilyfrom the abdomen and hip rolls.

2) In thinner women, the enhancement of the buttock is contributed to as much by the surrounding fat reduction as the buttock size achieved by fat injection.

3) The Brazilian Butt Lift in thinner women is better thought as buttock reshaping than buttock augmentation.

Dr. Barry Eppley

Indianapolis, Indiana

Enhancement of the buttocks has become enormously popular over the past decade. Most methods of cosmetic buttock surgery are perceived as that of increasing its size through either implants or, more commonlytoday, fat injections. But buttock enhancement is as much about contouring and reshaping as it is about size increase alone. Large poorly-shaped buttocks are far less appealing than slightly smaller ones that have a more desireable shape.

When evaluating the buttocks, it is best to see it as an anatomic structure with different areas as zones that can be modified. There are essentially six aesthetic zones to the buttocks which can be described as follows: zone 1 is the midline lower back/sacral area, zone 2 is the upper lateral region or low flanks often also called the muffin tops, zone 3 is the middle lateral region where the muscle inserts, zone 4 is the low lateral or greater trochanter area, zone 5 is the upper inner thighs, and zone 6 is the amount of buttock projection seen in the side view.

The relevance of these buttock zones is that they all represent areas of either reduction (liposuction) or augmentation. (fat injections) Zones 1 and 2 are the areas of greatest liposuction fat removal while zones 3, 4 and 6 are the primary areas of fat injection augmentation.

Improving buttock shape is more than just injecting a lot of fat all over the entire buttocks. Skillful reshaping by fat removal combined with fat augmentation is a more successful approach. In many patients, it just isn’t possible to place enough fat or have enough of it consistently survive to create a better shape by simple volume addition alone.

In improving the shape of the buttocks the contour of the hips is a key area. Buttock projection can look diminished when the hip and back area has a good thickness of fat. This obscures any appearance of an upper gluteal shelf. When liposuction is done to reduce the hip and back fat, an inward skin retraction occurs. This creates an inward indentation or concavity which can match the curve of the lower of the lower buttocks as it dips inward towards the posterior thigh. By so doing, the illusion of a greatee central buttock projection is created. This can be further enhanced by concurrent fat injections into this central mound. This is a good example of the ‘ying and tang’ approach to increasing any body contour. The combination is always better than either approach alone.

The survival of fat injections in the buttocks is always an issue of concern. While there are numerous methods of processing fat prior to injection, none have been shown to be better than another. Some method of concentration is important to eliminate excess oils and fluids. In the buttocks, unlike many other face and body areas where fat is injected, there is a choice of injecting into the subcutaneous fat layer, the muscle, or both. The buttocks have a large gluteus maximus muscle and most of the fat injected should be into it. This will ensure the most amount of injected fat survival due to the better intramuscular blood supply.

Buttock enhancement is best done through a combination of zonal liposuction reduction and intramuscular fat injections. This is best for those patients that have an excess of fat around the buttocks in the hips, back and waistline.

Dr. Barry Eppley

www.eppleyplasticsurgery.com

Indianapolis, Indiana

Enlargement of the buttocks has been one of the fastest growing procedures in body contouring over the past decade. While implants have been historically used for gluteal augmentation, the injection of fat has now become the most popular method. While fat injections have been used for numerous applications, mainly in the face, its use in the buttocks poses a new variable not seen elsewhere…the need for large volumes. Because of the need for large volume injections in the buttocks, new techniques and methods have evolved.

In the August issue of Plastic and Reconstructive Surgery journal, a 14 year experience of buttock fat grafting was published. The authors report the evolution of their buttock fat grafting technique over this period of time. The study was divided into three stages according to the infiltrated areas and the evolution of infiltration, stage I was infiltration into the upper gluteal region, stage II was infiltration into the upper and lower gluteal regions, and stage III included stage II location as well as the trochanteric and subgluteal regions. A total of 789 patients were treated over a 14 year period. In stage I, 492 patients received 120cc to 320cc of fat injections. In stage II, 132 patients received 210cc to 460cc of fat injections. In stage III, 165 patients received 220cc to 1,160cc of fat injections.

The relevance of this study is that they looked at postoperative complications with buttock fat injections including infection, fat necrosis, gluteal erythema and fat embolism syndrome. What they found was that the incidence of these complications was statistically higher and more serious in the stage I patients which, ironically, had the smaller volumes of fat injected. They concluded that the reason is the broader surface area of fat distribution. Rather than injecting just into one concentrated buttock area, it is much better both aesthetically and for survival of the fat to be placed over broader gluteal regions in different infiltration planes. Complications have decreased despite increasing the amount of fat injected because it is distributed in more extensive areas and in different layers which allows for better revascularization of more fat.

As buttock fat grafting has evolved, it has become apparent that there is a significant aesthetic component to it in the injection technique. While the harvesting and processing of the fat is important, how it is introduced into the buttocks is just as significant. There is definitely an artistic or sculpting skill in enhancing the buttocks with fat that is not easily taught. Incorporating an overall buttocks approach with multiple area enhancement produces better results. Sometimes the limiting factor is in how much fat the patient has to give based on their available donor sites. But it does not appear, as this study shows, that there is a limit to how much fat can be injected into the buttocks.

Buttock enhancement with fat, also known as the Brazilian Butt Lift, will remain a popular procedure even though its volume retention is not always completely predictable. Such variability is tolerated because there is also the body contouring benefits obtained from the liposuction harvest areas. While further refinements in its methods will undoubtably be achieved in the future, fat injection distribution over a broader gluteal area is a foundational technique.

Dr. Barry Eppley

www.eppleyplasticsurgery.com

Indianapolis, Indiana

Background:  Buttock enhancement has become a popular body contouring procedure in the past decade. Influenced by a growing multicultural population mix and the influence of pop culture and social media, the desire for rounder and fuller buttocks is growing. The typical patient is either African-American or Hispanic where the shape of the buttocks is one of the most significant body features.

While buttock implants have been around for some time, they are not behind the increase in buttock augmentation procedures. Rather than a synthetic material which involves a longer recovery and more pain, fat injections today account for the majority of buttock enlargement procedures. It offers the simultaneous benefits of concurrent body contouring of undesired fat areas, a faster recovery than a buttock implant, and a natural augmentation material.

Fat injection buttock augmentation has been given the procedure name known as Brazilian Butt Lift. That name is a bit deceiving in that there is no conventional buttock lift per se. Use of the term ‘lift’ in the procedure implies that the buttock is reshaped by actually lifting it through some type of skin removal and/or tightening. In reality, the lift of the procedure comes from making the buttock fuller through volume augmentation. To some degree the buttock is ‘lifted’ by making it bigger. That distinction is important as some patients may want their sagging buttocks lifted and not necessarily bigger. That would require a different procedure. (lower buttock lift or tuck)

Case Study: This 32 Hispanic female wanted her buttocks bigger and reshaped. Besides being too small or flat, she had a lot of irregularities/indentations in the overlying skin. She wanted fat injections and not an implant as she had other body areas that she wanted reduced as well. She was not a big person or had a large amount of abdominal fat. This limited her to the result that fat injections could achieve and that this would be a one-time procedure. (all available fat taken the first time) The choice she had to make was to have a buttock result with fat injections that was not as much as she wanted (but was natural with a quicker recovery) or use an implant to get a bigger result. (and have a longer recovery with more potential complications)

Under general anesthesia, he underwent liposuction of her full abdomen, waistline, lower back and upper back. A total of 1,900cc of aspirate was obtained. This was centrifuged to create a volume of concentrated fat of 700ccs. Each buttock was then injected with 350cc down into the muscle as well as in the subcutaneous space.

At three months after surgery, her result appeared stable and had not changed in any visible way from that seen at one month after surgery. It is presumed that this result will be volumetrically stable long-term. There may be the potential for growth (unlikely) but probably no further resorption or volume loss will be seen.

This patient represents a very typical Brazilian Butt Lift patient and result in my experience. Due to the volume of available fat to be harvested and surgical economics, this will be a one-time procedure. Visible buttock enlargement and reshaping is seen and maintained but the result is rarely as full as most patients would like. Some method fat concentration/purification should be used to get stable volume results.

Case Highlights:

1)      The Brazilian Butt Lift is not a skin excision or tuck procedure, rather it is buttock enhancement with fat injections. There is no real lift but volume expansion.

2)      There are secondary body contouring benefits from the liposuction harvest of fat in a Brazilian Butt Lift including abdominal, waistline, hip and lower back/upper buttock reduction.

3)      The amount of volume or size that the buttocks can be increased in this procedure is a function of three factors; amount of fat that can be harvested, amount of fat that can be injected, and how much inject fat will survive. As a general rule, most volume increases are less than what most patients desire but the result is natural and soft and will never cause any long-term problems.

Dr. Barry Eppley

http://www.eppleyplasticsurgery.com

Indianapolis, Indiana

While immigration issues, largely that of the Hispanic and Latino origin, have dominated the national headlines for a while and will continue into the future, there is a cosmetic medical issue also brewing within these U.S. communities. In large urban areas such as L.A. New York and Chicago, this influx of legal and illegals have become prime targets for cosmetic surgery scams.

The desire to have a larger or enhanced buttocks is a common aesthetic desire to the Latin and South American communities. In addition to African-Americans, they make up the overwhelming majority of those patients in the U.S. seeking buttock  enhancement by enlargement. While buttock implants is the most assured and immediate way to increase buttock size, it is major cosmetic surgery that involves significant recovery and expense. As a result, the allure of more ‘simple’ buttock injections is significant with less cost and minimal recovery.

When done by a board-certified plastic surgeon who uses your own fat, buttock injections are perfectly safe and one also gets the benefit of some body contouring from the harvest site. The problem with buttock fat injections is not safety but reliability. Patients often have to be content with less of a size than they want from a single surgery or be willing to undergo multiple fat grafting sessions.

But a subculture of buttock injections exist that uses unapproved silicone oil and is done by nothing short of cosmetic charlatans or black marketers. And they pray upon the most susceptible of patients….the uneducated and those who can not afford the real and proven surgery. The result has been a rash of such patients who have suffered complications including death. From cases in New Jersey to the  most recent one in California,  a pattern of illegal cosmetic surgeries is occurring in the largely Hispanic communities.While silicone is an FDA-approved filler material for breast implants, it is in a gel form that is contained in a bag and placed in a single tissue location. Silicone as an oil only exists as an approved medical procedure for replacement of eyeball fluid. It is not approved by the FDA or has ever proven to be safe when injected into fat. There are some plastic surgeons who may use it off-label as a facial soft tissue filler but for this application only small micro-droplets are injected. Such small quantities may not kill you but it could turn into small hard lumps and look irregular or lumpy. When large quantities are pumped into the buttocks, severe allergic reactions may develop or it could accidentally find its way into a large vein, going to the lungs and creating a potentially fatal embolus or blood clot. When poor quality or low-grade silicone oil is used, or worse some other material, severe complications are inevitable.

Despite these published complications, some patients persist in pursuing these black market buttock enlargement procedures. In my Indianapolis plastic surgery practice I just saw a buttock enlargement consult this week who specifically came in for silicone oil injections. Why she thought I ever did this illegal procedure I do not know. But she was young and naïve and had clearly done no research on the procedure. She was only focused on ‘immediate results that would be permanent’ and ‘she could return to work with no recovery or pain’.When it comes to buttock enlargement, like all cosmetic procedures, stay with the safe and proven. While fat injections and implants may not be perfect, they are safe and are accepted standards of medical practice. The allure of convenience and low cost should be reserved for fast food and coffee, not surgery.

Dr. Barry Eppley

www.eppleyplasticsurgery.com

Indianapolis, Indiana

1.      Why would someone want their buttocks bigger?

The shape and size of the buttocks, like the breast, is highly influenced by race and culture. African-Americans, Latinos, and South Americans place more aesthetic priority on the buttocks than most Caucasians. They desire fuller and rounder buttock dimensions. Unfortunately, no amount of diet and  exercise can increase buttock size. Nor can any topical cream or pill.

Buttock augmentation is the surgical implantation of natural grafts or synthetic implants to add volume and better shape to the buttocks. Patients who have volumetric buttock enhancement report their clothes fit more like they want and their confidence levels are improved with a fuller, better shaped derriere.

2.      What is a Brazilian Butt Lift and how does it differ from buttock enlargement?

A Brazilian butt lift, as known generically as injectable fat grafting to the buttocks, is one of the two primary methods of buttock augmentation. It garners the name because the concept originated and was developed in South America. The lift in the name does not come because skin is cut out and lifted in the conventional sense. Rather it refers to the ‘lift’ that results from being expanded and increased in size by the addition of fat grafts.

Using excess fat from other areas of the body, the fat cells are removed by liposuction

and then reinjected into different layers of the buttocks. The fat must be placed strategically through tunnels in layers for a smooth and natural result. This method is obviously natural and that is very appealing to many potential patients. With this fat transplantation method, there is no chance of the body rejecting the fat cells. But the cells are sensitive and careful surgical technique is needed to get them to live and make for a good result.

3.      What are the risks of buttock augmentation using injectable fat grafting?

Like all operations, enlarging one’s buttocks with fat does have some risks. The biggest risk, however, is not that of any serious adverse effect. Rather, the main risk is that the take or survival of the fat grafts is unpredictable. No one can precisely predict how much of the injected fat will live. For this reason, when possible, more fat is put into the buttocks than necessary accounting for some resorption after surgery.

In about 20% to 30% of patients who have had buttock fat grafting, significant fat absorption occurs early on necessitating a second grafting procedure. While the goal is not to do more than one operation,  patients choosing to undergo this method of buttock augmentation must be willing to accept this potential outcome. Aside from absorption, occasionally a minor touch-up may be necessary to correct minor irregularities or asymmetry. Other risks which are very uncommon include infection or sterile fat abscesses.

4.      What are the advantages of buttock augmentation with implants?

The greatest benefit of a buttock or gluteal implants is its stable volume after surgery. Once inserted, a gluteal implant will not change in size or volume. In addition, the size of most gluteal implants is more than what fat injections can achieve. In other words, patients are consistently satisfied with the size of the buttocks that is obtained with an implant. Gluteal implants come in a variety of sizes and several different shape designs.

They are made from a very soft and flexible silicone rubber material so they will not feel too firm or stiff. When implanted into the gluteal muscle, as they most commonly are, they will feel merely like a larger muscle. Contrary to popular belief, you did not sit on the implant after surgery. To do so would mean that the implant has been placed too low on the buttocks. The implant is positioned on the upper two-thirds of the buttock.

5.      What complications can occur with buttocks implants?

Because a buttock implant is a foreign body, there are several untoward effects which can occur. These include the potential for an unnatural feel, infection, seroma (fluid accumulation), asymmetry, possible nerve injury (if placed under the muscle),and prolonged postoperative pain.( if under the muscle)

Another important consideration is that one’s recovery will not be insignificant. Manipulating the gluteus muscle, and having to sit and lay on it after surgery, is more than just mild discomfort for a few days. You can sit from the first day of your buttock enlargement surgery. However, sitting for prolonged periods of time right after surgery is not encouraged.

6.      Are there any special garments that I need to wear after buttock augmentation surgery?

Patients will wear a special surgical garment, a compression girdle,  for 1 to 2 weeks after surgery for comfort and to minimize swelling. During the first week, it should be worn all day except for showering. During the second week, it may be taken off at night time.  It is also beneficial to have massage and ultrasound treatments, if possible, to minimize swelling, hardness, and to expedite one’s recovery.

7.       When can one return to work and resume exercising after buttock augmentation?

Most patients can resume light exercising after 3 weeks, gradually getting back to unrestricted working out by 6 weeks after surgery. Depending upon the physical nature of your job, one can return to work in a sit down type job in 10 to 14 days. More physical jobs can take as long as 3 weeks to a month to feel comfortable performing the job adequately.

Barry L. Eppley, M.D., D.M.D.

http://www.eppleyplasticsurgery.com

http://www.ologyspa.com

Clarian North Medical Center, Carmel, Indiana

Clarian West Medical Center, Avon, Indiana

Indianapolis

Buttock enhancement surgery continues to grow in popularity. One of these techniques is the Brazilian Butt Lift which helps to enlarge and reshape the buttocks to a more prominent and youthful appearance. Ironically, it is not a buttock lift in the traditional sense but a method of fat injections to do the reshaping and the ‘lifting’.

This method of buttock augmentation reshapes the tissues overlying the gluteus muscles by using one’s own fat in a transfer method. For thin patients who do not have enough fat to harvest and transfer, they will need to enlarge their buttocks by the insertion of a silicone implant. In a good candidate for the Brazilian Butt Lift, liposuction is first done in areas around the buttocks such as the hips, lower back, and on the posterior thigh up to the lower buttock crease. The removed fat is then carefully prepared and concentrated through differing methods of purification and isolation. (there is no universal agreement as to the best fat concentration method) The fat is then re-injected back into the gluteal area for reshaping and augmentation. The method of fat injection is important and I prefer placing small amounts of fat at different depths with the hope of decreasing the amount of fat absorption after surgery.

The procedure is usually performed all in one surgery. While multiple smaller injection sessions may lead to better fat volume retention, this approach is usually not economically practical for most patients. However, additional or touch-up injections months later can enhance the results or correct any minor deficiencies or irregularities that may remain.

The aesthetic objective of buttock fat transfer is to give the buttocks more of a bowl shape in its central regions. This means that the identified central region of the buttocks receives the most fat and it is tailored out from there. While no one knows a magic number as to how much volume of fat can be injected that will ideally survive, 250 to 300 ccs is what I usually inject. This will make most buttocks fairly tense and tight at that volume and more than that seems that one is only injecting ‘ free fat into free fat’.

Most patients can return to work and activities fairly quickly, one week for work and ten days for exercising. Any discomfort is more from the liposuctioned sites than it is from the injected buttock area.

Dr. Barry Eppley

http://www.eppleyplasticsurgery.com

http://www.ologyspa.com

Clarian North Medical Center, Carmel, Indiana

Clarian West Medical Center, Avon, Indiana

Indianapolis

Enlargement of the buttocks or buttock enhancement is a plastic surgery procedure that has become more commonly requested and performed in the past several years than ever before. Ten years ago, this was a procedure that was unheard of and rarely done. Due to cultural influences and a changing population mix, the shape and size of the buttocks has become an aesthetic issue of importance.

The buttocks is a three-dimensional structure of which its size and shape are both important. For some patients, their buttocks is too flat and lacks any definition, for other patients it is an issue of size more than shape.  As a result, when it comes to buttock recontouring, one has to consider what procedures can increase size as well as shape. It often takes a combination of procedures to create the best buttock result.

When it comes to increasing buttock size, it is a choice between natural fat injections or the use of synthetic implant. Both work and are capable of adding volume to the buttocks, but they are different in the results achieved and their associated potential risks and complications.

Buttock implants remain the gold standard for buttock enlargement. They have a long-standing history of success and their primary advantage is that the volume they add to the buttocks is both stable and permanent. The implants will not change in size over time as the material of which it is made (silicone rubber) does not degrade in the  body. While implants do have traditional risks of malpositioning, infection, and seroma (fluid) development, improved surgical techniques with intramuscular placement has gone a long way in decreasing these issues.  Nonetheless, these potential risks still exist and a patient must be willing to accept that a small percentage of buttock implants will develop these problems.

Fat injections, using the patients own fat, is a ‘newer’ buttock implant approach that has only become popular in the past few years. Its recent popularity is linked to the emergence of fat grafting in plastic surgery in general and as an easier alternative than traditional implant placement. Fat injections into the buttocks is less invasive and has a quicker recovery than an implant. It also uses the patient’s own fat which, if one is having liposuction anyway uses the discard, or if done by itself offers an aesthetic contouring benefit from the donor site. The primary disadvantage to fat injections is their unpredictability and that only a modest gain in buttock size can be achieved with one surgical treatment. It is far to say that fat injections can not create the same volume size that an implant can……in one surgical session. Multiple fat injections sessions, however, can create the same volume but at the disadvantage of considerable more expense and effort.

Which is better for any buttock enlargement patient….fat injections vs implant?  If one is opposed to the thought and risks of an implant, then fat injections are the way to go with the understanding of the limitations in size that can be obtained. Or if one is having liposuction anyway, then fat injections are worth trying since enlargement of the buttocks may not be the sole objective of the surgery. But if considerable buttock size is wanted and one wants the most predictable result, buttock implants are the best choice…..if one can accept their risks.

Dr. Barry Eppley

http://www.eppleyplasticsurgery.com

http://www.ologyspa.com

Clarian North Medical Center, Carmel, Indiana

Clarian West Medical Center, Avon, Indiana

Indianapolis

Enhancement of the buttocks is most consistently done with a gluteal implant. Despite its predictable improvement in the size and shape of the buttocks, buttock implants are not without complications. Intramuscular implant placement makes recovery more uncomfortable and having to sit on the implant predisposes it to positional shifting and the formation of fluid collections and possible infection.

 
Because of these concerns, the alternative treatment of fat injections or free fat grafting has emerged. Fat grafting to the buttocks has numerous potential advantages such as the elimination of the need for a synthetic implant, the use of a patient’s own body tissues, an easier recovery with few limitations, a simultaneous benefit of cosmetic emhancement of the donor site, and a very low risk of bleeding or infection. All of these advantages of free fat fat grafting is counterbalanced by one significant disadvantage….an unpredictability of after surgery shape and size. How much fat survives and is retained is widely variable. No plastic surgeon can guarantee or predict with 100% accuracy how much fat will survive on a consistent basis. I prefer to inject no more than about 300cc per buttock as I think much volume than that results in greater volume loss.

 
The burning question through the past several decades is…how to make fat grafting work better. The injection technique is, of course, important but is only half of the answer. How the fat is prepared after harvest in the oeprating room is the other half. Everyone agrees that concentration is very important after harvest. This is the mechanical process of removing the liquids from the more solid fat components. Whether this is done by a centrifuge or passing the fat aspirate through a strainer or sieve are two methods of which one has not been proven to be better than the other. Additives to the fat are theoretically appealing but there is no universal magical additive. Currently, I add platelet-rich plasma (PRP) to the concentrated fat prior to injection. Whether this aids fat survival is not proven but since it is a product of the patient, there is no risk in so doing. PRP is a concentrate of a patient’s own blood done at the time of surgery. While there is no standardized amount of PRP to add to fat, I typically use 3cc of PRP per buttock graft site.

 
If a patient opts for buttock augmentation with fat injections, they must accept that the amount of fat that will survive is unpredictable. It may require more than one injection session to obtain the best result. Most fat grafting methods will not achieve the degree of volume enhancement that a gluteal implant will.

 
Dr. Barry Eppley
http://www.eppleyplasticsurgery.com
http://www.ologyspa.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis

Buttock Enhancement Surgery in Indianapolis by Dr Barry Eppley:
An Overview of Techniques to Beautify the Buttocks

The appearance and shape of the buttocks has taken on great interest in the past few years. Whether it be too big, too flat, or sagging with age, the interest in improving one’s buttocks has never been this great in the world of plastic surgery. Much of this recent interest in the appearance of the buttocks in the United States is due to the northern immigration of South American culture. Each of the many different buttock problems is treated with various plastic surgery techniques. As I consult with patients here in Indianapolis, it is important to carefully analyze the shape of the buttocks and the patient’s desires and then match the appropriate plastic surgery procedure(s).

By far, the ‘simplest’ buttock problem to treat is the one in which the buttock is too big. The problem is ‘simple’ only because the only treatment approach is that of liposuction. The results from liposuction of the buttocks is usually modest. One must avoid too aggressive liposuction as this may cause the skin of the buttocks to sag after being ‘over-deflated’ by the fat removal. In rare cases, liposuction combined with a lower buttock lift (cutting a strip of skin and fat from the lower buttock crease) may produce a better overall result.

The flat buttock is treated either by implants or fat injections. Solid rubbery implants (which cannot leak) can be placed inside the muscle through a small incision in the upper buttock crease. Buttock implants are best for those patients who don’t have enough fat to transfer and want extra fullness in the upper portion of the buttocks. The implants generally don’t add much fullness to the lower portion of the buttocks. The discomfort with buttock implants is considerable and physical activity must be restricted for several weeks after surgery. Once you have buttock implants, removing them (if necessary) will lead to further disfigurement due to the extra skin that has been created. Fat injections are useful when only a small increase in buttock size is needed. It is unpredictable how much injected fat will survive and multiple surgery sessions may be needed to get the desired result. As fat is needed to inject, a double benefit is achieved by contouring two areas at once, reduction in size of the donor site (usually abdomen or thighs) and a larger buttocks.

The sagging buttock can be treated by two types of buttock lifts. When only a small amount of skin is sagging over the crease, a lower buttock lift as previously described can be used. The trade-off is a scar in the lower buttock crease. When a larger amount of buttock skin is hanging down (after bariatric surgery, for example, where a lot of weight loss has occurred), the buttock shape is addressed by a circumferential body lift where a low back scar is the result of removing a wedge of skin and fat from above.

As you can see, there are a lot of different approaches to buttock enhancement and a consultation with an experienced plastic surgeon can help you pick the right buttock operation(s) for your problem.

Dr Barry Eppley
http://www.eppleyplasticsurgery.com
http://ologyspa.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis