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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

Buttock Augmentation through Fat Injections by Dr Barry Eppley in Indianapolis

I have previously discussed buttock enlargement through the use of implants, known as implant or alloplastic gluteoplasty. Another popular option is buttock enlargement through the use of fat injections or transplants, known as autogenous gluteoplasty. Fat injections as a method for soft tissue volume enhancement is well known and has a good track history in the face where smaller amounts of fat are needed, usually in the range of 1 to 10ccs. In the buttocks, however, much larger amounts of fat are needed to make a significant size difference, usually in the range of hundreds of ccs per buttock.

Here in my practice in Indianapolis, I always discuss the merits of buttock implants vs fat injections for buttock enlargement. Fat injections to the buttocks have several advantages. First, it eliminates the need for a synthetic implant and all the inherest risks such as infection, implant malpositioning, and notoriously a seroma build-up or fluid collection. Second, the buttock enlargement operation is much simpler, less invasive and has less pain after surgery. Thirdly, the amount of recovery is dramatically different with no activity limitations after surgery unlike implants. Fourth, there is an added cosmetic bonus from the harvest at the donor site. Some other body area gets to be reduced at the same time, usually the abdomen, waistline, or thigh areas. A two-for-one bonus if you will.

However, despite these significant advantages, fat injections to the buttocks for enlargement has one big potential disadvantage. How much of the fat will survive and get the volume that was put in at the time of surgery? That is an unknown question. And the issue of volume retention of injected fat has persisted with the use of this fat technique since its inception. What we do know for certain is this; 100% of the fat will not survive. Somewhere in the range of 1% - 99% will be the amount of fat that will persist. In larger fat injection volumes, such as the buttocks (and there is no larger amount of fat that is injected anywhere), a good result is probably in the 50 - 60% range for most patients. Therefore, I always tell my patients here in Indianapolis this: I will over-correct with fat injections to the buttocks (I don’t think you can ever inject too much fat or get the buttocks too big as they will only hold so much) and be prepared that it will likely take more than one fat injection session to get the best volume improvement. Unlike a buttock implant, which remains the same after one surgery, fat injections to the buttocks are unstable and require more than one surgery to get close to the same result.

The most important question for patients who want to avoid a buttock implant by undergoing fat injections for buttock enlargement then is; is the price and recovery from possibly two surgeries better than having a buttock implant? That is a question that each patient has to decide on their own in consultation with their plastic surgeon.

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