Explore Plastic Surgery - Dr. Barry Eppley

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

Enhancing the Shape and Size of the Buttocks with Butt Implants (Gluteoplasty) in Indianapolis by Dr Barry Eppley

For those women, and rarely for a few men, the desire for a larger more shapely buttocks is more prevalent today than ever in the history of plastic surgery. This buttock enhancement trend is undoubtably fueled by fashion style issues such as the well known ‘J-Lo Butt’ and the northern influence by immigration of Hispanic and South American cultures, which is a larger buttock with no crease underneath. (known as the Brazilian buttocks) As a result, buttock size increase can be done with either implants or fat injections. I will talk here only about the use of buttock or gluteal implants for buttock enhancement or medically known as, implant gluteoplasty.

Buttock implants or gluteal implants are semisolid, rubbery silicone implants that have several basic shapes and sizes for the buttock area. They are not liquid filled nor should any surgeon ever use those type of implants for anything other than the breast. The buttock implants are fairly soft and flexible and don’t feel that much different from dense buttock tissue. The main plastic surgery issue with buttock implants is the surgical technique by which they placed. This has been controversial over the years. Should the buttock implant go into the gluteal muscles (intramuscular) or on top of them? (subfascial) While some controversy probably still exists, I think the best technique is that advocated by plastic surgeon Dr Gonzalez in Brazil. He probably has the world’s largest buttock implant experience and I was privileged to work with one his disciples, Dr. Jose Flores, in Indianapolis for several months.

Through a midline incision in the upper buttocks crease, a pocket is carefully developed in the gluteus maximus muscle. The pocket is developed with an instrument staying within carefully determined markings done prior to surgery with the patient standing. The size and shape of the buttock implant (round or oval) is determined prior to surgery during the initial consultation based on the size and shape of the buttocks and what area of the buttock needs to be increased in size the most. The buttock implant is then slipped into this carefully made pocket. No type of compression garments is needed after surgery. Walking and sitting are allowed after 24 hrs. Sleeping should be done on the patient’s side for 1 week and driving is allowed after 7 days. Working out and running should not be resumed for at least one month after surgery.

I have found buttock implant surgery to be very gratifying for most patients, However, be aware that buttock implant surgery is painful and some sufficient recovery time is needed. The most common complication of buttock implant surgery is fluid collection (seroma) around the implant which may require drainage.

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