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Attention to the size and shape of the buttocks has always been an important part of body aesthetics. But fashion trends, Hollywood and societal awareness has driven the demand for aesthetic buttock surgery to new levels in the U.S. over the past few years. As a result, buttock enhancement is one of the most rapidly increasing aesthetic procedures, outstripping the percent increase in breast implants and tummy tucks over the past two years. While the overall numbers are still small by comparison to these two body reshaping operations,  the percent increase in patient demand and surgeries performed is impressive.

Buttock reshaping like that of the breast consists of two fundamental approaches; volume addition and lifting/tightening by tissue excision. It is augmentation with the desire for a larger and more round buttocks that has driven the increase in buttock enhancement surgeries. Utilizing either synthetic implants or the patient’s own fat, fuller buttocks are in particularly amongst certain ethnic groups.

Much of the increase in buttock augmentation procedures has been because of the popularity of fat injections. Getting the dual benefit of reduction of the donor harvest areas (usually the abdomen and flanks) and using a natural tissue, the appeal of buttock enlargement by fat injections is understandable. In addition, fat injections are a simpler technique to do and master. Therefore a much larger number of plastic surgeons perform it than the traditional use of synthetic implants.

But implants have one significant advantage over fat, their volume is stable and often more than that which can be achieved by fat injections in many cases. When it comes patient satisfaction, however, what do patients say about comparing the two? From the September 2012 issue of the American Journal of Cosmetic Surgery, a study was reported comparing buttock augmentation using bothi techniques. Over a three year-period, over 125 buttock augmentation procedures were performed with a heavy preference for implants. (96 vs 33 patients)  The satisfaction rate was 76% for implants and 70% for fat injections.  Complication rates for implants were seromas (17%), capsular contracture (13%) and incisional wound dehiscence. (14%)  Complication rates for fat injections were primarily lumps and dents. (33%) The authors conclude that buttock augmentation with implants led to higher patient satisfaction rates.

While this study finds higher satisfaction rates with buttock implants, I do not think it is that simple. The study was conducted in a practice that had a preference and long history of using body implants. But besides that issue, there are different indications for these two procedures for buttock augmentation. Buttock implants are usually reserved for those patients who do not have adequate fat for harvest and have no other option. Because of only having an implant option, they take the higher risk of infection, seromas and capsular contracture. (although these rates reported in this study are higher than what I typically see)  Fat injections are done in those patients who have adequate fat deposits and want the secondary benefit of reduction/contouring of the trunk region. With proper education and preoperative counseling they are aware that the volume retention and contour with fat injections is both variable and unpredictable. But they view the secondary benefit as being worth the risk of the primary procedure.

In buttock augmentation, it is never as simple as one treatment is better than the other. It is important to weigh the benefits and risks of implants and fat injections for buttock augmentation in each patient and their unique body shape that surrounds the buttock region.

Dr. Barry Eppley

Indianapolis, Indiana

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