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Posts Tagged ‘buttock lift’

Case Study – The Ultimate Buttock Makeover

Saturday, March 26th, 2016

 

Background: Aesthetic buttock deformities consist of two types of undesired structural changes. Inadequate volume is the far more recognized buttock problem which can occur from either inadequate natural development (or natural development that one sees an inadequate) or from volume loss due to aging or weight loss. The other is tissue sag over the infragluteal crease (known as banana rolls) which can also occur from aging and weight loss. An induced cause is a result of the sequelae from liposuction of the lower buttocks.

The treatment of lack of adequate buttock size is either fat injections (BBL surgery) or buttock implants. While fat and implants may seem interchangeable in buttock augmentation, they are not. Implants are reserved for those patients who simply do not have enough fat to do BBL surgery. When using buttock implants the decision is whether to go into or above the muscle. When placed in the intramuscular position, it is possible to combine fat injections with buttock implant surgery.

Lower buttock sag is occurs when the superior skin and fat ‘fall’over the fixed infragluteal fold. Buttock ptosis or sag can also occur when the infragluteal fold attachments are lost or disrupted. In either case, a lower buttock lift or tuck is done to remove the overhanging tissues and recreate a fixed infragluteal fold position.

Case Study: This 48 year-old male wanted to improve the appearance of his buttocks. He had lost some weight over the past several years and his buttocks had gone flat. He also did not like the tissue overhang on the bottom of the buttocks. (the sagging)

Ultimate Buttock Makeover intraop result one sideUnder general anesthesia in the supine position he initially had his abdomen and flanks aspirated of fat by liposuction. Once moved into the prone position his flanks was also aspirated. Total liposuction aspirate was 1,800ccs. Once processed by filtering and washing a total of 360ccs of concentrated fat was available for injection. Through an infraguteal incision, solid silicone 270cc buttock implants were placed in the intramuscular position. A lower buttock lift was done on each side removing a predetermined strip and skin and fat. Through suturing to the muscular fascia, the infragluteal fold was remade. Lastly, 180ccs of concentrated fat was injected in various locations of the buttocks that had not been previously undermined for the placement of the buttock implants.

Ultimate Buttock Makeover intraop left oblique viewUltimate Buttock Makeover intraop left side viewUltimate Buttock Makeover intraop result back view Dr Barry Eppley IndianapolisHis immediate intraoperative results showed a significant improvement in the size and shape of his buttocks. While the amount of fat that will be retained remains to be determined, the contributions of the buttock implants and the lower buttock lift will be retained.

This case of buttock augmentation demonstrates the concept of the ultimate buttock makeover. Between implants, fat grafting and a buttock lift, there is no more aesthetic changes that can be performed on the buttocks at one time.

Highlights:

1) Genetics and aging affects the buttocks like any other body area with loss of volume and sagging.

2) Intramuscular buttock implants can be combined with subcutaneous fat injection grafting for an overall buttock augmentation effect.

3) Buttock augmentation can be combined with a lower buttock lift to create the ultimate buttock makeover.

Dr. Barry Eppley

Indianapolis, Indiana

Technical Strategies in Plastic Surgery – Dermal-Fascial Suturing in Lower Buttock Lifts

Saturday, November 15th, 2014

 

There are numerous strategies to improving the shape of the buttocks of which the most popular is the Brazilian Butt Lift. (BBL) While this buttock augmentation method is called a lift, it really does not lift the buttocks at all.  It fills out the buttocks to make it bigger or more round but is not a formal buttock lift per se.

Prior to the current craze of BBL surgeries was the era of a true buttock lift procedure. Such procedures were excisional in nature, requiring the sagging buttock tissue to be removed and the remaining tissues tucked in its place. While many lifts are perceived as being pulled up, a buttock lift is really done on the bottom side of the buttocks for a tissue overhang or ptosis. Its goal is to create a more defined infragluteal crease with no tissue overhang. The most common reason women request this procedure is because they want to get rid of buttock tissues that hangs out of a swimsuit or underwear. (an overextended infragluteal fold)

Lower Buttock Lift technique side view Dr Barry Eppley Indianapolis Lower Buttock Lift technique back view Dr Barry Eppley IndianapolisPrecise markings are done before surgery to define the new location of the fold and to prevent its lateral extent from going to far to the side lest it become visible after surgery. The amount of tissue to be excised is done by creating a fold of the lower buttock tissue to the level and shape desired and then mark the upper and lower edges of it. A crescent pattern is then marked. During surgery, the crescent-shaped zone is excised and the skin edges anchored to the gluteal fascia to create a more defined infragluteal crease.

Lower Buttock Lift Excisions back view Dr Barry Eppley IndianapolisIt is important to remove full thickness skin and fat in the lower buttock lift rather than simply de-epitheliazing the skin and folding it together for a higher gluteal fold  position. This effectively gets rid of the tissue overhang to allows for a better fold shape.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study: Lower Buttock Tuck (Lift) for the Saggy Buttocks

Sunday, July 21st, 2013

Background: There are numerous features of a shapely buttocks. Short of a nipple-areolar complex, the buttocks share many of the same physical components of the female breast. Ideally it is an identifiable mound that projects outward away from the lower back and upper posterior thigh. While the upper pole is a smooth sloping transition from the back, the lower pole of the buttocks should have a more defined separation of the thigh known as the infragluteal crease.

Like the lower breast fold or inframammary crease, the infragluteal fold is a defined attachment of the skin to the underlying gluteal muscle.. It helps create the lower buttock shape and separates it from the back of the leg. It’s presence is caused by fibrous attachments of the dermis of the skin to the muscle fascia. Any disruption of the infragluteal crease results in a saggy buttocks or buttock ptosis.

Buttock ptosis occurs from either loss of a well-defined infragluteal crease or loose buttock tissue falling over a well-defined infragluteal crease. (often called a banana peel deformity) Both aesthetic buttock conditions are treated by a buttock lift, which is more accurately called a buttock tuck. By removing skin and fat from the lower buttocks, any tissue overhang can help reshape an existing infragluteal crease. In a non-existant or lost infragluteal crease, an elliptical excision of loose tissue can help recreate a more discernible infragluteal line.

Case Study: This 49 year-old female wanted to improve her saggy buttocks. She was an ultra-thin middle-aged female that had little subcutaneous fat throughout her body. Her buttocks were completely flat with little volume and folds of hanging skin over the lower buttocks and the upper posterior thigh. There was no discernible infraguteal crease. It appeared that her loss of buttock volume was just part of aging of an historically very thin person.

Under general anesthesia, a large curved elliptical excision of skin was done on both lower buttocks in the prone position. The orientation of this skin excision was both above and below where the infraguteal crease was determined to be placed. The wound was closed by suturing the dermis of the skin flaps down to the muscle fascia from the inner aspect from near the rectum out to the outer thigh.  Subcuticular suturing was then done for the final skin closure. Glued on tapes were her only dressing.

She had uneventful recovery and no wound healing problems. To reduce the potential risk of any wound separation, she avoided any exercise for a month after surgery as well as bending at the waist over 90 degrees as much as possible. All folds of unsightly skin were removed and an infragluteal line was created. Due to lack of any buttock volume, a more defined crease could not be obtained.

A buttock tuck (lower buttock lift) is a very effective surgery for remaking the infraguteal fold and creating a buttock-thigh demarcation. It has little after surgery discomfort but does not require avoiding stretching (no exercise) across the suture line for 3 to 4 weeks after surgery The resultant scar heals well and, when well placed, is barely detectable.

Case Highlights:

1) A shapely buttocks, regardless of its size, has an infragluteal crease that separates the buttocks from the posterior thigh.

2) Loose skin from loss of buttock volume creates skin folds that obscures the infragluteal fold.

3) A lower buttock lift, better defined as a buttock tuck, removes loose skin and creates an infragluteal line.

Dr. Barry Eppley

Indianapolis, Indian

Dispelling Common Myths of Buttock Enhancement

Monday, January 14th, 2013

 

The desire for fuller and more uplifted buttocks is one of the most popular body contouring requests in the past few years. When it comes to the buttocks, the issues mainly consist of its size and shape as well as the texture of the overlying skin. Implants, fat injections, liposuction and cellulite treatments are available for the cosmetic improvement of the buttocks. But because of their relative newness of buttock enhancement procedures, there are many misconceptions and myths about them. Here are some of the most common butt myths.

Liposuction can help get rid of cellulite on the buttocks. The search for an effective cellulite treatment has been ongoing for years and to say that it is elusive is an understatement. The buttocks is a prime location for the cottage cheese look of the skin. Over the years such treatments as Endermologie and VelaShape have been promoted but their effects are short-term and any improvement requires regular maintenance treatments. Liposuction surgery, however, is exactly what you don’t want to do. Liposuction removes the superficial layer of fat and removes the support from the overlying skin…this has the high likelihood to make the appearance of cellulite even worse. The newest cellulite treatment, Cellulaze, may offer improvement of buttock cellulite on a more sustained basis but long-term results (years) remain to be reported.

Fat injections are a better option for buttock enlargement than implants. The most popular method today for increasing the size of the buttocks is fat injections. Known as the Brazilian Butt Lift, its popularity is because it requires simultaneous liposuction for the fat harvest and a a result one also gets some body contouring through  abdominal and flank reduction. (the largest sources of excess fat in most people) Fat injections also make the recovery from the surgery much easier as the real recovery is from the liposuction harvest sites not the buttocks. All of this makes fat injections so much more appealing than the intramuscular placement of implants which have a much longer recovery. With the exception of one thing…the survival of fat injections is unpredictable while implant produce a reliable and permanent means of buttock augmentation.

Sitting on buttocks that have been injected with fat will cause it to resorb. The take of fat injections into the buttocks depends on some of the fat getting an adequate blood supply (nutrition) and perhaps some of its stem cells that accompany it becoming fat cells themselves. This is a process that takes several weeks after surgery. But once the fat cells take, the y should be permanent provided one takes does lose a lot of weight later. But sitting on the buttocks over time is not going to cause the fat to resorb anymore than one’s natural fat there would. But it is important in the first few weeks after surgery to avoid prolonged sitting so as to not induce pressure on the newly implanted fat which may have a negative effect on its survival.

The buttocks can be enlarged and lifted by exercise. The gluteus muscles (maximus and minimus) are large-sized and occupy a significant part of the buttocks depending upon their natural size. Like any muscle, it can be toned and enlarged. So to say that exercise can make your buttocks bigger is true…but only by a minimal amount. Strengthening and toning of the gluteal muscles can definitely be done and this may provide a degree of a ‘buttock lift’ but not actual enlargement of the buttocks.

Dr. Barry Eppley

Indianapolis, Indiana

Options in Buttock Lift Surgery in Extreme Weight Loss

Sunday, December 28th, 2008

Like the rest of the body after a lot of weight loss, the buttock area is not spared. While this is usually not at the top of the list of desired body changes, it can become the focus after other more higher priority areas such as the abdomen, arms, and breasts are addressed.

 Under the normal aging process, the buttocks do sag over time, more in some people than others. After extreme weight loss, this sagging is greatly exaggerated.  The deflation of the buttocks creates folds of loose hanging skin that either fold over the lower buttock crease or cause the buttocks to shift lower as a whole unit. In women, this sagging effect is usually much greater than in men as they generally have  more buttock skin and fat to begin with.

Lifting of the buttocks can be done with several different methods, approaching the problem from either above or below depending upon  the buttock problem and what other simultaneous procedures are being done. One of the most effective methods is the superior or upper buttock lift which is the back half of a circumferential body lift. Skin and fat is cut out around the waistline above the buttock area as part of the 360 degree excision of a body lift. While not as much skin can be removed in the lower back as the front part of the abdomen, the buttocks can be lifted a significant amount. Think of this procedure as ‘pulling up your pant’s’ so to speak. This buttocks lift can also be done alone, without the front half of a body lift, but it would be unusual to have a significantly sagging buttocks after weight loss without an abdominal overhang as well.

While the body lift or superior buttocks lift raises up sagging skin, it will not cause the buttocks to ‘re-inflate’ or solve its loss of volume from the weight loss. In essence, the buttock sag will be improved but it will still be fairly flat. Some plastic surgeons do an ‘auto-augmentation’ at the same time using some skin and fat that would normally be discarded with the cutout. Essentially using your tissue to serve as an implant. While this is a clever use of tissue flaps, it rarely adds significant volume and often does not  put it where the volume is really needed. (lower not higher) I remain not overly enthusiastic about this approach even though it is your own tissue.  If someone ultimately wants a buttocks that is bigger, I will usually do buttock implants at a later time.

Another type of buttock lift is from below or a lower buttock lift. This is an ‘old’ approach  that removes skin from the lower half of the buttocks that overhangs the buttocks crease. This is not usually helpful in cases of extreme weight loss as it pulls the buttock down further in cutting off skin. This  is pulling in the wrong direction for most patients. In cases of mild buttock sagging without a significant loss of volume, this type of buttock lift may be acceptable.

Dr. Barry Eppley

Indianapolis, Indiana

The Many Options for Buttock Reshaping

Tuesday, December 25th, 2007

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 reshaping and a consultation with an experienced plastic surgeon can help you pick the right buttock operation(s) for your problem.

Dr Barry Eppley
Indianapolis, Indiana

Buttock Reshaping – Different Operations for Different Problems

Monday, November 5th, 2007

The shape of the buttocks has taken on great interest in the past decade. Whether it be too big, too flat, or sagging with age, the interest in changing one’s buttock has never been greater. Each of these buttock problems are treated differently.

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 and the patient must not have to high an expectation. Contrarily, 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.

The flat buttock is treated either by buttock implants or fat injections. Solid rubbery implants (which cannot leak) can be placed inside (intramuscular) or on top of the muscle (subfascial) 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 not insignificant and physical activity must be restricted for several weeks after surgery. Exercise can not be resumed for about 6 weeks after surgery. Surgical risks include infection, bleeding, fluid collections (seroma) around the implants, shifting of the implants, and uneven appearance between the two sides. Once you have buttock implants, removing them (if necessary) will lead to further disfigurement due to sagging skin. Conversely, 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. Usually fat is simply redistributed……sucked from one undesired location and transferred to the buttocks. This gets a double benefit of contouring two areas which creates a better overall result.

The sagging buttock can be treated by two types of lifts. When only a small amount of skin is sagging over where the crease joins the back of the thigh (banana roll). This more limited buttock lift creates a scar in this crease and helps shape this lower buttock area. When the entire buttock needs to be lifted (usually in the bariatric surgery patient where a large amount of weight has been lost), a more aggressive lift is done by creating a ‘cutout’ of upper buttock and back skin (often done in conjunction with a tummytuck around the front, thus creating a 360 degree scar, a.k.a. a body lift). The buttock skin is then lifted and sewn upward, providing a lift to more of the entire buttocks.

Dr Barry Eppley

Indianapolis, Indiana


Dr. Barry EppleyDr. Barry Eppley

Dr. Barry Eppley is an extensively trained plastic and cosmetic surgeon with more than 20 years of surgical experience. He is both a licensed physician and dentist as well as double board-certified in both Plastic and Reconstructive Surgery and Oral and Maxillofacial Surgery. This training allows him to perform the most complex surgical procedures from cosmetic changes to the face and body to craniofacial surgery. Dr. Eppley has made extensive contributions to plastic surgery starting with the development of several advanced surgical techniques. He is a revered author, lecturer and educator in the field of plastic and cosmetic surgery.

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