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Buttock augmentation is a popular and commonly performed aesthetic body contouring procedure. Because it can be done by multiple different methods, it is probably best thought of as a menu of treatment option as the name alone does not convey which technique or techniques is being used. Enhancing the shape of the buttocks is primarily done by volumetric addition through synthetic fillers, fat injections or implants. But specific areas of contour reduction can be also be done by liposuction.

The concept of BBL surgery (Brazilian butt lift) brought buttock augmentation to the level of public interest that we see today. BBL surgery historically is all about adding lots of fat to the buttocks or as much as possible. But there are many patients who seek a larger buttocks size and improved shape that have limited fat stores for which fat injections alone would be inadequate. Conversely, buttock implants offer volume for those who have limited fat donor sites. But the size of the buttocks they can achieve, when the intramuscular position is used which is the safest approach, can be less than what some patients want to achieve.

In the July 2020 issue of the journal Plastic and Reconstructive Surgery an article was published on this topic entitled ‘Tridimensional Combined Gluteoplasty: Liposuction,Buttock Implants and Fat Transfer’. In this paper the authors describe the integrated approach to buttock enhancement surgery using implants, fat transfer and liposuction in fifty-two (52) patients over a ten year period. The average size of anatomical silicone buttock implants was 300ccs. The average volume of injected fat was around 240ccs for the hips and around 140ccs for then buttocks. Liposuction, other than harvest areas, was specifically performed for buttock contouring by lateral supragluteal reductions.

The report 100% patient satisfaction from the surgery with a 10% occurrence of partial wound dehiscence of the intergluteal incision used for buttock implant placement. (which went on to heal without further surgery0

It is both logical and needed to combine different contouring techniques for many patients seeking buttock enhancement. In integrating these techniques it requires multiple intraoperative body positions and placement of the buttock implants, which require the greatest degree of sterility, can not be the first one. (an implant procedure should always the the first one done if possible) The fat injections over the implants are possible because of their intramuscular position with the fat placed at the more superficial subcutaneous tissue level.

The combination of buttock implants and fat injections is best applied to the patient who lacks central and lateral buttock projection. This would be the patient who lacks adequate fat to inject the entire buttocks but has sufficient fat to at least do the hip areas just lateral to the maximal projection region of the buttocks. This tridimensional approach is only superseded by the quadradimensional approach in buttock enhancement which also incorporates a lower buttock lift as well.

Dr. Barry Eppley

Indianapolis, Indiana

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