Aesthetic Contouring of the Buttocks

Abstract

Gluteal fat grafting currently ranks 12th among aesthetic surgical procedures with over 20,000 cases performed by board certified plastic surgeons in the USA last year. It is currently the fastest growing surgical procedure in plastic surgery with a 25% increase in the number of cases reported last year. Although gluteal fat grafting is sometimes necessary to achieve the ideal buttock contour, it is the fat extraction from surrounding anatomical areas that offers the greatest contribution to the final aesthetic result. Contouring of the posterior trunk, upper lateral thighs, and infra-gluteal rolls has a profound effect on the shape of the buttocks. In recent years, an increase in the mortality rate for the procedure was the result of intramuscular grafting combined with injury to the gluteal vessels resulting in fat emboli. Currently this procedure is associated with the highest mortality rate in all aesthetic surgery! For safety reasons, gluteal enhancement by means of fat grafting has recently become an operation of the subcutaneous tissues. As plastic surgeons move away from intramuscular grafting, the volumes grafted will need to be adjusted accordingly. Tissue compliance and overall gluteal surface area will play a significant role in determining the fat graft volume limits for a particular patient, in order to not exceed the recipient site capacity. There will be graft volume limitations based on what the recipient site can accommodate. The new mantra for this procedure should be “extract more and graft less.”