In enhancing the female face and figure, plastic surgeons first visualize the result, then apply techniques to reduce excess, augment deficiencies, and reposition tissue to achieve the most satisfactory end result possible. Buttock augmentation and lift have become increasingly popular in the United States. The buttocks are a highly mobile area of the body, and are subject to pressure when sitting or laying on the back. Procedures to enhance buttock size and shape must be performed in the context of maintaining these functions. The selected technique should be as reliable, complication free, and predictable as possible.
Dr. Laverson incorporates five approaches, separately or together, in augmenting the derriere. Many factors influence the choice of procedure.
First, the gluteus maximus muscle of the buttocks is the largest single muscle in the body. If the patient has not made an effort to exercise and enlarge this muscle naturally but is willing to do so, this is a good first step that is both reliable, natural, inexpensive, and complication free.
Second, if the waist can be narrowed by removal of fat (liposuction), the adjacent buttocks will appear larger. This is also reliable, inexpensive, and complication free. Liposuction to reduce the waist and flank is a ninety minute procedure with a brief recovery.
Third, if the patient has excess skin over the buttocks from aging, weight fluctuation, poor skin elasticity, or a combination of these, dermolipectomy lifts soft tissue of the buttocks. The remaining skin and fat contours over the gluteus muscles well, enhancing buttock shape. Dermolipectomy results in a transverse scar in the panty line across the sides and back above the buttocks, a distinct disadvantage of the procedure. Mobility and sitting are delayed after dermolipectomy to promote healing. Recovery to an active lifestyle is two to three months.
Fourth, if buttocks are deficient in volume and projection and there is not enough fat of waist and flanks to remove by liposuction, insertion of soft silicone buttock implants is possible. This three hour procedure demands commitment from both surgeon and patient. Implant selection is based on buttock measurements and patient goals. Often, these devices must be adjusted during surgery to achieve the desired result and to fit each individual properly. They are placed through a single opening between the buttocks, and Dr. Laverson prefers placement beneath gluteal connective tissue, but above the muscles. Commitment from the patient involves an understanding that these mechanical devices are prone to re-position themselves over the highly mobile buttocks, and are subject to other complications such as infection, positional discomfort, implant visibility, and dissatisfaction with the result. Sitting is uncomfortable following placement of buttock implants for a variable period of time. If the implants become bothersome, removal is recommended.
Fifth, if the patient has sufficient fat and desires removal from the waist, flanks, and/or other areas, this fat may be grafted into the buttock muscles for augmentation. This approach is popularly known as a “Brazilian Butt Lift,” and although augmentation is a near certainty with fat transfer, the degree of augmentation can be unpredictable. Some grafted fat is always absorbed. Overgrafting is commonly practiced, but if most of the fat successfully incorporates, buttocks may be larger than anticipated. If excessive absorption of grafted fat occurs, buttocks may be smaller than anticipated, and secondary grafting or implants may be desired. Recovery after fat grafting may be uncomfortable and prolonged. Sitting on the buttocks is avoided for six weeks following the procedure to facilitate engraftment and avoid compression and/or trauma to fat cells with a delicate new blood supply.