Age-related ptosis of the buttock: an anthropometric gender-specific analysis

Gluteal Fold: Cadaveric Dissection of the Superficial Fascial System in the Buttock and Anatomy-Based Gluteal Liposculpture

BACKGROUND

The anatomy and formation mechanism of the gluteal fold (GF) remain unclear. Given that understanding the anatomy of the superficial fascial system (SFS) may facilitate the improvement of liposuction techniques, this study aimed to clarify and define the anatomical components of the GF.

METHODS

A total of 20 fresh female buttocks and thighs were dissected sagittally to observe the changes of the SFS along the GF and were dissected horizontally to observe the SFS on the upper, middle, and lower levels of the buttock.

RESULTS

Through these dissections, 2 patterns of the SFS in the GF region were identified. The retinaculum cutis (RC)-dominant SFS, named the fascial condensation zone, features an extremely dense and tough RC, originating from the bony structures (eg, the ischium) and radially anchored by the dermis. The fat-dominant SFS features a classic double-layered SFS structure. The RC-dominant SFS is mainly distributed at the medial GF, thus forming the depressed fold. It gradually disappears along the GF and the SFS becomes fat-dominant, making the fold increasingly less visible. At the lateral buttock, the SFS of the buttock and thigh reach an identical status in terms of morphologic features, showing a smooth curve between the buttock and the thigh instead of a fold. Thus, based on these findings, different liposuction methods were formulated to manage GF contouring.

CONCLUSIONS

The SFS of the GF region shows a regional variation pattern. Topographic anatomy of the SFS in the GF region helps us understand GF contour deformities and provide an anatomical basis for surgical correction.

Defining the Ideal Male Buttocks

BACKGROUND

There is no well-defined male buttock aesthetic. The authors performed a crowdsourced analysis to define the ideal male buttocks.

METHODS

A survey was deployed using the Amazon MTurk platform. Respondents rated a panel of digitally altered male buttocks from most to least attractive using three views. Respondents were asked questions pertaining to their own interest in gluteal augmentation, self-reported body type, and other demographics.

RESULTS

A total of 2095 responses were recorded; 61% were from male respondents, 52% of respondents were between the ages of 25 and 34 years, and 49% were White respondents. The preferred lateral ratio in the anteroposterior dimension was 1.18; the oblique angle between the sacrum, lateral gluteal depression, and point of maximal projection of the gluteal sulcus was 60 degrees; and the posterior ratio between the waist and maximal width of the hips was 0.66. This corresponds to moderate gluteal projection in the lateral and oblique views, with a narrower gluteal width and defined trochanteric depression in the posterior view. Loss of the trochanteric depression was associated with lower scores. Subgroup analysis revealed differences when stratified by region, race, sexual orientation, employment industry, and athletic interest. No appreciable difference was found based on respondent sex.

CONCLUSIONS

The authors' results demonstrate that there is a preferred male gluteal aesthetic. This study suggests that men and women favor a more projected male buttock with a more pronounced contour, but preferred a narrow width with defined lateral depression. These findings have the potential to guide future aesthetic gluteal contouring techniques in men.

Collagenase Clostridium Histolyticum-aaes Injections for Volumetric Change of Cellulite Dimples and Gluteal Contouring

BACKGROUND

Collagenase clostridium histolyticum-aaes (CCH) is approved for the treatment of moderate-to-severe cellulite.

OBJECTIVE

This is a retrospective image review of subjects previously enrolled in Cohort 2 of the EN3835-305 trial to determine the effects of CCH on volumetric changes of cellulite dimples and overall gluteal contouring.

METHODS

In this retrospective analysis, photographs from Day 90 and Day 180 were superimposed on baseline images and the volumetric change of each treated cellulite dimple was quantified. Side-by-side photographs of the buttocks were also evaluated for change in gluteal contour using the Physician Global Aesthetic Improvement Scale (PGAIS).

RESULTS

Fifty-eight female subjects and 403 cellulite dimples were evaluated. Three-dimensional imaging analysis revealed a significant improvement in total negative dimple volume at both Day 90 and Day 180 of 27% and 26%, respectively ( p < .001 and p = .002, respectively). At Day 90, the overall gluteal contour, as signified by the mean PGAIS among the 3 blinded dermatologists, was rated as +1 (improved) in 27% ( n = 17) of the subjects. At Day 180, the mean PGAIS was +1 (improved) or +2 (very much improved) in 39% ( n = 26) of the subjects.

CONCLUSION

CHH is an effective tool for treating cellulite dimples and improving gluteal contour.

The infragluteal fold: An appraisal by MRI combined with an anatomic study

PURPOSE

The gluteal region is a key element of beauty balance and sexual appearance. However, there is no clear anatomical description of the infragluteal fold, nor any classification exists allowing standardizing treatment of this area in case of jeopardisation. The purpose of this study was to perform an anatomical description of the infragluteal fold (IGF) matching radiological and anatomical findings in describing specifically raise of the fibrous component at the bone level.

METHODS

Six volunteers (three males and three females) underwent an MRI scan (Siemens Aera® 1.5 T) of the pelvic region. T1 Vibe Morpho T2, Sag Space 3D, and Millimetric slices were performed in order to obtain a more detailed selection of the gluteal landmark. Trabecular connective tissue of the region was analyzed using Horos® ROI (region of interest) segmentation function. Four fresh cadavers (two males, two females, accounting for 8 hemipelvis) were dissected in order to compare the radiological findings.

RESULTS

The infragluteal fold is a connectival fibrous band extending from the ramus of the ischium (but not involving the ischial tuberosity, for a length of 21 mm ± 2 and 21 mm ± 3), the apex of the sacrum (for a length of 13 ± 2 and 11 mm ± 2), and the coccyx (for a length of 19 mm ± 2 and 20 mm ± 2, all measures referring to volunteers and cadavers, respectively) reaching superficially the dermis of the medial one-third of the cutaneous fold. No significant difference was found between volunteer and cadaver group in MRI measurement of bony origins, or between MRI and cadaveric dissection measurements.

CONCLUSION

Knowledge of this structure will define novel surgical techniques in infragluteal fold restoration.

Poly-L-Lactic Acid for Minimally Invasive Gluteal Augmentation

BACKGROUND

There is increased emphasis on the importance of the gluteal region in the perception of beauty. Biodegradable fillers provide a nonsurgical method of augmenting and rejuvenating this area.

OBJECTIVE

To review pertinent aspects of anatomy, patient evaluation, injection technique, and complications for gluteal augmentation using injectable biodegradable fillers.

METHODS

The authors review the literature for poly-L-lactic acid-based gluteal augmentation.

RESULTS

Like many aesthetic procedures, there is a paucity of literature on this emerging treatment modality (Level 4, Centre for Evidence-Based Medicine, Oxford). However, the collective clinical experience is that poly-L-lactic acid fillers are an effective treatment for patients seeking noninvasive gluteal enhancement with minimal downtime. Physicians must understand gluteal anatomy and avoid injecting deeply in the danger triangle to prevent intravascular injection into the gluteal vessels or injury to the sciatic nerve. Other safety elements include the use of blunt cannulas, reduced pressures, smaller volumes, and retrograde delivery.

CONCLUSION

Gluteal augmentation with fillers can safely and effectively improve gluteal firmness, shape, proportion, and projection. Practitioners injecting fillers in the gluteal region must be aware of appropriate patient selection, regional anatomy, and safe injection techniques. Given the increasing demand for this procedure, further high-quality studies are needed.

Breast Shape Change Associated with Aging: A Study Using Prone Breast Magnetic Resonance Imaging

Background:

Objective assessments of the shapes of various parts of the body can be made using images acquired with multidetector row computed tomography or magnetic resonance imaging. These images can be useful for understanding the changes in body shape that accompany aging.

Methods:

Data from our previous bilateral prone breast magnetic resonance imaging studies between March and August 2013 were analyzed. Breast size and volume were measured using these images. All the patients included in the study were divided into a younger group (54 years or younger) and an older group (55 years or older). The values were compared between the 2 groups using paired t tests. Regarding variables that were shown to have a significant difference between the 2 groups, the relationships between age and the values of the variables were evaluated using the Pearson correlation coefficient.

Results:

A total of 90 breasts, 45 breasts in the younger group and 45 breasts in the older group, were used for analysis. There was a significant correlation between age and craniocaudal nipple deviation (R = −0.38; P < 0.001) and between age and the measured breast volume (R = 0.26; P < 0.05). There was also a significant correlation between the measured breast volume and the craniocaudal nipple deviation (R = −0.48; P < 0.001).

Conclusions:

A caudal deviation of the nipple and an increase in volume were age-related changes in breast shape. These 2 variables were also correlated.