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Si L, Li Z, Fu L, Zhang M, Tian T, Qi Z, Long X, Wang X, Wang Y. Gluteal Fold: Cadaveric Dissection of the Superficial Fascial System in the Buttock and Anatomy-Based Gluteal Liposculpture. Plast Reconstr Surg 2024; 154:241e-253e. [PMID: 37220258 DOI: 10.1097/prs.0000000000010723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
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.
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Affiliation(s)
- Loubin Si
- From the Department of Plastic Surgery, Peking Union Medical College Hospital
| | - Zhijin Li
- From the Department of Plastic Surgery, Peking Union Medical College Hospital
| | - Lin Fu
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Mingzi Zhang
- From the Department of Plastic Surgery, Peking Union Medical College Hospital
| | - Tong Tian
- Department of Plastic Surgery, The People's Hospital of Zhaoyuan City
| | - Zheng Qi
- From the Department of Plastic Surgery, Peking Union Medical College Hospital
| | - Xiao Long
- From the Department of Plastic Surgery, Peking Union Medical College Hospital
| | - Xiaojun Wang
- From the Department of Plastic Surgery, Peking Union Medical College Hospital
| | - Yang Wang
- From the Department of Plastic Surgery, Peking Union Medical College Hospital
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Kollu T, Giutashvili T, Bhat D, Fournier C, Patel A. Defining the Ideal Male Buttocks. Plast Reconstr Surg 2023; 152:1030e-1039e. [PMID: 36877749 DOI: 10.1097/prs.0000000000010378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
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.
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Affiliation(s)
- Tejas Kollu
- From the Department of Surgery, Division of Plastic Surgery, Albany Medical Center
| | | | - Deepa Bhat
- From the Department of Surgery, Division of Plastic Surgery, Albany Medical Center
| | - Craig Fournier
- From the Department of Surgery, Division of Plastic Surgery, Albany Medical Center
| | - Ashit Patel
- Department of Surgery, Division of Plastic, Maxillofacial and Oral Surgery, Duke University
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Hartman NN, Almukhtar RM, Wood ES, Fabi SG. Collagenase Clostridium Histolyticum-aaes Injections for Volumetric Change of Cellulite Dimples and Gluteal Contouring. Dermatol Surg 2023; 49:383-386. [PMID: 36826346 DOI: 10.1097/dss.0000000000003727] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
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.
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Affiliation(s)
- Nina N Hartman
- Lupo Center for Aesthetic and General Dermatology, New Orleans, Louisiana
| | | | - Emily S Wood
- Westlake Dermatology and Cosmetic Surgery, Austin, Texas
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Stivala A, di Summa PG, Bernard C, Moris V, See LA, Loffroy R, Zwetyenga N, Cheynel N, Guillier D. The infragluteal fold: An appraisal by MRI combined with an anatomic study. Surg Radiol Anat 2021; 43:1131-1139. [PMID: 33462737 DOI: 10.1007/s00276-020-02636-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 11/20/2020] [Indexed: 12/01/2022]
Abstract
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.
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Affiliation(s)
- A Stivala
- Department of Plastic Reconstructive and Hand Surgery, Department of Oral and Maxillofacial Surgery, University Hospital, Boulevard de Lattre de Tassigny, 21000, Dijon, France
| | - P G di Summa
- Department of Plastic and Hand Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - C Bernard
- Department of Cardiac Surgery, University Hospital, Boulevard de Lattre de Tassigny, 21000, Dijon, France
| | - V Moris
- Department of Plastic Reconstructive and Hand Surgery, Department of Oral and Maxillofacial Surgery, University Hospital, Boulevard de Lattre de Tassigny, 21000, Dijon, France
| | - L A See
- Department of Plastic Reconstructive and Hand Surgery, Department of Oral and Maxillofacial Surgery, University Hospital, Boulevard de Lattre de Tassigny, 21000, Dijon, France
| | - R Loffroy
- Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, François-Mitterrand University Hospital, Dijon Cedex, France
| | - N Zwetyenga
- Department of Plastic Reconstructive and Hand Surgery, Department of Oral and Maxillofacial Surgery, University Hospital, Boulevard de Lattre de Tassigny, 21000, Dijon, France.,Department of Plastic and Hand Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland.,Department of Cardiac Surgery, University Hospital, Boulevard de Lattre de Tassigny, 21000, Dijon, France.,Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, François-Mitterrand University Hospital, Dijon Cedex, France.,Lipid Nutrition Cancer Team NuTox, UMR866, University of Burgundy and Franche-Comté, Boulevard Jeanne d'Arc, 21000, Dijon, France
| | - N Cheynel
- Department of Digestive Surgical Oncology, University Hospital, Boulevard de Lattre de Tassigny, 21000, Dijon, France.,Department of Morphology and Anatomy, UFR Sciences de Santé, 7 boulevard Jeanne d'Arc, 21000, Dijon, France
| | - D Guillier
- Department of Plastic Reconstructive and Hand Surgery, Department of Oral and Maxillofacial Surgery, University Hospital, Boulevard de Lattre de Tassigny, 21000, Dijon, France. .,Department of Plastic and Hand Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland. .,Department of Cardiac Surgery, University Hospital, Boulevard de Lattre de Tassigny, 21000, Dijon, France. .,Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, François-Mitterrand University Hospital, Dijon Cedex, France. .,Lipid Nutrition Cancer Team NuTox, UMR866, University of Burgundy and Franche-Comté, Boulevard Jeanne d'Arc, 21000, Dijon, France. .,Department of Digestive Surgical Oncology, University Hospital, Boulevard de Lattre de Tassigny, 21000, Dijon, France. .,Department of Morphology and Anatomy, UFR Sciences de Santé, 7 boulevard Jeanne d'Arc, 21000, Dijon, France.
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Abstract
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.
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