Buttock Lifting Using Elastic Thread (Elasticum®) with a New Classification of Gluteal Ptosis

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.

Comparison of tissue response and lifting effect induced by non-absorbable elastic thread and commercialized threads in rat model

As we age, our skin loses elasticity and wrinkles form. To prevent this, most people try to improve skin wrinkles by performing procedures such as fillers, and absorbable lifting threads. Another way to solve this structural problem is to use an elastic thread. Although elastic sutures made of polymer materials (such as silicone) are widely used, data regarding their properties and potential effectiveness are lacking. This study aimed to investigate the effects of inserting non-absorbable elastic threads, with different manufacturing requirements and methods, on the skin and subcutaneous tissue. In this study, non-absorbable elastic threads ELATENS and Elasticum using different manufacturing methods were compared. Each thread was transplanted into the subcutaneous layer of the back of a rat to induce wrinkles. After inducing wrinkles in the skin of rat, the degree of skin maintenance by each thread and the thickness of the capsule formed around the suture were measured. Through ex-vivo experiments on each thread, the fixation force in the tissue was confirmed. In a comparison of inflammatory response and collagen formation through histological analysis, it was confirmed that there was no significant difference from the equivalent comparative product. In conclusion, the degree of encapsulation between tissues and collagen fiber formation for improving skin wrinkles was superior in elastic threads compared to non-elastic threads. It is believed that this provides certain elasticity to the skin layer and can induce cell influx to improve wrinkles.

Thread Lifting Materials: A Review of Its Difference in Terms of Technical and Mechanical Perspective

Thread lifting involves the use of slender materials, reminiscent of threads, for aesthetic procedures. These materials are distinct from traditional sutures and vary in composition, purpose, and performance. The introduction delves into the literal and material significance of threads, establishing the broad concept of thread lifting materials. The article revisits the evolution of thread lifting materials, emphasizing the preexistence of cog threads for tissue manipulation before their widespread adoption in plastic surgery. Observations regarding the efficacy and longevity of absorbable versus non-absorbable threads are discussed, stressing the efficiency of high-quality absorbable cog threads. The conclusion underlines the proliferation of thread lifting materials beyond PDO, highlighting the importance of considering multiple factors beyond duration when selecting threads for lifting procedures.

Lower Gluteal Liposuction Combined With Upper Gluteal and Infragluteal Region Fat Grafting: A Novel Concept to Improve Gluteal Ptosis

BACKGROUND

Gluteal ptosis results in a severe disturbance of gluteal aesthetics. Currently, satisfactory procedures for improving gluteal ptosis are lacking.

OBJECTIVES

To improve gluteal ptosis, the authors propose a novel concept of combined liposuction of the lower gluteal region and fat grafting to the upper gluteal and infragluteal regions, and verify its efficacy and safety.

METHODS

Patients who underwent liposuction of the lower gluteal region combined with fat grafting to the upper gluteal and infragluteal regions between January 2020 and July 2023 were retrospectively reviewed. Postoperative changes in the gluteal ptosis grade, complications, and patient satisfaction were evaluated.

RESULTS

A total of 28 patients were enrolled in this study; 21 (75.0%) patients had gluteal ptosis grade 4 and 7 (25.0%) patients had gluteal ptosis grade 5. The median fat removal volume was 210 mL, and the median fat graft injected volume was 355 mL in the gluteal region and 180 mL in the infragluteal region. All patients showed improvement in gluteal ptosis; 16 (57.1%) patients improved by 1 grade and 12 (42.9%) patients showed a 2-grade improvement. All patients were satisfied with their posttreatment outcomes. Only 1 patient showed lateral translocation of the fat graft. No other complications were observed.

CONCLUSIONS

Liposuction of the lower gluteal region combined with fat grafting to the upper gluteal and infragluteal regions is effective in improving gluteal ptosis, with a low risk of complications and high patient satisfaction.

LEVEL OF EVIDENCE: 3

Circumferential Liposuction of the Thigh with Concomitant Fat Transplantation to the Infragluteal Region: A Promising Option for Preventing Postliposuction Gluteal Ptosis

BACKGROUND

Gluteal ptosis is a common complication of circumferential liposuction of the thigh. The authors propose a novel concept of combining circumferential liposuction of the thigh with concomitant fat transplantation to the infragluteal/posterior thigh junction region to prevent postliposuction gluteal ptosis.

METHODS

Patients underwent circumferential liposuction of the thigh with or without concomitant fat transplantation from 2015 to 2020 and were retrospectively reviewed. The postoperative changes in the grade of gluteal ptosis, length of hospitalization, time to recovery, postoperative complications, and patient satisfaction were evaluated.

RESULTS

A total of 109 patients were enrolled in this study, including 46 patients in the liposuction-only group and 63 patients in the liposuction plus fat transplantation group. There was no significant difference in fat removal volume between the liposuction-only group and the liposuction plus fat transplantation group ( p = 0.152). Aggravation of gluteal ptosis occurred in 43 patients (93.5 percent) in the liposuction-only group and four patients (6.3 percent) in the liposuction plus fat transplantation group ( p < 0.001). The length of hospitalization and time to recovery was not significantly different between the two groups ( p = 0.402 and p = 0.423, respectively). Complications were rare in both groups. With a minimum evaluation time of 6 months, patients in the liposuction plus fat transplantation group showed significantly higher satisfaction ( p < 0.001).

CONCLUSION

Concomitant fat transplantation to the infragluteal/posterior thigh junction region during circumferential liposuction of the thigh is effective in preventing postliposuction gluteal ptosis and improving patient satisfaction.

CLINICAL QUESTION/LEVEL OF EVIDENCE

Therapeutic, III.

Difficulty of Severe Post-liposuction Infragluteal Deformity Correction With Autologous Fat Transplantation: A Case Report

Overaggressive liposuction of the infragluteal region can lead to iatrogenic infragluteal fold deformity and result in esthetic defects in the gluteal contour. We report a case of using autologous fat transplantation to correct severe post-liposuction infragluteal fold deformity. In the process of reconstruction, the patient experienced fat graft overabsorption, fat graft translocation, and gluteal ptosis aggravation. Despite multiple operations, the effect of fat transplantation was limited. In conclusion, severe post-liposuction infragluteal deformity is very difficult to correct. The infragluteal region should be preserved during liposuction to avoid deformity.

Gluteal Soft-Tissue Repositioning Using Polydioxane Threads

BACKGROUND

Buttock reshaping has recently gained popularity. Gluteal soft-tissue repositioning can be performed using polydioxane threads, followed by anthropometric measurements.

OBJECTIVE

To evaluate the effectiveness of polydioxane threads for noninvasive gluteal soft-tissue repositioning.

MATERIALS AND METHODS

From February 2018 to August 2019, 27 women (mean age, 38.9 years; range, 26-65 years) underwent thread lifting. Multiple polydioxane threads (total, 24-30 threads for each buttock side) were used for gluteal soft-tissue repositioning. The treatment outcomes were based on comparisons of the preoperative and postoperative findings.

RESULTS

The mean ratio of the upper and lower vertical proportions of the buttocks changed from 63:37 preoperatively to 55:45 postoperatively. The mean projection angle of the upper portion decreased from 60.1° preoperatively to 54.3° postoperatively. Twenty-four patients (86%) were satisfied with the results up to 8 months postoperatively. One patient developed persistent pain (>1 month), and 4 patients showed skin dimpling, which resolved within 2 weeks after minimal massages. No hematomas, foreign body sensation, or thread protrusions were noted.

CONCLUSION

Polydioxane threads could be an alternative, minimally invasive tool for buttock lifting. Our novel technique of repositioning the buttock soft tissue improved lifting and augmentation and provided a better buttock shape.

Improving the Female Silhouette and Gluteal Projection: An Anatomy-Based, Safe, and Harmonious Approach Through Liposuction, Suspension Loops, and Moderate Lipofilling

BACKGROUND

Liposuction is the main technique to improve body contour, emphasize appealing curves, and highlight one's muscular definition. The number of procedures in which the harvested fat is utilized for gluteal augmentation has greatly increased.

OBJECTIVES

The authors aim to demonstrate their technique in order to obtain a sculpted harmonious body through a safe procedure, as well as review their 101 consecutive cases between 2014 and 2018.

METHODS

Anatomical guidelines and preoperative markings were provided to guide the 3-step procedure: zones of maximal and mild liposuction, barbed wire suspension, and moderate fat grafting. Novel concepts are introduced as the anterior body diagonal, posterior body diagonal as well as other specific axes the pubic unit, and a vertical ratio for the buttock, which are the basic foundations for sculpting the female body into a pleasing hourglass shape with a well projected buttock. Recommendations for location of sacral diamond, sacral dimples, and the maximally projected point of the buttock are given. The authors explain their philosophy through 4 principles: knowledge of anatomy, the relationship between specific body areas and surrounding zones, a balanced gluteal augmentation is not achieved through large volume fat grafting alone, and grafting in the subcutaneous layer.

RESULTS

A total of 101 patients were treated following the described technique and examples are shown. The complication rate was low. No serious adverse effects were recorded apart from 1 ruptured suspension loop.

CONCLUSIONS

The described anatomy-based approach, including liposuction, suspension loops, and fat grafting, is a novel and safe technique leading to a desirable, long-lasting outcome.

LEVEL OF EVIDENCE: 4

The Outlook of the Development of Innovative Products from Biocompatible Natural Spider Silk in the Beauty Thread-Lifting Industry

Embedding thread lift rhytidectomy, also known as "thread lifting" in China, with the natures of simple operation, less trauma and quick recovery, is progressively used in clinical practice as a new technology of face lifting. Herewith, a brief introduction of the previous advances of thread lifting techniques and materials in the facial beauty industry, combined with the discussion on various types of sutures, common complications, and the site of actions were provided. The main limitations of present thread lifting material include: (1) the use of non-absorbable sutures is liable to cause allergies and a series of complications; (2) the absorbable sutures are easily degradation, and people need to reshape in a relatively short period. Therefore, the high biocompatible spider silk was proposed as a novel material of thread lifting suture and related devices, the advantages and preliminary achievements on spider silk were also addressed.

Elastic thread modified minimal access cranial suspension lift for lower and middle third facial rejuvenation

Thread lift boasts the advantage of minimal invasion for facial rejuvenation and has been increasingly used nowadays. The purpose of this study was to evaluate the outcomes and safety of elastic thread when it was used in the modified minimal access cranial suspension (MACS) lift for rejuvenation of the lower and middle third of the face.Forty-six patients with sagging and laxity of the lower face treated by the elastic thread modified MACS lift from December 2015 and December 2017 were enrolled in this study. A retrospective chart review was conducted. The degree of Wrinkle Severity Rating Scale (WSRS) score and satisfaction score were evaluated immediately, 6 months and 12 months after procedure. Complications during the study were also recorded.All the patients were female, with a mean age of 50.7 ± 6.4 years and a mean follow-up period of 15.4 ± 2.1 months. The mean operation time was 114 ± 13 minutes. For the left face, the mean WSRS score was 4.0 ± 0.8 preoperatively and 3.1 ± 0.8 on the 1-year follow-up; and 4.1 ± 0.9 and 3.1 ± 0.7 on the right face (P < .01). Thirty-nine (84.8%) patients considered the long-term results satisfactory. There were no major complications during the follow-up period.The elastic thread modified MACS lift is a minimally invasive, effective and safe method to improve lagging middle and lower third of the face without significant postoperative morbidity or complications.

Biomechanical Properties and Biocompatibility of a Non-Absorbable Elastic Thread

To date, extensive studies have been conducted to assess diverse types of sutures. But there is a paucity of data regarding biomechanical properties of commonly used suture materials. In the current experiment, we compared biomechanical properties and biocompatibility, such as tensile strength and elongation, the degree of bovine serum albumin (BSA) release, in vitro cytotoxicity and ex vivo frictional properties, between a non-absorbable elastic thread (NAT; HansBiomed Co. Ltd., Seoul, Korea) (NAT-R: NAT with a rough surface, NAT-S: NAT with a smooth surface) and the Elasticum® (Korpo SRL, Genova, Italy). The degree of tensile strength and elongation of Si threads was significantly higher in both the NAT-R and -S as compared with the Elasticum® (p < 0.05). Moreover, the degree of tensile strength and elongation of PET threads was significantly lower in both NAT-R and -S as compared with the Elasticum® (p < 0.05). Furthermore, the degree of tensile strength and elongation of braided Si/PET threads was significantly lower in NAT-S as compared with NAT-R and Elasticum® (p < 0.05). The degree of BSA release was significantly higher in the NAT-R as compared with Elasticum® and NAT-S throughout a 2-h period in the descending order (p < 0.05). The degree of cell viability was significantly higher in both NAT-R and -S as compared with Elasticum® (p < 0.05). The degree of coefficient of friction as well as the frictional force and strength was significantly higher in NAT-R as compared with NAT-S and Elasticum® (p < 0.05). NAT had a higher degree of biomechanical properties and biocompatibility as compared with Elasticum®. But further experimental and clinical studies are warranted to compare the efficacy, safety, and potential role as a carrier for drug delivery between NAT and Elasticum®.

[Secondary gluteal surgery augmentation: Surgical techniques and outcomes]

OBJECTIVES

The interest in the posterior aspect of the body keeps increasing, thus trigerring an increase in the number of gluteal augmentations with implants, also trigerring a proportional increase in postoperative complications and secondary gluteal surgeries. Nevertheless, there are currently few publications on this subject. The purpose of this study is to identify methods to treat and prevent gluteal augmentation complications.

PATIENTS AND METHODS

In this study, the author reviews 14 cases of secondary gluteal surgeries. Some patients simply have their implants removed. For others, the solution to get rid of excess skin relies on buttock lifting or the creation of a purse with an elastic thread. A new deeper plane intramuscular pocket surgery can also be performed. Moreover, capsuloplasty is often required to treat malpositions. Finally, a "hybrid or composite augmentation" can be completed by grafting autologous fat into the subcutaneous fat layer in combination with the implants.

RESULTS

Out of the 14 secondary gluteal surgery cases, the implants were removed in five cases, eight cases involved deeper insertion of implants and one case with a capsuloplasty; five cases benefited from a hybrid or composite augmentation and two cases of a butt lift. Minor postoperative complications occurred in four cases.

CONCLUSION

A better knowledge of the gluteal area anatomy, a good understanding of the gluteal surgical techniques coupled with a good mastery of the composite or hybrid technique for the gluteal augmentation as well as a good management of malpositions, seromas and delayed healing can enhance secondary gluteal surgery success.