Lower Body Lift in the Massive Weight Loss Patient: A New Classification and Algorithm for Gluteal Augmentation

Analysis of the Thigh Aesthetic Profiles: One of Physical Ideal Body Proportions

BACKGROUND

The contour of the thigh is increasingly being recognized as crucial component of the ideal human physique, giving rise to heightened interest in attaining the perfect thigh profile. Notwithstanding, the contemporary landscape of cosmetic surgery appears to be bereft of efficient and precise objective methodologies to evaluate the outcomes of thigh contouring treatments. The present study is aimed to investigate the aesthetic appeal of varying thigh contours, employing specialized software as an indispensable instrument for quantitative and qualitative analysis.

METHODS

Standardized photographs of the lower body were obtained from a sample of 200 healthy volunteers. A linear analysis was conducted, examining aspects such as the vertical length and transvers width of the thigh, as well as angular measurements including the posterior gluteal angle (PGA) and lateral angle thigh (LAT). Variables relating to thigh measurements and body mass index (BMI) were documented, with the relationships between them ascertained through Pearson's correlation and regression analysis.

RESULTS

In males, the LAT was measured at 168 ± 3.9, and the PGA at 170 ± 3.4, while in females, these measurements were 166 ± 2.8 ve 166 ± 2.8, respectively. Linear analyses, including the vertical length of thigh (VLT), transverse width of thigh (TWT), lateral width (LW), and posterior width (PW), were conducted. Based on the LW inferior/LW superior ratio values, the most commonly observed thigh types were Type III (0.90) at 45% and Type II (0.85) at 24.75% while the least common was Type V at 4% (0.99). PW inferior/PW superior was 84.7%. The PWI/PWS ratio was highest for Type V, at 0.99, accounting for 84.70% of the total. Furthermore, an increase in the LWI/LWS ratio leads to an increase in the PWI/PWS ratio.  The frequency of the VLT/TW1 ratio 0.31-0.35 (Type 3) was found to be on the left side and Type 4 on the right side. A strong correlation was found between BMI and all thigh indexes, with a significant positive correlation between the index and factors tied to the buttocks and upper thigh.

CONCLUSIONS

The concept of an ideal thigh may vary based on an individual's gender, race, country of residence, and self-esteem, aiming to achieve a more natural silhouette. Focusing on the different ratios of hip and thigh varieties in the study is quite intriguing. Further inquiry and rigorous exploration are warranted to delineate the optimal techniques and methodologies for attaining ideal thigh proportions.

LEVEL OF EVIDENCE IV

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Gluteoplasty With Lumbar Gluteal Flap Associated With Liposuction and Fat Grafting: A Safe Technique for Massive Weight Loss Patients

BACKGROUND

Weight loss leads to excessive flaccidity, volume loss, and tissue descent in the gluteal region. Translated autologous flaps during lower body lifting have been utilized in patients; they address sagging tissue and the lack of volume. However, sometimes use of these autologous flaps does not provide adequate gluteal projection, and a second procedure with fat injection may be required.

OBJECTIVES

The authors describe their technique of a lower body lift with a lumbosacral flap in association with liposuction and lipofilling for gluteoplasty.

METHODS

A prospective series of 23 post-bariatric surgery individuals who underwent a lower body lift with lumbosacral flap gluteal augmentation, liposuction, and lipofilling between January 2021 and September 2022 were described. The satisfaction rate and complications were assessed 6 months postoperatively with a validated questionnaire (BODY-Q scale).

RESULTS

The patients had a mean age of 38.18 (range, 28-56 years) and median body mass index of 26. Four patients with dehiscence were diagnosed and treated conservatively. All wound breakdowns were observed in the paramedian plane of the torsoplasty. No reoperations were performed. The mean satisfaction percentage of the BODY-Q scale transformed score was 97.5.

CONCLUSIONS

A technique for a lower body lift with buttock augmentation combined with liposuction and fat grafting was presented. In future studies other techniques to maximize gluteal contouring should be investigated.

Vertical Body Lift: Surgical Technique and Comparison with the Inferior Body Lift Technique

BACKGROUND

Patients with massive weight loss have excessive skin laxity along both vertical and transverse axes. Vertical body lift (VBL) is a body-contouring technique addressing both excesses, promoting not only body lifting but also a tightening effect. The aim of this study was to describe the authors' VBL surgical technique and its potential clinical applications. In addition, they present their experience among postbariatric surgery patients to compare surgical aspects and outcomes of VBL and the classic inferior body lift (IBL) technique.

METHODS

The authors reviewed data on 140 consecutive postbariatric surgery patients who underwent a body lift procedure between January of 2018 and March of 2020. The patients were divided into two groups: the VBL group and the IBL group. Patient demographics, operative details, and postoperative outcomes were compared between groups.

RESULTS

Of the 140 patients included in the study, 92 underwent IBL and 48 underwent VBL. There were no statistically significant differences between groups for surgical duration (IBL, 192 minutes; VBL, 193 minutes), hemoglobin decrease (IBL, 2.32 g/dL; VBL, 2.11 g/dL), hospital length of stay (IBL, 5.4 days; VBL, 5.7 days), or complication rate (IBL, 32%; VBL, 31%).

CONCLUSIONS

The authors' study shows comparable operative details and postsurgical outcomes between the VBL and classic IBL techniques. In their experience, VBL is a reliable and reproducible technique that can improve aesthetic and functional outcomes in a subpopulation of approximately one-third of patients with massive weight loss.

CLINICAL QUESTION/LEVEL OF EVIDENCE

Therapeutic, III.

Autologous Gluteal Augmentation with Parasacral Perforator-Pedicled Propeller Flaps

BACKGROUND

De-epithelialized flaps have been used in gluteal contouring over the last three decades, but most improve the projection rather than the upper quadrants. The authors provide a detailed description of their method of gluteal augmentation using parasacral perforator-pedicled propeller flaps. This technique achieves a volumetric increase and maximal buttock projection at the midlevel and in the medial half of the buttocks.

METHODS

Between January and December of 2019, a series of 18 patients on whom a lower body lift with a parasacral perforator-pedicled propeller flap had been performed by the senior author (F.B.) were prospectively evaluated. Postoperatively, the satisfaction rate was assessed using a 10-point analog scale (1 = unsatisfied, 10 = very satisfied) by the patient and by two independent surgeons based on photographs taken 1 year after surgery.

RESULTS

Eighteen patients underwent this procedure. Their mean age was 32.2 ± 5.6 years (range, 24 to 40 years). The mean flap length was 20.3 cm, their mean width was 10.4 cm, and the mean thickness was 3.4 cm. The authors noted only two minor complications, one seroma and two skin dehiscences that healed without surgery. The rate of satisfaction as assessed by the patients was 8.3 out of 10 (±1.1), and by surgeons, 7.9 and 8.1.

CONCLUSION

This article describes a gluteal autoaugmentation flap technique using parasacral perforator-pedicled propeller flaps to increase projection and volume in the inferomedial gluteal region after lower body lift.

CLINICAL QUESTION/LEVEL OF EVIDENCE

Therapeutic, IV.

Evaluation of a new adipose tissue processing method for breast and buttock fat grafting procedures

Background

There is still some debate about the best adipose processing method for autologous fat transfer procedures. This article reports a series of 66 fat grafting procedures using a novel fat processing technique that involves washing, “micronization,” and decantation.

Methods

We retrospectively reviewed the files of all patients operated on over a 2-year period by the two investigators. They underwent breast or buttock surgery that employed the novel fat processing technique for fat transfer. Complications and patient satisfaction were recorded, and fat resorption was qualitatively assessed based on clinical examination and photographs.

Results

Data were retrieved from a total of 66 procedures performed on 43 patients: 17 breast augmentations, 8 buttock augmentations, and 41 breast reconstructions. Five patients also underwent concomitant facial fat grafting. The complications were one case of transient liponecrotic cyst in the breast, one case of transient areolar sensitivity reduction, and two cases of infection. The infections were reported in patients from the breast reconstruction cohort who had a history of radiotherapy. There was no complication associated with facial fat grafting. Patient satisfaction was achieved in 82.4 to 92.5% of cases depending on the study cohort. Fat resorption was graded as minimal to moderate in 95% of all cases.

Conclusions

This retrospective study supports the safety and effectiveness of this novel fat processing method in breast and buttock surgeries. Further controlled studies are needed to compare its performance with that of other techniques.

Level of evidence: Level III, therapeutic study

Physical attractiveness: analysis of buttocks patterns for planning body contouring treatment

BACKGROUND

As buttocks region is one of the most characteristic features of the ideal female body figure, the popularity of gluteal region contouring is on the rise. Perception of body form is influenced by its shape and size. Interventions to modify the form of this region are often difficult due to influence. The aim of this study is to investigate the attractiveness of various buttock shapes with the aid of a dedicated software.

METHODS

Standard personal photographs of the lower body were obtained from 200 healthy volunteers. Linear analyses were made and anatomical perception was calculated according to reference points.

RESULTS

Compared to males, all measurements concerning buttock dimensions were a significantly greater in females. Proportional assessments revealed that in females, the most attractive buttock waist-to-hip ratio was 0.75 from the posterior view. This ratio was 0.85 in males. From the lateral view, the most attractive buttocks have a waist-to-hip ratio of 0.70 in females. Positioning of the lateral prominence at the inferior gluteal fold was rated by 25% of the respondents as the most attractive in males from the posterior view. From the lateral view, the most prominent portion positioned at the midpoint (a 50:50 vertical ratio) was considered the most attractive for females.

CONCLUSIONS

These results suggest that utilizing digitalized reference values for a given body region may be an invaluable tool for determination of the correct fat volume, thus individualization of body contouring procedures. With the help of certain software, this research has shown that it is possible to measure the parameters of buttock, which may in turn be used to offer the best solution for any individual in quest for an improved buttocks form. New ideal waist-to-hip ratios of 0.7 update the previous standards.