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Seabra Robalo Gomes Jorge AC, Feng YS, Santos Stahl A, Grözinger G, Nikolaou K, Glanemann M, Daigeler A, Stahl S. Danger Zones of the Gluteal Anatomy: Improving the Safety Profile of the Gluteal Fat Grafting. Aesthetic Plast Surg 2024; 48:1597-1605. [PMID: 38302712 PMCID: PMC11058931 DOI: 10.1007/s00266-023-03824-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 12/14/2023] [Indexed: 02/03/2024]
Abstract
INTRODUCTION Knowledge of the vascular anatomy is critical to performing safe gluteal surgery. To date, only the course of the main blood vessels within the muscles has been outlined. These findings are based on MRI and CTA images that do not conform to a topographically standardized and normalized probability distribution. OBJECTIVES The aim of this study was to develop a three-dimensional mapping of the gluteal zones of high vascular density in relation to anatomical landmarks. MATERIALS AND METHODS This single-center retrospective cohort analysis comprised all consecutive patients who underwent cone-beam computed tomography (CBCT) scans between January 2016 and October 2021. The location of blood vessels in the gluteal region was allometrically normalized in relation to anatomical landmarks. Moreover, the caliber and area of the blood vessels were assessed. RESULTS CBCT scans of 32 patients with an average age of 64 ± 12 years (range 34-87 years) were included. Fifty-three percent were female. The median [IQR] caliber of the intramuscular gluteal vessels was 1.47 [1.15-1.88] mm, significantly greater than that of the subcutaneous vessels 1.09 [0.72-1.44] mm (p < 0.001). Vascular density was higher intramuscularly, as 4.5% of the area of the muscle was occupied by blood vessels, as opposed to 0.3% in the adipose tissue. CONCLUSION The analysis of the CBCT scans showed a higher vascular density and larger vessels intramuscularly. We, therefore, recommend the injection of autologous fat merely to the subcutaneous plane. LEVEL OF EVIDENCE II This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
| | - You-Shan Feng
- Institute for Clinical Epidemiology and Applied Biometrics, Medical University of Tübingen, Tübingen, Germany
| | | | - Gerd Grözinger
- Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Tübingen, Germany
| | - Konstantin Nikolaou
- Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Tübingen, Germany
| | - Matthias Glanemann
- Department of General, Visceral, Vascular, and Pediatric Surgery, Saarland University Hospital, Kirrberger Straße, 66421, Homburg, Saarland, Germany
| | - Adrien Daigeler
- Department of Hand, Plastic, Reconstructive and Burn Surgery, BG Clinic Tübingen, Tübingen, Germany
| | - Stéphane Stahl
- CenterPlast private practice, Bahnhofstraße 36, 66111, Saarbrücken, Germany
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Pazmiño P, Del Vecchio D. Safety in Gluteal Augmentation. Clin Plast Surg 2023; 50:521-523. [PMID: 37704319 DOI: 10.1016/j.cps.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
Gluteal fat grafting is the fastest growing surgery in body contouring because of the powerful results that no other procedure can achieve. Efforts made to improve the safety of this procedure are reviewed.
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Affiliation(s)
- Pat Pazmiño
- Division of Plastic Surgery, University of Miami.
| | - Daniel Del Vecchio
- Department of Plastic Surgery, Massachusetts General Hospital, Boston, MA, USA
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Pazmiño P, Del Vecchio D. Static Injection, Migration, and Equalization: A New Paradigm for Safe Ultrasound-Guided BBL: Safer, Faster, Better. Clin Plast Surg 2023; 50:603-614. [PMID: 37704327 DOI: 10.1016/j.cps.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
Static injection, migration, and equalization allows for always subcutaneous-targeted fat grafting to either the deep or the superficial subcutaneous spaces.
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Affiliation(s)
- Pat Pazmiño
- Division of Plastic Surgery, University of Miami, 848 Brickell Avenue, Suite 820, Miami, FL 33131, USA.
| | - Daniel Del Vecchio
- Department of Plastic Surgery, Massachusetts General Hospital, 38 Newbury Street, Suite 502, Boston, MA 02116, USA
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Aslani A. Combining Fat and Implants for Gluteal Augmentation. Clin Plast Surg 2023; 50:563-571. [PMID: 37704324 DOI: 10.1016/j.cps.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
Guidelines for optimal buttock implant management, time-efficient preparation of implant pocket, and breakdown of optimal implant choice, combined with large-volume fat transfer for best possible outcome.
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Affiliation(s)
- Alexander Aslani
- Cirumed Clinic Marbella, Edificio Panorama, Autovía del Mediterráneo, km 184, planta baja, local 2B y 2C, Marbella, Málaga 29603, Spain.
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Pazmiño P. Ultrasound-Guided Gluteal Fat Grafting: A to Z. Clin Plast Surg 2023; 50:587-601. [PMID: 37704326 DOI: 10.1016/j.cps.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
Low-cost, high-resolution ultrasound systems allow surgeons to visualize and manipulate the subcutaneous space and inject fat graft with millimeter accuracy.
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Affiliation(s)
- Pat Pazmiño
- Division of Plastic Surgery, University of Miami.
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Atiyeh B, Ghieh F, Oneisi A. Safety and Efficiency of Minimally Invasive Buttock Augmentation: A Review. Aesthetic Plast Surg 2023; 47:245-259. [PMID: 35999464 DOI: 10.1007/s00266-022-03049-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 07/26/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Volume restoration and enhancement of the gluteal region appearance has become nowadays a popular concern in particular for many women. Several options are available, none however are without complications and side effects. Volume enhancement with soft tissue fillers of the gluteal region is emerging as a highly attractive minimally invasive modality. It has led unfortunately to more unlicensed, nonmedical practitioners administering illicitly injections for buttock augmentation at relatively low costs. MATERIALS AND METHODS To determine safety, efficacy, and cost effectiveness of mostly used soft-tissue fillers for buttock augmentation, a systematic literature search of PubMed, Medline, and Embase was conducted to identify the mostly used fillers for gluteal augmentation. It was complemented by searching for each of the identified filler material separately to retrieve any missed reports. References of clinical studies and trials, reviews, and consensus reports were reviewed as well for the same objective. RESULTS In the final analysis 12, mostly strongly biased clinical reports providing a low level of evidence, were identified for inclusion in the review. Two studies involved Polymethylmethacrylate (PMMA), 5 Poly-L-lactic acid, 1 Calcium hydroxyapatite and 4 hyaluronic acid filler injection. No studies were identified involving liquid silicone or Polyacrylamide hydrogel. The little available evidence provided by this review indicates that a specific brand of PMMA in Brazil has a demonstrable relatively good safety, efficiency, and cost-effectiveness record superior to surgical alloplastic gluteal augmentation or to lipofilling only when injected by experts. CONCLUSION Gluteal augmentation with soft tissue fillers is not as simple and innocuous as advertised. Serious complications may occur. Moreover, optimal buttock contouring entails not only volume augmentation but also volume removal; thus, volume augmentation with soft tissue fillers may not be ideal. Popularizing this modality must also be approached with great care. Serious complications do occur; they become inevitable when performed illegally by non-specialized, non-authorized, and unscrupulous practitioners in non-accredited facilities. Patients must be warned that adherence to regulations is critical and that only well-trained certified experts practicing legally in accredited facilities can address safely and efficiently their concerns. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Bishara Atiyeh
- Division of Plastic and Reconstructive Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Fadi Ghieh
- Division of Plastic and Reconstructive Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ahmad Oneisi
- Division of Plastic and Reconstructive Surgery, American University of Beirut Medical Center, Beirut, Lebanon.
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Sadideen H, Akhavani MA, Mosahebi A, Harris PA. Current perceptions of 'Brazilian butt lift' (BBL) surgery in the UK: A BAAPS-led survey of BAAPS members. J Plast Reconstr Aesthet Surg 2020; 73:1966-1975. [PMID: 32919948 DOI: 10.1016/j.bjps.2020.08.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 06/28/2020] [Accepted: 08/01/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND The BAAPS advice against Brazilian butt lift (BBL) surgery in the UK was set in October 2018. A Delphi study conducted by BAAPS highlighted the importance of defining current practice and perceptions amongst UK surgeons, as this is currently unknown. OBJECTIVES To evaluate BAAPS members' current practice and perceptions around BBL surgery to ensure patient safety and propose better recommendations. METHODS A BAAPS-commissioned survey was emailed to all BAAPS members through an on-line link. The survey collected quantitative and qualitative information in several domains. RESULTS This survey received a 44% response rate. Of 102 respondents, 32 surgeons undertook BBL surgery before the BAAPS advice to halt it. There was a wide variation in actual fat volumes injected, and in perceptions of what constituted a small or large volume. Virtually all respondents (96.9%) performed only subcutaneous fat injections. There were differences in fat harvest techniques. The majority (66.7%) felt that BAAPS should maintain its recommendation against undertaking BBL surgery until further data became available. Nearly a quarter of 102 respondents (20.6%) had been treated for BBL complications, the majority as a result of surgical tourism. CONCLUSIONS The survey provides member-reported perception and experience with regard to BBL surgery in the UK. The demand for BBL surgery and its provision should be reassessed in the UK. This information will be analysed with further national and international data to better define and shape the scope of the safety of BBL surgery in the UK. BAAPS will use such data towards the production of future guidance and support for surgeons and patients.
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Affiliation(s)
- H Sadideen
- Cadogan Clinic, 120 Sloane Street, London,UK; Department of Surgery and Cancer, Imperial College London, London, UK.
| | - M A Akhavani
- Department of Plastic Surgery, Royal Free Hospital, London, UK
| | - A Mosahebi
- Department of Plastic Surgery, Royal Free Hospital, London, UK
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Abs R. [Secondary gluteal surgery augmentation: Surgical techniques and outcomes]. ANN CHIR PLAST ESTH 2019; 64:653-9. [PMID: 31324505 DOI: 10.1016/j.anplas.2019.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Accepted: 06/28/2019] [Indexed: 11/21/2022]
Abstract
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.
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Abstract
Gluteal augmentation with autologous fat transfer is an increasingly popular procedure that has the ability to transform a patient's entire body silhouette and gluteal appearance. Proper patient selection, preoperative evaluation, and planning are critical to the success of the procedure. Using the preoperative planning, surgical technique, and postoperative care described, the procedure can be performed safely with powerful and consistent results and avoidance of complications associated with gluteal fat transfer.
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Affiliation(s)
- Ashkan Ghavami
- Division of Plastic and Reconstructive Surgery, Department of Surgery, David Geffen School of Medicine at UCLA, 200 UCLA Medical Plaza, Suite 465, Los Angeles, CA 90095, USA; Private Practice, Ghavami Plastic Surgery, 433 North Camden Drive, Suite 780, Beverly Hills, CA 90210, USA.
| | - Nathaniel L Villanueva
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, 1801 Inwood Road, Dallas, TX 75390, USA
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Abstract
The buttock area has received much media attention in recent years, which has produced increased patient demand for buttock reshaping or contouring and augmentation. Increasing patient demand has necessitated a more structured approach to evaluation of gluteal anatomy and the development of surgical procedures to enhance its beauty.
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Affiliation(s)
| | - Aditya Sood
- Department of Plastic and Reconstructive Surgery, The Ohio State University Medical Center, Columbus, OH, USA.
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Abstract
Massive weight loss patients and aesthetic patients can present with significant gluteal contour abnormalities. Gluteal ptosis, skeletal deformities, severe platypgia, and a paucity of donor fat for autologous transfer are common problems. Excisional procedures are used to treat massive-weight-loss contour abnormalities. These procedures present an opportunity to address severe gluteal deformities using autologous tissue augmentation. With a working knowledge of the relevant anatomy, sound surgical technique, and meticulous postoperative care, autologous gluteal autoaugmentation with circumferential body lift/excisional buttock lift using the "Moustache" flap technique will enhance massive weight loss body contouring outcomes and improve patient satisfaction.
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Affiliation(s)
- Robert F Centeno
- Department of Plastic Surgery, The Ohio State University, 915 Olentangy River Road, Suite 2100, Columbus, OH 43212, USA; Private Practice, Columbus Institute of Plastic Surgery, 6499 East Broad Street, Suite 130, Columbus, OH 43213, USA.
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Abstract
This article focuses on practice-based recommendations for surgeons performing gluteal augmentation with implants (GAI). Preoperative planning, including the indications, precautions, and contraindications to GAI, is discussed. Advantages and disadvantages of subfascial and intramuscular implantation are addressed along with recommendations for implant size, shape, and position. Recommendations for patient management before and after surgery along with operative and nonoperative strategies for postoperative complications, including wound dehiscence, infection, and seroma, are included. Aesthetic concerns and recommendations for the management of poor results are addressed. A comprehensive literature review is included along with illustrative preoperative and postoperative photos.
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de la Peña Salcedo JA, Gallardo GJ, Alvarenga GE. Subfascial Gluteal Implant Augmentation. Clin Plast Surg 2018; 45:225-36. [PMID: 29519491 DOI: 10.1016/j.cps.2017.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Gluteal augmentation has gained popularity. It might be the only option to increase volume for lean patients without donor tissue for grafting. Subfascial augmentation is a safe treatment with low morbidity when performed in an appropriate setting with the right equipment. It is an anatomically based procedure. It is very important that pocket dissection is limited to the anatomic landmarks. Implants should be placed vertically to allow for proper contouring. The wound should never be closed with tension. One of the most important steps is postoperative care, which should avoid any pressure on the buttocks and stress on the wound.
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Abstract
There has been increased interest in buttock contouring and augmentation in recent years, which has translated into increased demand for these procedures. In addition, we are witnessing a growing number of patients from all ethnic groups requesting cosmetic surgery in the United States. Buttock aesthetic surgery today consists of either augmentation or recontouring of the gluteal region by one of three methods: (1) liposuction (if only reductive shaping is required); (2) liposuction and augmentation by micro fat grafting; and (3) gluteal implants. Whereas there certainly exists a "universal ideal" of beauty in buttock augmentation, there are fundamental ethnic differences that must be recognized to achieve a desirable surgical outcome. We present an article reviewing current trends in buttock aesthetic procedures and discuss issues relevant to the ethnic populations.
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Affiliation(s)
- Edward I Lee
- Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas
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