Brazilian Butt Lift: An Experience Over 3000 Patients

INTRODUCTION

The Brazilian Butt Lift (BBL) is a safe technique that entails body reshaping through buttock augmentation using autologous fat transfer.

METHOD

Between 2018 and 2022, 3000 patients underwent surgery. Each procedure commenced with the patient in supine position, starting with abdominal liposuction, followed by fat transfer to hips. Subsequently, the patient was repositioned to a prone stance. Liposuction of the back and waist ensued, concluding the surgery with fat transfer to the buttocks. Stringent precautions were implemented to ensure the safety of the patient throughout the procedure.

RESULTS

Eighty-six percent of patients express satisfaction with their outcomes, while seventy percent of the transferred fat calls survive in the buttocks. One serious complication and some minor complications have been encountered and effectively managed through conservative measures.

CONCLUSION

BBL proves to be a safe and satisfactory surgery when performed by experienced surgeons who adhere to fundamental principles. LEVEL OF EVIDENCE 3: 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 .

Effectiveness and Role of Using Hyaluronic Acid Injections for Gluteal Augmentation: A Comprehensive Systematic Review of Techniques and Outcomes

INTRODUCTION

There has been a rapid increase in the number of patients undergoing non-surgical gluteal augmentation in recent years, leading to an increase in the number of articles in the literature regarding the use of hyaluronic acid (HA) for gluteal augmentation. No systematic review has been published on the effectiveness of HA for gluteal augmentation. This study aimed to provide a comprehensive review regarding the effectiveness and role of using HA for gluteal augmentation.

METHODS

This review was conducted according to the PRISMA guidelines for reporting systematic reviews and meta-analyses. We conducted a search across MEDLINE, EMBASE, Cochrane, and Google Scholar, using the following search keywords: gluteus, buttocks, gluteoplasty, gluteal augmentation, hyaluronic acid, and filler.

RESULTS

Ten articles published between 2013 and 2022 that included 168 patients. The estimated duration of product effectiveness is 16.16 months. Most studies showed statistically significant improvements in patients' satisfaction. Mean volume of HA injected for optimal gluteal fat augmentation was 206.71 ml. Of included studies, two reported major complications, five patients experienced bruising and erythema as minor complications, five patients experienced effusion and inflammation at the injection site, three patients experienced gel dislocation, and one patient experienced irregular contours.

CONCLUSIONS

Based on our findings, HA is a predictable method for gluteal augmentation. Patients were satisfied with their outcomes. Despite gluteal augmentation with HA having a modest complication rate, it can still involve serious complications such as diffuse alveolar hemorrhage and death. There is a need for further research in a randomized control trial.

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 .

Effectiveness and Role of Using Hyaluronic Acid Injections for Gluteal Augmentation: A Comprehensive Systematic Review of Techniques and Outcomes

We have reviewed the article "Effectiveness and Role of Using Hyaluronic Acid Injections for Gluteal Augmentation: A Comprehensive Systematic Review of Techniques and Outcomes" by Mortada et al. in Aesthetic Plastic Surgery with keen interest. This study aims to comprehensively assess the effectiveness and role of hyaluronic acid (HA) in gluteal augmentation. However, we raise concerns about the methodologies employed in the reviewed studies. For effective treatments, understanding the properties of the active substance is essential for standardization. Thoroughly grasping the key characteristics of the employed HAs is vital to identify correlations between these properties, outcomes, and complication risks. Understanding HA's rheological properties, including viscosity, elasticity, and cohesiveness, is pivotal for selecting appropriate dermal fillers for the gluteal region. Another significant aspect of HA use is cohesiveness, arising from internal adhesion based on HA concentration and cross-linking. This cohesiveness resists vertical forces upon implantation, influencing tissue lifting and projection. Gel texture, influenced by Cross-Linking Degree, Particle Size, Molecular Weight, and HA Concentration, also plays a crucial role. While acknowledging authors' contributions, further analysis should consider these factors. LEVEL OF EVIDENCE V: 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 .

Complications of Fat Grafting Versus Implants in Gluteal Augmentation: A Retrospective Review and Lessons Learnt

There have been various studies and literature reviews about gluteal augmentation, possibly due to the high complication rates associated with the procedure. But in the recent past, there has been extensive work in an effort to reduce the complications and various different methods have been developed for this purpose. This article brings to view the procedure followed in our surgery centre for fat grafting and implants for gluteal augmentation. We have compiled the complications we encountered with these procedures and the lessons we learnt to prevent them. 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 .

Combining Fat and Implants for Gluteal Augmentation

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.

Comparing the safety profiles of implants and autologous fat grafting in gluteal augmentation: A systematic review

Gluteal augmentation has become a popular esthetic procedure since its inception. The main methods are augmentation using implants or autologous fat grafting, which is the harvesting and grafting of patients' own fat tissue. The last review comparing the safety of these methods was written 7 years ago, which warrants the writing of a new one. PubMed, Cochrane, and Medline were searched for studies focusing on the methods of gluteal augmentation listed previously. Five search terms were used and 15 studies fulfilled the criteria. The data were cataloged according to the method described and outcomes compared. Seven articles focused on gluteal implants and another seven assessed autologous fat grafting, whereas one detailed both. The most common complications in 524 implant procedures were wound dehiscence (9.16%), excessive implant palpability (5.92%), and seroma (3.82%), with an overall complication rate of 25%. The most common complications in 1788 gluteal fat augmentation procedures were seroma (6.9%), infection (3.0%), and transient sciatic paresthesia (1.0%), with an overall complication rate of 13%. Several articles listed satisfaction figures, but these were not assessed because this article was not powered to assess this outcome. Overall, gluteal augmentation using autologous fat grafting leads to fewer postoperative complications than implants and allows greater contouring of the buttocks and the surrounding areas. However, it can also be a far more dangerous procedure if certain recommendations are not followed.

Liquid silicone filler migration following illicit gluteal augmentation

The illicit use of fillers has significantly increased, especially among transgender women (transwomen) attempting to fulfill unmet gender affirmation needs. We present a case of liquid silicone filler migration to the distal lateral thigh, multiple years following an illicit gluteal augmentation, and mimicking a neoplasm. Initial clinical and imaging findings were inconclusive necessitating advanced imaging, an orthopedic oncology surgical consultation, and finally an ultrasound-guided biopsy. Knowledge of the increasing use of fillers, their complications, and imaging findings is critical as these patients commonly choose not to disclose this history. A radiologist suggesting this diagnosis may assist the clinician, who is often unaware of this history which could help prevent unnecessary imaging and invasive procedures.

Distant migration of gluteal augmentation fat presenting as a soft tissue knee mass

Gluteal augmentation with autologous fat grafting is an increasingly popular procedure. While complication rates are low, the clinical and imaging evaluation of the various complications can be challenging. We report a case of distal migration of a failed gluteal fat graft in a young female patient presenting as a soft tissue mass in the knee, mimicking a soft tissue sarcoma. Surgical resection of the migrated fat graft confirmed the diagnosis. The diagnosis was challenging as the patient was initially reluctant to disclose her surgical history due to perceived negative social stigmas related to cosmetic contouring procedures. This case highlights the imaging findings of a rare complication following autologous fat grafting for gluteal augmentation and the importance of obtaining a thorough medical history.

Gluteal Augmentation with Fat Grafting: Literature Review

BACKGROUND

The buttock is the second sex feature of the human body, and the graceful buttock curve gives people confidence. Although the safety of gluteal augmentation with autologous fat grafting is still controversial, the proportion of operations is increasing year by year.

PURPOSE

To provid a comprehensive and detailed review of the literature on gluteal augmentation with fat grafting.

METHODS

A comprehensive review of the published literature through September of 2020 was performed in PubMed database, with the search terms "gluteal augmentation," "buttock augmentation," "Brazilian buttock lift," "fat grafting," "fat transfer," "gluteal AND aesthetic," "gluteal AND anatomy."

RESULTS

A total of 64 articles were included. On the basis of the information obtained, surgical recommendations are proposed to achieve buttocks as close as possible to aesthetic standard and improve surgical safety.

CONCLUSION

With a good grasp of the anatomical structure of the buttocks, complications can be reduced. At the same time, based on the theoretical basis of buttock aesthetics, better postoperative results can be obtained.

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 .

Clinical Experience with Treatment of Aquafilling Filler-Associated Complications: A Retrospective Study of 146 Cases

BACKGROUND

Aquafilling filler is used for breast and buttock augmentation, which are the most commonly performed cosmetic surgery procedures. However, complications after using Aquafilling filler for breast augmentation have been reported, and there are concerns regarding its use in large areas, such as the buttocks. We provide our experience with complications after breast augmentation and buttock augmentation using Aquafilling filler.

METHODS

This observational cohort study analyzed the data of 399 patients treated for filler-related complications at our institutes from September 2015 to November 2019. Of these patients, 146 underwent surgery to remove Aquafilling filler from the breast or buttock.

RESULTS

The mean time between Aquafilling filler use and complication onset was 38.5 ± 10.2 months. The average amount of filler material removed from one side of the breast or buttock was 285.5 ± 95.8 mL (range 150-750 mL). The most common complications were induration and masses (83.6%), followed by pain (52.1%), firmness (24.7%), asymmetry (10.3%), migration (8.2%), mastitis (6.8%), dimpling (6.2%), fever (3.4%), and sepsis (n = 1). After treatment, there was no recurrence of infection, and the patient satisfaction level based on the visual analogue scale was 8.0 ± 0.9.

CONCLUSIONS

Although Aquafilling filler is easily injectable and has long-term clinical effects, complications can occur. Furthermore, there are concerns regarding its toxicity and influence on the surrounding tissues. Hence, further research studies on Aquafilling filler and evidence regarding its long-term safety are needed.

LEVEL OF EVIDENCE IV

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 .

Slow-growing buttock mass after failure of incorporation of autologous fat transfer for gluteal augmentation: ultrasound and MRI features

Gluteal augmentation procedures are gaining popularity and encompass a variety of surgical techniques and methods of graft preparation. While surgical history remains essential for diagnosis, the radiologist must avoid pitfalls and rely on imaging features to recognize both the expected appearance and complications of gluteal augmentation procedures. We report a case of a slowly growing buttock mass after gluteal augmentation with autologous fat transfer 1 year after surgery. The potential diagnostic imaging pitfalls and characteristics on ultrasound and contrast-enhanced MRI are discussed. Multiplicity of fat-containing lesions depicted on large field-of-view images and granulated appearance of the intralesional fat on MRI should allow the radiologist to recognize the appearance of failed fat graft incorporation that can present as a slowly growing encapsulated collection with layered fat and fluid contents.

Gluteal Augmentation and Contouring with Autologous Fat Transfer: Part I

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.

Complications in Gluteal Augmentation

Gluteal augmentation is rapidly gaining in popularity and this is driving aesthetic surgeons to gain experience and develop techniques to meet patient expectations. Currently, the 2 main techniques - gluteal fat grafting and gluteal implant for augmentation have significant limitations. Autologous fat grafting seems to have a mortality rate significantly higher than other aesthetic procedures. Implant based gluteal augmentation is equally difficult. This is a broad review of all the complications associated with both types and autologous gluteal augmentation. Society and individual surgeons are developing guidelines for the procedure based on theoretic etiologies. Gluteal implant augmentation is also fraught with problems.

Autologous Gluteal Augmentation with the Moustache Transposition Flap Technique

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.

Practice-Based Patient Management Strategies in Gluteal Augmentation with Implants

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.

Subfascial Gluteal Implant Augmentation

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.

Autologous Flap Gluteal Augmentation: Purse-String Technique

The ideal patient for purse-string gluteoplasty has buttock deflation and ptosis, and wishes to improve projection. Key elements of the procedure are buttock lifting combined with auto-augmentation, no undermining of auto-augmentation tissue, and use of a purse-string suture to enhance projection of auto-augmentation tissue. Purse-string gluteoplasty is a safe and effective technique to correct buttock ptosis and atrophy.

Improvement of the Gluteal Contour: Modern Concepts with Systematized Lipoinjection

Buttock enlargement with lipoinjection is a procedure that has had a very high demand in the last 5 years. Changes in aesthetics have made more patients request greater volume in their buttocks and hips. The procedure requires not only liposuction, in which the fat is obtained, but also a systematization off the fat injection process in the buttock to obtain the appropriate aesthetic results according to the characteristics of each patient. The procedure achieves very satisfactory results because it can transform the patient's physical appearance significantly.

Does intramuscular gluteal augmentation using implants affect sensitivity in the buttocks?

The evolution of techniques and materials has made gluteoplasty a safe and reproducible operation with high acceptance among surgeons and patients. Functional aspects should be considered in gluteoplasty but are poorly studied. The sensitivity of the buttocks is fundamental as it represents an erogenous zone and provides protection through sensory stimuli for the prevention of pressure sores and burns. This study aimed to evaluate the sensitivity of the gluteal region in patients undergoing gluteal augmentation with implants. We included 20 consecutive patients undergoing gluteoplasty and 20 controls not undergoing gluteal surgery. All patients are females and were being treated at the Division of Plastic Surgery of the Rio de Janeiro State University. The right and left gluteal regions were delimited, and each one was divided into four quadrants numbered 1-8. Sensitivity tests were performed in all quadrants for six different stimuli: touch, heat, cold, pain, vibration, and pressure. The mean age and BMI were 36.3 years and 26.3, respectively. No difference in sensitivity was observed in the gluteal region after augmentation gluteoplasty when compared with those patients who had no operation in this series. Prospective and controlled studies are needed to better assess these issues.

A staging system for gluteal foreign body reaction to injectables

BACKGROUND

Esthetic augmentation of the gluteal region can lead to complications including debilitating pain, infections, wounds, and scars. To our knowledge, a general consensus of staging and treatment guidelines for managing gluteal foreign body reaction to injectables has not yet been established.

OBJECTIVE

The objective of this study was to develop a reliable staging system that can be used to implement a treatment algorithm for gluteal foreign body reactions.

METHODS

A retrospective review of 40 patients treated for complications of gluteal injections between September 2010 and May 2014 was performed. Patient symptoms, imaging, and photographs were used to develop a staging system of disease. Institutional review board approval was obtained from the University of Miami Miller School of Medicine. Five independent observers reviewed the patients' documented symptoms and photographs. Using our staging system, the independent observers reviewed the patient cases at two separate time intervals. Intra- and interclass correlation coefficients (ICCs) were computed to assess the reliability for each of the observers.

RESULTS

Seven patients were classified as Stage I, fifteen as Stage IIa, nine as Stage IIb, and nine as Stage III. The mean patient age was 34 years (21-50). Analysis of the independent reviewer results revealed ICC for each rater to range from 0.96 to 0.98, demonstrating high indexes of intra-rater reliability.

CONCLUSIONS

Based on our statistical analysis, we found an excellent inter- and intra-observer reliability, indicating that the staging system is reproducible and reliable. A treatment strategy dependent on the stage can be implemented as a guideline to optimize functional and esthetic outcomes.

Buttock Lifting with Polypropylene Strips

BACKGROUND

The purpose of this study was to evaluate the results of gluteal suspension with polypropylene strips.

PATIENTS AND METHODS

Ninety healthy female patients between the ages of 20 and 50 years (mean, 26 years), who wished to remodel their buttocks from December 2004 to February 2013 were studied retrospectively. All 90 patients were treated with 2 strips of polypropylene on each buttock using the following procedures: 27 (30 %) patients were suspended with polypropylene strips; 63 (70 %) patients were treated with tumescent liposuction in the sacral "V", lower back, supragluteal regions, and flanks to improve buttocks contour (aspirated volume of fat from 350 to 800 cc); 16 (18 %) patients underwent fat grafting in the subcutaneous and intramuscular layers (up to 300 cc in each buttock to increase volume); 5 (6 %) patients received implants to increase volume; and 4 (4.4 %) patients underwent removal and relocation of intramuscular gluteal implants to improve esthetics.

RESULTS

Over an 8-year period, 90 female patients underwent gluteal suspension surgeries. Good esthetic results without complications were obtained in 75 of 90 (84 %) cases. Complications occurred in 15 of 90 (16.6 %) patients, including strip removal due to postoperative pain in 1 (1.1 %) patient, and seroma in both subgluteal sulci in 3 (3.3 %) patients.

CONCLUSION

The results of this study performed in 90 patients over 8 years showed that the suspension with polypropylene strips performed as a single procedure or in combination with other cosmetic methods helps to enhance and lift ptosed gluteal and paragluteal areas.

LEVEL OF EVIDENCE IV

This journal requires that the 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.

Results and long-term patient satisfaction after gluteal augmentation with platelet-rich plasma-enriched autologous fat

Background

Buttock augmentation is gaining increasing popularity in aesthetic surgery. The relatively high incidence of complications after silicone implant placement lead to the increased use of lipofilling techniques, yielding variable results with respect to graft take rate and long-term stability. Platelet-rich plasma (PRP) has been shown to have beneficial effects on wound healing and angiogenesis in the past. Therefore, we aimed at investigating the long-term results and patient satisfaction after PRP-enriched lipofilling for buttock augmentation.

Methods

Twenty-four bilateral gluteal augmentations with PRP-enriched autologous fat were performed. Additionally, contour shaping was achieved by liposuction of the adjacent zones. Post-operative results and complications were recorded, and satisfaction with buttock shape was estimated by a patient questionnaire.

Results

Mean follow-up time was 44 months, and mean amount of transferred fat was 481 cc for both sides. No seroma or hematoma formation, infection or liponecrosis were reported during the post-operative follow-up. Subjective patient satisfaction in general increased from preoperatively to 3 months postoperatively and declined only slightly in the long-term course. Satisfaction levels in general were specific for each patient. Patient recovery was quick, and the majority of patients returned to work within 10 days after surgery.

Conclusions

PRP-enhanced lipofilling of the buttocks proved to be a safe procedure including a low complication rate and consistent results. However, subjective patient expectations have to be taken into account when choosing the indication. Further large volume studies are needed to elucidate the potential and benefit of PRP in this context.

Level of Evidence: Level IV, therapeutic study.