Buttock Augmentation

The standard of beauty has always been a variable concept. Although the practice of butt enlargement using silicone implants has been available since the 1960s, it was used mainly for the reconstruction of gluteal agenesis to achieve symmetry between the two butt cheeks. In 1973, the first gluteal enlargement procedure for purely cosmetic purposes was done. Even then, the practice itself did not take off in the US. It was more accepted in Latin America and Brazil where the procedure and implants were perfected. Initially, breast implants were used.

Now that society has begun to accept the beauty of the voluptuous, round buttocks, more people have opted to undergo the procedure. Surgeons have also refined the process further and are starting to offer other options aside from gluteal implants. It must be understood that buttocks augmentation does not only entail adding volume into the gluteal area, but also accentuating, contouring and reshaping the hips, flanks, and waist in order to achieve an aesthetically pleasing result.

Things You Need to Know about Buttock Augmentation

In order for us to recreate a beautiful derriere, we must first identify the ideal. There must be an apparent V Zone (the v-shape formed by the inner gluteal-sacral space). If this were the chest, the V zone would be the cleavage. The more visible the v zone, the more the buttocks have aesthetic appeal. An absent v zone may be due to a lack of excess fat or poor muscle volume in the area. At the area where the lower inner gluteal fold meets the inner leg, there should be a 45-degree downward slope (near mirror image of the v zone).

As the buttocks lose their fullness, this line may lie horizontally or even become an upward slope. The lateral aspect of the mid-buttock should have no depression. The presence of a depression disrupts the appearance of a nicely-rounded gluteal area. The length of the intergluteal crease (butt crack) and its relationship to the presacral space is also worth noting.

Ideally, the intergluteal crease is longer than the presacral space. A longer presacral space gives the appearance of a too-short butt crack. Conversely, an even shorter presacral space makes the butt crack look abnormally long. Both these variants give a less than optimal result in terms of the ideal buttock.

In the lateral view, there should be a gentle sloping curvature (lazy S) from the back down to the bottom of the gluteus muscle. The peak of the buttock should be at the central zone opposite the pubis.

Your Consultation with Dr. Joel Nicdao

At the initial consultation, there are several things that must be noted. First and foremost is the patient’s build. Whether the patient has a small, medium, the large or extra-large frame will determine the kind of procedure to be done. It must be determined how near or far the patient is from the ideal buttock and how to get as close to it as possible. Based on the findings at the physical examination, the patient’s options are discussed along with their possible shortcomings and/or complications.

The Buttock Augmentation Procedure

Essentially, the two ways to do a gluteal augmentation is through an implant or autologous fat transfer. Silicone gluteal implants are available in various sizes and may either be round, oval or anatomic. The patient’s anatomy will determine the best shape to use and the patient’s preference will determine the size. Some difficulty will arise if the patient would prefer a large implant and he/she is of a small build. The muscular coverage over the implant may not be adequate hence increasing the risk for wound dehiscence, malposition/migration of the implant, infection and patient dissatisfaction due to unmet expectations.

Apart from the insertion of the implants, the patients will need to undergo some liposuction in order to contour the abdomen and flanks to emphasize the effect of the augmentation. This type of patient may also undergo an autologous fat transfer, however, not much fat may be harvested due to her small frame.

In an autologous fat transfer, especially in patients with not much fat for harvest, they are advised to gain weight in order to have enough to transplant. The volume needed to have a perceptible change is anywhere from 400cc to 800cc per cheek. However, not all fats harvested will be viable or fit to transfer. Therefore, in order to have enough to transplant, the surgeon must harvest twice the amount of fats. Although larger patients may have more fats to give, it must also be remembered that they also need more fats to transfer. Even then, the viable transferrable fats obtained may still not be enough. Although the size the patient wants and the number of fats may already be predetermined, the actual amount of fats will only be apparent during surgery. These possible pitfalls must be discussed with the patient along with solutions in order to be as close to the patient’s aesthetic goals as possible.

The patient is asked to obtain laboratory tests and a medical risk assessment prior to surgery. Once cleared, the patient may undergo the procedure. Deep vein thrombosis prophylactic measures are done primarily with pneumatic leg compression. Antibiotics are given. The patient is positioned for the intended liposuction procedure and then repositioned for implant insertion or fat transfer or both.

Risks & Recovery

Apart from wound dehiscence and infection, other possible complications are seroma formation, chronic pain, neurapraxia, and capsular contracture. The risks are quite low but must still be discussed with the patient for their reference.

Postoperatively, patients are advised to wear a garment and refrain from strenuous activities for 4 to 6 weeks. If drains are used, they are removed when there is minimal output. If the drain needs to stay longer, antibiotics must be administered until the drain is removed to guard against ascending infections through the drain. The drain must not stay longer than 10 days.

The patient may have bathroom privileges. Cleaning after defecation is done using baby wipes while standing, leaning forward from top going down in order to prevent any possible contamination to the incision sites. The patient must expect the follow-ups to be frequent especially right after the procedure since the more serious complications present during this time. Between the two procedures, fat transfer is less problematic.

Frequently Ask Questions