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Gluteal Ligamentous Anatomy and Its Implication in Safe Buttock Augmentation

Ghavami, Ashkan, M.D.; Villanueva, Nathaniel L., M.D.; Amirlak, Bardia, M.D.

Plastic and Reconstructive Surgery: August 2018 - Volume 142 - Issue 2 - p 363-371
doi: 10.1097/PRS.0000000000004588
Cosmetic: Original Articles
Patient Safety CME

Background: The number of buttock augmentations with fat transfer is steadily increasing, but a number of fatalities caused as a direct result of gluteal fat grafting have been reported. The technical details relating to cannula size, injection angle or trajectory, and plane of injection are critical for avoiding morbidity and mortality. However, the ligamentous anatomy has not been thoroughly explored, particularly how the ligaments are encountered in the clinical setting of fat transfer by means of cannulas.

Methods: The gluteal regions of five fresh cadavers were dissected, for a total of 10 hemidissections. All pertinent cutaneous ligaments in the region were identified. In addition, cannulas were used to simulate typical variations in injection planes.

Results: The osseocutaneous and fasciocutaneous ligaments of the buttocks were identified.

Conclusions: The authors describe important ligamentous structures consistently found in the region in cadaveric dissections and discuss the implications while safely performing gluteal augmentation. The anatomical features, boundaries, and soft-tissue attachment points may play a role in cannula-directed fat injection misguidance. The ligaments, when not released, can lead to undesired deep injection and therefore fat lobule migration into the venous system. The density, danger zones, and soft-tissue attachments must be clarified further as we continue to offer our patients improved buttock contour with a higher safety profile.

Patient Safety CME.

Los Angeles and Beverly Hills, Calif.; and Dallas, Texas

From the Department of Surgery, Division of Plastic and Reconstructive Surgery, David Geffen UCLA School of Medicine; Ghavami Plastic Surgery; and the Department of Plastic Surgery, University of Texas Southwestern Medical Center.

Received for publication September 25, 2017; accepted February 15, 2018.

Disclosure:The authors have no financial interest to declare in relation to the content of this article.

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Ashkan Ghavami, M.D., 433 North Camden Drive, Beverly Hills, Calif. 90210,

Copyright © 2018 by the American Society of Plastic Surgeons