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Composite Buttock Augmentation – The Next Frontier in Gluteal Aesthetic Surgery

Aslani, Alex MD; Del Vecchio, Daniel A. MD MBA,

Plastic and Reconstructive Surgery: August 23, 2019 - Volume PRS Online First - Issue - p
doi: 10.1097/PRS.0000000000006244
Special Topic: PDF Only

Introduction: Despite rapid growth, gluteal fat transplantation has a dismal safety record and often results in inadequate domal projection. Implants alone for gluteal augmentation have also been reported to be less than ideal, with significant complication rates. The idea of combining both implants and fat, as has been described in the breast, was therefore applied to surgery of the buttocks.

Materials and Methods: 147 consecutive cases of buttock augmentation were reviewed. Average follow-up was 18 months. The technique of Composite Buttock Augmentation employed Progressive Instrument Dissection in order to precisely define the correct intramuscular plane of the implant pocket with a minimum amount of pocket access dissection.

Results: Operating times averaged one hour and 55 minutes. The average volume of fat inserted was 380cc. The average implant volume was 300cc. Complications included implant displacements and implant pocket infections requiring surgical intervention. There were no cases of pulmonary thromboembolism, fat embolism or death.

Conclusions: Taking a lesson from composite breast augmentation, Composite Buttock Augmentation is a new method for gluteal reshaping that seeks to utilize the best of both worlds: the reliable core projection of an implant combined with the natural look and feel of fat. Progressive Instrument Dissection seeks to minimize unnecessary dissection, and to accurately and safely define the intramuscular pocket. The intramuscular placement of implants instead of fat should eliminate the risk of fatal fat pulmonary embolism in these patients.

Cirumed Clinic, Marbella, Spain

Back Bay Plastic Surgery , Boston, MA, USA

Financial Disclosure Statement: The authors have the following to disclose:

Dr. Del Vecchio is a founder of Surgistem Technologies, a developer of surgical instruments for fat transplantation, a consultant to Establishment Labs, Inc, a manufacturer of breast implants, and receives royalties from Microaire, Inc.

Corresponding Author: Daniel Del Vecchio, MD MBA, Back Bay Plastic Surgery, 38 Newbury Street, Boston, MA 02116,,

©2019American Society of Plastic Surgeons