Secondary Logo

Journal Logo

Institutional members access full text with Ovid®

Influence of Age, Gender and Body Mass Index on the Thickness of the Gluteal Subcutaneous Fat – Implications for Safe Buttock Augmentation Procedures

Frank, Konstantin1,*; Casabona, Gabriela M.D.2,*; Gotkin, Robert H. M.D.3; Kaye, Kai O. M.D., Ph.D.2; Lorenc, Z. Paul M.D.4; Schenck, Thilo L. M.D., Ph.D.1; Lachman, Nirusha Ph.D.5; Jeremy, Green B. M.D.6; Duran-Vega, Héctor M.D.7; Cotofana, Sebastian M.D., Ph.D.8

Plastic and Reconstructive Surgery: April 9, 2019 - Volume PRS Online First - Issue - p
doi: 10.1097/PRS.0000000000005707
Original Article: PDF Only

Objective: The deep intramuscular approach during buttock augmentation with fat grafting has been associated with a significantly increased risk for pulmonary fat embolism. This study was designed to provide guidance for the injection into the subcutaneous fat i.e. the area between the muscle and the skin; the so-called “safe space”.

Material and Methods: A total of 150 Caucasian individuals were investigated with an equal distribution of males and females (each n=75) and a balanced distribution of age (n=30 per decade: 20–29, 30–39, 40–49, 50–59 and 60–69 years) and body mass index (BMI) (n=50 per group: BMI≤24.9kg/m2, BMI between 25.0 and 29.9kg/m2 BMI≥30kg/m2. Ultrasound-based measurements were conducted of the thickness of the total, superficial and deep gluteal fatty layers.

Results: An increase in 1.0 BMI value corresponded to an increase of 3mm of the total gluteal subcutaneous fat of males and a 4mm increase of the total gluteal subcutaneous fat in females. With increasing age, the thickness of the deep fatty layer increased while with increasing BMI the thickness of the superficial layer primarily increased. A formula was generated to estimate the total thickness of the gluteal subcutaneous fatty layer: Males: Total thickness (mm)=-33.56+(agex0.078)+(BMIx3.042); Females: Total thickness (mm)=-56.997+(agex0.1)+(BMIx3.86).

Conclusion: Knowing the total thickness of the gluteal subcutaneous fat i.e. the safe space allows surgeons to estimate their operating range for cannula motion even if no ultrasound machine is available during buttock augmentation with fat grafting. This can increase safety potentially reducing the number of adverse events.

1 Department for Hand, Plastic and Aesthetic Surgery, Ludwig – Maximilian University Munich, Germany

2 Ocean Clinic, Marbella, Spain

3 Private Practice, New York, NY, USA

4 Department of Plastic Surgery, Lenox Hill Hospital, New York, NY, USA

5 Department of Anatomy and Department of Surgery, Division of Plastic Surgery, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, MN, USA

6 Skin Associates of South Florida, Coral Gables, FL, USA

7 Private Practice, Merida, Yucatan, Mexico

8 Department of Medical Education, Albany Medical College, Albany, NY, USA

* Both authors contributed equally to this work

Author disclosure: None of the other authors listed have any commercial associations or financial disclosures that might pose or create a conflict of interest with the methods applied or the results presented in this article.

Funding: This study received funding by Merz North America, Inc., Raleigh, NC, USA (Grant Nr.: 02092018).

Corresponding author: Sebastian Cotofana, MD, PhD, Associate Professor, Albany Medical College, 47 New Scotland Avenue MC-135, Albany, NY 12208, Phone: 518-262-5667, Email:

©2019American Society of Plastic Surgeons