We read with extreme interest the CME article on body contouring by Almutairi et al. published in the March of 2016 issue of the Journal.1 We applaud this work from Dr. Rubin’s group who, during the past decades, widely expanded our knowledge on this topic with fundamental contributions to the literature, describing new procedures and investigating relevant aspects. This last review clearly discusses essential principles of patient selection and safety, anatomical concepts, staging, and combining techniques1; this will certainly guide our future daily practice.
Significantly, the authors observe that body contouring surgery is evolving in many ways to meet the needs of our patients, with some procedures showing a tremendous increase in popularity. In this regard, we believe that special attention needs to be given to buttock augmentation, which is a very hot topic. Indeed, despite a 58 percent increase in the number of buttock augmentation operations performed in the United States in 2013 and 20,000 Americans undergoing this procedure in 2015,2,3 surprisingly, there is a paucity of data to guide treatment paradigms. Although many studies have been published in recent decades, including case reports, retrospective and prospective case series, and multicenter reviews, there has been no study of the overall complications or satisfaction rates associated with the broad spectrum of techniques.
Summarizing the data available from the literature, five buttock augmentation techniques can be identified: gluteal augmentation with implants, autologous fat or dermal fat grafting, local tissue rearrangement or local flaps, hyaluronic acid gel injection, and silicone injection. According to the U.S. cosmetic surgery statistics, gluteal augmentation with implants and autologous fat grafting are the most commonly used techniques.2,3
Gluteal augmentation with implants has been described with many procedural variations, especially with regard to dissection plane and incisional access; no standardization or outcomes comparison are currently available. However, in their multicenter survey review of 2226 patients undergoing buttock augmentation with silicone implants, Mofid et al. reported that 68.4 percent of surgeons favored the intramuscular plane of dissection over the subfascial plane, whereas no preference was observed between a single midline intergluteal incision and two parallel incisions within the gluteal cleft.4 The total number of complications reported was 38.1 percent; wound dehiscence was determined to be the most common complication (7.9 percent). Thus, many surgeons who prefer to place two separated incisions in the gluteal cleft cite the attempt to reduce wound dehiscence.
Gluteoplasty with autologous fat tissue is certainly associated with a lower rate of complications. A recent study by Rosique et al. on 106 consecutive cases emphasized the advantages of this technique, described as simple and inexpensive, with minimal morbidity (4.7 percent rate of seroma in the donor area) and excellent results in terms of patient satisfaction (97.1 percent).5 However, the unpredictability of volume maintenance remains the main concern related to this promising procedure. In this regard, a study by de Pedroza on 556 patients reported a long-term fat graft survival varying approximately between 50 and 75 percent.6 Further prospective studies with preoperative randomization of patients are required to better compare different techniques and establish best practices.
The authors have no financial interest to declare in relation to the content of this communication.
Carlo M. Oranges, M.D.
Martin Haug, M.D.
Dirk J. Schaefer, M.D.
Department of Plastic, Reconstructive,
Aesthetic, and Hand Surgery
Basel University Hospital
1. Almutairi K, Gusenoff JA, Rubin JP. Body contouring. Plast Reconstr Surg. 2016;137:586e602e.
2. American Society for Aesthetic Plastic Surgery. Labiaplasty and buttock augmentation show marked increase in popularity. Available at: http://www.surgery.org/media/news-releases/labiaplasty-and-buttock-augmentation-show-marked-increase-in-popularity
. Accessed March 1, 2016.
3. American Society for Aesthetic Plastic Surgery. Initial data from the American Society for Aesthetic Plastic Surgery points to 20% increase in procedures in 2015. Available at: http://www.surgery.org/media/news-releases/initial-data-from-the-american-society-for-aesthetic-plastic-surgery-points-to-20percent-increase-in-procedu
. Accessed March 1, 2016.
4. Mofid MM, Gonzalez R, de la Peña JA, Mendieta CG, Senderoff DM, Jorjani S. Buttock augmentation with silicone implants: A multicenter survey review of 2226 patients. Plast Reconstr Surg. 2013;131:897901.
5. Rosique RG, Rosique MJ, De Moraes CG. Gluteoplasty with autologous fat tissue: Experience with 106 consecutive cases. Plast Reconstr Surg. 2015;135:13811389.
6. de Pedroza LV. Fat transplantation to the buttocks and legs for aesthetic enhancement or correction of deformities: Long-term results of large volumes of fat transplant. Dermatol Surg. 2000;26:11451149.
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