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Archive for the ‘buttock lift’ Category

Plastic Surgery’s Did You Know? Gender Differences in Buttock Aging

Wednesday, April 2nd, 2014

 

Did You KnowButtock reshaping through fat injections or implants has surged in popularity in the past decade. The vast majority of these buttock procedures, to the level of probably 99% of them, are done in women. There may be a lot of cultural and beauty standards for this gender bias but there may also be some age-related reasons as well. In a recent anthropometric study, the age-related changes of the gluteal region were analyzed in women and men from age 15 to 85 years old. Their study results showed that women’s buttocks aged more significantly and earlier with loss of fullness and sagging than in men. The female buttock appears to age faster and suffer more flattening and falling. Men may eventually develop a flat buttocks but it is not associated with much sagging. Such findings support the common plastic surgery procedures today, mainly for women, for buttock augmentation and lifts which either add or bring back the curves to the gluteal region.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study: Lower Buttock Tuck (Lift) for the Saggy Buttocks

Sunday, July 21st, 2013

Background: There are numerous features of a shapely buttocks. Short of a nipple-areolar complex, the buttocks share many of the same physical components of the female breast. Ideally it is an identifiable mound that projects outward away from the lower back and upper posterior thigh. While the upper pole is a smooth sloping transition from the back, the lower pole of the buttocks should have a more defined separation of the thigh known as the infragluteal crease.

Like the lower breast fold or inframammary crease, the infragluteal fold is a defined attachment of the skin to the underlying gluteal muscle.. It helps create the lower buttock shape and separates it from the back of the leg. It’s presence is caused by fibrous attachments of the dermis of the skin to the muscle fascia. Any disruption of the infragluteal crease results in a saggy buttocks or buttock ptosis.

Buttock ptosis occurs from either loss of a well-defined infragluteal crease or loose buttock tissue falling over a well-defined infragluteal crease. (often called a banana peel deformity) Both aesthetic buttock conditions are treated by a buttock lift, which is more accurately called a buttock tuck. By removing skin and fat from the lower buttocks, any tissue overhang can help reshape an existing infragluteal crease. In a non-existant or lost infragluteal crease, an elliptical excision of loose tissue can help recreate a more discernible infragluteal line.

Case Study: This 49 year-old female wanted to improve her saggy buttocks. She was an ultra-thin middle-aged female that had little subcutaneous fat throughout her body. Her buttocks were completely flat with little volume and folds of hanging skin over the lower buttocks and the upper posterior thigh. There was no discernible infraguteal crease. It appeared that her loss of buttock volume was just part of aging of an historically very thin person.

Under general anesthesia, a large curved elliptical excision of skin was done on both lower buttocks in the prone position. The orientation of this skin excision was both above and below where the infraguteal crease was determined to be placed. The wound was closed by suturing the dermis of the skin flaps down to the muscle fascia from the inner aspect from near the rectum out to the outer thigh.  Subcuticular suturing was then done for the final skin closure. Glued on tapes were her only dressing.

She had uneventful recovery and no wound healing problems. To reduce the potential risk of any wound separation, she avoided any exercise for a month after surgery as well as bending at the waist over 90 degrees as much as possible. All folds of unsightly skin were removed and an infragluteal line was created. Due to lack of any buttock volume, a more defined crease could not be obtained.

A buttock tuck (lower buttock lift) is a very effective surgery for remaking the infraguteal fold and creating a buttock-thigh demarcation. It has little after surgery discomfort but does not require avoiding stretching (no exercise) across the suture line for 3 to 4 weeks after surgery The resultant scar heals well and, when well placed, is barely detectable.

Case Highlights:

1) A shapely buttocks, regardless of its size, has an infragluteal crease that separates the buttocks from the posterior thigh.

2) Loose skin from loss of buttock volume creates skin folds that obscures the infragluteal fold.

3) A lower buttock lift, better defined as a buttock tuck, removes loose skin and creates an infragluteal line.

Dr. Barry Eppley

Indianapolis, Indian

Case Study: The Lower Buttock Lift for the Sagging Buttocks

Friday, April 26th, 2013

 

Background: Buttock enhancement surgery has become a primary method of body contouring plastic surgery. Having  a shapely and fuller buttocks has taken on great signficance for a more attractive body form. The buttocks for some now rivals what has been the breasts for many in the past. While most of the notoriety belongs to the Brazilian Butt Lift, a method of buttock augmentation by autologous fat injections, there are other buttock rehaping surgery techniques.

The oldest buttock reshaping surgery is the original buttock lift. Unlike the Brazilian Butt Lift, which really doesn’t lift the buttocks but fills it out, the lower buttock lift really does. By removing skin and fat from the bottom of the buttocks, a reshaping will occur with a more defined buttock-thigh demarcation/crease. The lower end of the buttocks will be tucked up and will be a little rounder.

A lower buttock lift still has a valuable role to play in buttock reshaping for correcting several problems that fat injections can not improve. The ‘banana peel’ deformity is one such problem where a roll of buttock tissue overhangs the existing lower buttock crease. It is also effective for a buttock crease that is too low and ill-defined which creates a vertically long buttock shape. Lastly for buttock asymmetry that is caused by different levels of the lower folds, a lower buttock lift can correct the location of the fold and also creare better symmetry in the buttock shapes.

Case Studies: This 34 year-old female wanted to improve the sagging appearance of her buttocks. While she was not overweight nor had lost any significant weight, her buttocks had always had a roll of skin that ‘fell over the lower buttock crease’ that could not be improved by exercise or any non-surgical skin tightening techniques.

Under general anesthesia, she was placed in the supine position with the hips elevated on a gel roll. The overhanging skin and fat were elliptically excised down to the gluteus muscle fascia in a wedge-type fashion. Using heavy resorbable sutures, the opposing skin edges were swen down to the fascia creating a bit of an inverted fold. The skin was then closed with a running barbed suture in a subcuticular fashion. No drains were used. The incisions were covered with glued-on tapes and required no garment wear.

Her postoperative course had the typical tightness of the lower buttocks but no significant pain. She was not placed on any specific physical activity restrictions other than to not bend over more than 90 degrees and no physical exercise or working out. She could shower daily and get the tapes wet. Her tapes were removed one week later. After three weeks she returned to light exercise and regular exercise after 6 weeks. She had no wound healing problems and the scar was inset perfectly into her lower buttock crease. Her buttock skin overhang was completely gone and she had a more pleasing lower buttock shape.

The lower buttock lift still has a valuable role in buttock reshaping surgery even if it is largely forgotten by some. As a standalone procedure, it redefines the lower buttock crease, removes any overhang and tucks up the lower buttock shape. It is also useful in conjunction wih the Brazilian Butt lift for a more complete buttock reshaping.

Case Highlights:

1) The sagging buttocks is when the edge of the lower buttocks falls over the lower buttock/thigh crease, creating an overhang. The lower end of the buttocks may also have little shape and be positioned too low.

2) The lower buttock lift removes the overhanging buttock tissue and creates a new and more defined buttock crease.

3) The lower buttock lift also tightens the lower pole of the buttock and creastes a deeper buttock fold/crease.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study: Lower Buttock Lift for the Saggy Derriere

Friday, July 20th, 2012

Background:  Buttock enhancement has become a popular contemporary procedure, offering improvements to a body part that historically has been thought of as having few choices. People have numerous aesthetic buttock concerns including size, shape and tone/firmness issues. Buttock augmentation with fat injections (aka Brazilian Butt Lift) is most well known today as it has become fashionable to have a rounder fuller buttock, particularly amongst Hispanic and African-Americans.

But not all buttock concerns are about size. The saggy buttock  is an unflattering shape that is associated with being flat and having skin that has slide off of the gluteal muscle onto the posterior thigh area. This happens as the buttock is affected by weight loss and aging. Weight loss causes the skin to fall as the volume support vanishes with fat absorption. Aging has its own  volume loss but the skin sags as it loses elasticity after having been exposed to repetitive stretching over a lifetime.

One important aesthetic feature of the buttock is the inferior gluteal fold. Like the inframammary fold in the breast, it serves as the transition point between two anatomic structures…the buttock and the thigh. It exists because there are attachments from the underside of the skin along the crease to the muscle below. This allows the more fibrofatty tissue to remain over the buttock where it is needed for padding support. Loss of the inferior gluteal fold attachments allows the buttock skin to sag down onto the thighs.  

Case Study: This 35 year-old female wanted to improve the shape of her buttocks. She had adequate volume but did not like the lower end of her buttocks because it was ‘saggy’. She wanted the bottom part to tuck in more and have a well-defined crease. She was willing to accept a scar for that improvement.

Under general anesthesia she underwent a lower buttock lift using an ellipitical excision technique. The underside of the skin was sewn to the fascia overlying the gluteal muscle to help create a well-defined crease and invert the incisional closure. All sutures were under the skin in a subcuticular fashion. Her only dressing afterward was surgical tapes that were glued over the incision line. This was an outpatient procedure with few restrictions afterward other than avoiding strenuous activities that involved bending over greater than 90 degrees at the waistline for three to four weeks after surgery.

She had an uneventful recovery with no wound separation problems. She had fine line scars along the natural inferior gluteal crease that faded to white by six months after surgery. In profile she had a well-defined break at the crease between the buttocks and the posterior thigh.

Of the available buttock enhancement procedures, the lower buttock lift is the least commonly performed. While it is the one buttock procedure that has the longest history in plastic surgery, it is less desired than buttock augmentation that provides volume by an implant or fat injections. But for the patient who has effacement of their inferior gluteal fold and a saggy lower buttocks, this simple lift procedure can provide a significant improvement. It can also be performed in conjunction with either of the buttock augmentation procedures since its surgery site is away from where implants or fat are placed.  

 Case Highlights:

1)      A common buttock deformity is ptosis or the sagging buttock due to skin falling over the gluteal  crease or descent of the gluteal crease itself.

2)      Excision of loose and overhanging skin can recreate the inferior gluteal fold and create a clear transition between the buttocks and the posterior thigh.

3)      Inferior gluteoplasty or lower buttock lift requires a minimal recovery other than avoiding severe stretching of the incision line.

Dr. Barry Eppley

Indianapolis, Indiana

The Brazilian Butt Lift Explained

Sunday, April 12th, 2009
The Brazilian butt lift is not a lift in the classic sense. No skin is excised and subsequently lifted. Unlike what the name suggests, it is a type of buttock enlargement procedure which creates a fuller and rounder buttock shape. Fat is removed from selected areas of your body (often above and below the buttocks), purified and concentrated, and then injected into selected areas of the buttocks. The process of putting the fat into the buttock may involve up to a hundred or so injections. The buttocks essentially becomes like a pin cushion during the procedure. The key, however, is to place the fat in the upper quadrant of the buttocks so it appears fuller and lifted.
The Brazilian butt lift uses three steps during the procedure. The areas around the buttocks is first contoured by performing liposuction. Common areas to liposuction include the back area directly above the butt, the flanks or waistline, outer thighs and the back of the thighs just below the butt. For many patients, the liposuction helps the buttocks look better. Certain types of liposuction can not be used, such as ultrasonic and laser liposuction, as they damage fat cells and make them unusable for transfer.
The fat from the liposuction is then carefully washed, concentrated, and then packed into syringes. By this method, the greatest percentage of alive fat can be re-injected so that it has the best chance of survival. A certain amount of fat must be capable of being suctioned to do this procedure. Usually at least 1 liter (1000 ccs) must be suctioned out at a minimum.  Some small thin women do not have enough fat on their body in order to perform the Brazilian butt lift procedure. Without enough donor fat (and no you can’t use someone elses) the only option would be buttock  augmentation with silicone implants.The purified fat in syringes is then injected into the buttocks through many injection sites. The goal is to place small amounts of fat in the gluteus muscle as well as the existing fat layer between the skin and the muscle. By so many small fat injections, this enables the fat cells to quickly get an adequate blood supply so that they can survive. This method results in the highest percentage of fat survival and the best long-term maintenance of the buttock enlargement. How much fat will stay? This is impossible to predict for any one patient. But what you see four to six weeks after surgery will likely be permanent.
The Brazilian butt lift is a well tolerated procedure that is both safe and effective. In my Indianapolis plastic surgery practice experience, it is no more risky than liposuction with no greater rate or type of complications. The biggest concern is whether enough fat can be injected and survive to make the patient happy.  The after surgery requirements are few. There will definitely be some discomfort and sitting on your buttocks may be uncomfortable for a few days. Most people can return to work in one week or less, depending on how physical their work is.  One should be able to resume all normal activities within a month or less after surgery.

Dr. Barry Eppley

Indianapolis, Indiana

The Many Options for Buttock Reshaping

Tuesday, December 25th, 2007

An Overview of Techniques to Beautify the Buttocks

The appearance and shape of the buttocks has taken on great interest in the past few years. Whether it be too big, too flat, or sagging with age, the interest in improving one’s buttocks has never been this great in the world of plastic surgery. Much of this recent interest in the appearance of the buttocks in the United States is due to the northern immigration of South American culture. Each of the many different buttock problems is treated with various plastic surgery techniques. As I consult with patients here in Indianapolis, it is important to carefully analyze the shape of the buttocks and the patient’s desires and then match the appropriate plastic surgery procedure(s).

By far, the ‘simplest’ buttock problem to treat is the one in which the buttock is too big. The problem is ‘simple’ only because the only treatment approach is that of liposuction. The results from liposuction of the buttocks is usually modest. One must avoid too aggressive liposuction as this may cause the skin of the buttocks to sag after being ‘over-deflated’ by the fat removal. In rare cases, liposuction combined with a lower buttock lift (cutting a strip of skin and fat from the lower buttock crease) may produce a better overall result.

The flat buttock is treated either by implants or fat injections. Solid rubbery implants (which cannot leak) can be placed inside the muscle through a small incision in the upper buttock crease. Buttock implants are best for those patients who don’t have enough fat to transfer and want extra fullness in the upper portion of the buttocks. The implants generally don’t add much fullness to the lower portion of the buttocks. The discomfort with buttock implants is considerable and physical activity must be restricted for several weeks after surgery. Once you have buttock implants, removing them (if necessary) will lead to further disfigurement due to the extra skin that has been created. Fat injections are useful when only a small increase in buttock size is needed. It is unpredictable how much injected fat will survive and multiple surgery sessions may be needed to get the desired result. As fat is needed to inject, a double benefit is achieved by contouring two areas at once, reduction in size of the donor site (usually abdomen or thighs) and a larger buttocks.

The sagging buttock can be treated by two types of buttock lifts. When only a small amount of skin is sagging over the crease, a lower buttock lift as previously described can be used. The trade-off is a scar in the lower buttock crease. When a larger amount of buttock skin is hanging down (after bariatric surgery, for example, where a lot of weight loss has occurred), the buttock shape is addressed by a circumferential body lift where a low back scar is the result of removing a wedge of skin and fat from above.

As you can see, there are a lot of different approaches to buttock reshaping and a consultation with an experienced plastic surgeon can help you pick the right buttock operation(s) for your problem.

Dr Barry Eppley
Indianapolis, Indiana

Buttock Reshaping – Different Operations for Different Problems

Monday, November 5th, 2007

The shape of the buttocks has taken on great interest in the past decade. Whether it be too big, too flat, or sagging with age, the interest in changing one’s buttock has never been greater. Each of these buttock problems are treated differently.

By far, the ‘simplest’ buttock problem to treat is the one in which the buttock is too big. The problem is ‘simple’ only because the only treatment approach is that of liposuction. The results from liposuction of the buttocks is usually modest and the patient must not have to high an expectation. Contrarily, one must avoid too aggressive liposuction as this may cause the skin of the buttocks to sag after being ‘over-deflated’ by the fat removal.

The flat buttock is treated either by buttock implants or fat injections. Solid rubbery implants (which cannot leak) can be placed inside (intramuscular) or on top of the muscle (subfascial) through a small incision in the upper buttock crease. Buttock implants are best for those patients who don’t have enough fat to transfer and want extra fullness in the upper portion of the buttocks. The implants generally don’t add much fullness to the lower portion of the buttocks. The discomfort with buttock implants is not insignificant and physical activity must be restricted for several weeks after surgery. Exercise can not be resumed for about 6 weeks after surgery. Surgical risks include infection, bleeding, fluid collections (seroma) around the implants, shifting of the implants, and uneven appearance between the two sides. Once you have buttock implants, removing them (if necessary) will lead to further disfigurement due to sagging skin. Conversely, fat injections are useful when only a small increase in buttock size is needed. It is unpredictable how much injected fat will survive and multiple surgery sessions may be needed to get the desired result. Usually fat is simply redistributed……sucked from one undesired location and transferred to the buttocks. This gets a double benefit of contouring two areas which creates a better overall result.

The sagging buttock can be treated by two types of lifts. When only a small amount of skin is sagging over where the crease joins the back of the thigh (banana roll). This more limited buttock lift creates a scar in this crease and helps shape this lower buttock area. When the entire buttock needs to be lifted (usually in the bariatric surgery patient where a large amount of weight has been lost), a more aggressive lift is done by creating a ‘cutout’ of upper buttock and back skin (often done in conjunction with a tummytuck around the front, thus creating a 360 degree scar, a.k.a. a body lift). The buttock skin is then lifted and sewn upward, providing a lift to more of the entire buttocks.

Dr Barry Eppley

Indianapolis, Indiana


Dr. Barry EppleyDr. Barry Eppley

Dr. Barry Eppley is an extensively trained plastic and cosmetic surgeon with more than 20 years of surgical experience. He is both a licensed physician and dentist as well as double board-certified in both Plastic and Reconstructive Surgery and Oral and Maxillofacial Surgery. This training allows him to perform the most complex surgical procedures from cosmetic changes to the face and body to craniofacial surgery. Dr. Eppley has made extensive contributions to plastic surgery starting with the development of several advanced surgical techniques. He is a revered author, lecturer and educator in the field of plastic and cosmetic surgery.

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