There is a growing interest in aesthetic surgery of the buttocks and posterior body contouring. More and more patients are requesting buttocks reshaping. Patients primarily seek an enhancement of the buttock’s shape and projection. According to the International Society of Aesthetic Plastic Surgery (ISAPS) statistics, this is the current fastest-growing field.
Recontouring a flat and saggy buttock is not easy. Like breast surgery, buttocks surgery can be performed with several different techniques, all of which aim to achieve an aesthetically pleasing shape in or out of clothing.
Nowadays, buttock contouring is most frequently performed through sculpturing the adjoining regions such as the hips, flanks, and saddlebag deformities, achieving excellence. Fat grafting is available for contour improvement solely or in combination with liposculpture.
The range of indications for buttock lifting includes discreet dropping, moderate skin laxity in the buttock or lateral thigh, asymmetry, double lower buttock crease, long buttocks, and even deformities that follow significant weight loss.
Therefore, indications for buttocks lifts range from subtle aesthetic reasons to a major recontouring following bariatric surgery. The range of problems that can be solved with a buttocks lift is significant, but no single buttocks-lifting technique can solve all aesthetic problems.
Lipobuttock lift surgery can drastically improve excess skin laxity and fat from aging, heredity factors, or dramatic weight loss in the buttock area. A Lipobuttock lift involves only removing skin and fat through surgical excision and liposuction. Not to be confused with a “Brazilian butt lift,” which adds volume ” fat transfer.”
Only patients with MWL who suffer only from skin laxity without extra fatty tissues elsewhere may need a different surgical approach, such as the circumferential lower body lift. New developments include autologous tissue augmentation, such as the de-epithelialized buttock flaps for the buttock.
Options in Lipobuttock Lift Surgery
There are many techniques and approaches, but choosing the correct technique, combining techniques, or even adding an implant may be the key to achieving the actual buttocks reshaping. Available options are buttock tissue reduction by direct excision, liposuction, fat grafting, or autologous buttock tissue augmentation by mobilization.
If there is a large amount of skin removal, you may consider having a lower body lift, which would help remove skin around the stomach, buttock, thighs, and hips. If skin removal results in a loss of volume to the buttock, a buttock augmentation might be proper following a lipobuttock lift.
Surgical techniques for buttock lift surgery can be classified as:
- Upper buttock lifts
- Lower buttock Lift (dermo-tuberal anchorage) or DTA
- Lateral buttock lift
- Medial “Butterfly” buttock lift.
- Lower lipo body lift
- Purse string with autologous buttock augmentation
Ideal Buttock Shape
The patients should illustrate an S-shaped contour concerning the back and thigh as a smooth inward sweep of the low back and waist area.
A well-shaped buttock is characterized by several factors: it is more rounded than angular, the natal cleft is shorter than long, and it has a superior and inferior buttock separation. The ideal maximum projection should be between the upper and middle third.
The term dropping, of Greek origin, means sagging. We can define buttock dropping as sagging of the buttocks with redundant buttock tissue that crosses the lower buttock crease at the midline of the posterior thigh. The buttock fold is short, minimal, and should run in a round rather than a horizontal line, ideally without droop. Dropping in this area may be congenital or result from weight loss or aging.
When to Consider Lipobuttock lift Surgery?
- If you have sagging skin and extra fat in your buttocks
- If you recently experienced dramatic weight loss and are close to your ideal weight
- If your buttock area makes you feel self-conscious
- If the excess skin and fat make you uncomfortable or cause mobility problems.
Am I the Right Candidate for Lipobuttock lift Surgery?
Excess skin and fat in the buttock area can add bulk and frustrate your efforts to make a slimmer, more sculpted body through weight loss. If any of these conditions apply to you, then you might be the right candidate for a lipobuttock lift:
- You have undergone bariatric surgery or significant weight loss through dieting.
- Pregnancy and aging have left you with loose skin and cellulite below the waistline.
- You have significant skin laxity, excess skin, and ptosis (sagginess) of the buttocks.
- The layers of fat under your loose skin are thin.
Lipobuttock Lifting Basic Principles
Beautiful buttocks are rounded, with significant projection in the mid to upper buttock. These two characteristics are the primary objectives of any buttock surgery aimed at improving the aesthetics of the buttocks.
A lipobuttock lift should not be a total-thickness tissue excision to achieve these objectives but rather a recontouring procedure. All apparent redundant tissue should be used to shape the buttocks; if necessary, excess volume can be removed later by liposuction.
The main drawback of a buttocks lift is the scar, and every effort must be made to produce the shortest possible scar that is well placed and of good quality.
Patient selection and screening
A precise physical examination and assessment of a patient’s medical history during the first consultation of a lipobuttock lift are mandatory. We recommend a repeat of the evaluation before lipobuttock lift surgery.
Patient History of Lipobuttock Lift
The assessment of medical history includes the current weight; with weight fluctuations and constancy periods; the frequency of exercising; former bariatric procedures; nutritional patients; medication; the number of pregnancies and children; history of cesarean section; abdominal surgeries, and abdominal hernias; gastrointestinal, cardiac, and pulmonary history; and smoking history.
It is essential to know which bariatric procedure has been used. Look for the port; if a gastric banding was performed, that might be in your area of undermining or liposuction. Traction on your flap may result in a dislocation of the band, causing strangulation of the stomach. Some anesthesiologists prefer to have the band deflated. Watch out for a proper supplement of vitamin B12 in patients after bypass and sleeve resection.
The previous liposuction in the abdominal area must be ascertained, and inquired whether the patient might conceal this prior treatment.
Patients must present a stable weight for at least 6–12 months preoperatively; You should complete weight loss before the surgery.
As a guideline, we do not operate on patients with a BMI above 32 because local and general complications are at increased risk, and aesthetic outcomes are disappointing. Those patients are referred” to the bariatric surgeon to decide whether there is a conversion option.
The clinical examination is an essential part of every medical history assessment. The examiner assesses the tissue conditions regarding volume and mobility by pinching and metric measurement. Examining the lower trunk should include accurate palpation of the abdominal, lateral thigh, and buttock fatty tissue in the patient’s upright, prone, supine, and lateral position.
Any pre-existing scar (subcostal, midline, horizontal) in the abdominal and buttock area must be documented in writing and photographically since it can impair the blood supply of the tissue flap. Further, I must assess the status of the abdominal muscles, and any existing hernia must be excluded.
Patients’ detailed information on the operative procedure, alternative techniques, and general and operation-related risks and benefits is essential for preoperative documentation.
Patients should be informed about their postoperative care, including their expected activity level. They must understand the limitations of the surgical result in cases of existing variables of bone structure, fat distribution, and any existing scars.
During the clinical examination of the abdominal region, It should note the following parameters:
- Abdominal tissue excess
- Abdominal skin quality (striae?)
- Umbilical stalk deformity
- Number of skin folds and their continuity to the flanks Skin quality
- Fatty tissue volume and mobility
- Abdominal muscle tone
- Mons pubis region.
During the clinical examination of the buttock region, It should note the following parameters:
- Buttock width
- Maximum height of the
- Round projection shape versus rectangular shape
- Skin quality Fatty tissue volume and mobility
- Buttock muscle tone
- Back folds Vertebral status.
During the clinical examination of the buttock region, the following parameters should be noted:
- Buttock height
- Buttock width
- Maximum height of the projection
- Round shape versus rectangular shape
- Skin quality
- Fatty tissue volume and mobility
- Buttock muscle tone
- Back folds
- Vertebral status, e.g., scoliosis.
In MWL, patients can be divided into three groups:
- Large buttocks with an excess amount of buttock fatty tissue
- Normal-sized buttocks with ptosis and skin redundancy
- Flattened, hypoplastic buttocks with ptosis and skin redundancy.
Surgical Modifications of Lipobuttock Lift Surgery
The Lipobuttock lift procedure aims to restore buttock volume shape and the surrounding regions. Since every patient presents with different preoperative conditions, I must select individual therapy.
Classification for surgical planning of the lipobuttock lift can be divided into three groups.
- Large buttocks with an excess amount of buttock fatty tissue
- Normal-sized buttocks with ptosis and skin redundancy
- Flattened, hypoplastic buttocks with ptosis and skin redundancy
Upper buttocks lift
The main indication for an upper buttock lift is to correct significant excess skin or dropping in the lateral thigh area. The resulting scar should be slightly arched, following—as much as possible—the skin’s tension lines, and located in a position that will be covered by underwear or a swimsuit. I prefer to draw a bird’s wing arching line that almost forms a V-shape at the natal cleft crease.
Lower Buttocks Lift (dermo-tuberal anchorage or DTA)
Indications for a DTA lift
- To correct the average dropping in the lower buttock fold.
- To shorten long buttocks.
- To correct asymmetry.
- To improve a double lower buttock crease.
Medial “Butterfly” buttocks lift
Indications for a medial buttocks lift
- To treat mild cases of skin excess in the buttocks
- As an adjunct to the lower buttock lift
- In mild buttock ptosis.
Lateral buttocks lifting
Indications for a lateral buttocks lift
- To correct moderate cases of lateral thigh laxity
- To support a lower buttock lift in cases of significant lower buttocks laxity and moderate Lateral thigh laxity.
Purse String Buttock Lift with Autologous Augmentation
The purse-string buttock lift uses the patient’s redundant soft tissues to augment the atrophic buttocks in conjunction with buttock lifting. The procedure can be done as an isolated buttock reshaping surgery or in conjunction with circumferential abdominoplasty/body lift.
The Lower Lipo-body lift
Circumferential tightening procedures aim to restore and improve the body shape, including the abdominal, flank, and buttock regions.
In lipobuttock lift, we remove extra fatty tissue through liposuction as a staged procedure before or during the lipobuttock lift. The harvested fat tissue may be prepared and used for additional fat grafting in the buttock region.
General Principles of Lipobuttock Lift Surgery
Each patient should be carefully examined, and the type and degree of dropping determined as part of the surgical planning.
The scars should match the severity of the deformity. In other words, the improvement in shape and appearance must warrant the severity of the scar. Large scars are acceptable only when the changes produced are significant.
Two short scars may be better than one long one.
Preoperative markings should be precise and correctly placed because the markings determine the location of the resultant scar.
All fatty and dermal tissue should be preserved, even when it appears redundant.
Every effort should be directed at obtaining adequate volume and projection in the upper two-thirds of the buttocks.
If the buttocks are very flat and lack adequate projection and rounded volume after a lifting procedure, an implant or fat grafting should be considered.
Adequate support and anchorage are necessary to avoid secondary dropping and scar spreading.
Surgical Technique of Lipobuttock Lift Surgery (all techniques)
Every patient should be marked in the standing position. Marking should be meticulous, and double-checking symmetry with a ruler, compass, or caliper is recommended.
- All surgeries are performed under general or epidural anesthesia; however, thin patients with minor to moderate dropping may be sedated and given local anesthesia
- The deep layers of the areas previously marked for undermining should be infiltrated with the tumescent solution to provide hemostasis and facilitate the removal of the epidermis.
- The prone position is chosen; for the lateral and upper buttock lifts, a roll is placed beneath the lower abdomen of the side being operated. When that side is completed, the roll is moved to the other side before that side is lifted.
- The anal area must be isolated and covered with a sutured dressing
- The incisions are made with a No.10 scalpel partially through the dermis. Electrocautery is used to complete the incisions control bleeding throughout the procedure, and continue the dissection through the subcutaneous tissue down to the deep muscular fascia.
- The lipobuttock lift is routinely performed by two surgeons and optionally with one or two medical assistants. Both sides perform tissue preparation, dissection, and wound closure simultaneously.
- We start with the liposuction of the area that will be excised. We reduce the volume below and above Scarpa’s fascia and go superficially until the tissue is resected paper-thin. Then the lower incision line is infiltrated with a local anesthetic to reduce postoperative pain and increase the risk of blood pressure.
- Undermining of the buttock soft tissue inferiorly is performed as needed to allow the autologous tissue to fit correctly and allow adequate tissue recruitment for closure.
- After dissection, the waist and buttock fatty tissue should be widely mobilized and ideally covered by a stable superficial fascia. By trans- positioning and tightening the buttock fatty tissue, the buttock region is lifted up with a consequent final skin closure under reduced tension. Further, this maneuver can improve the waist’s shape by mobilizing the waist fatty tissue.
- The purse-string suture is then placed around each mound at the level of the superficial fascia using a No.1 braided polyester suture. When tightened, it narrows the base and increases the projection of the buttock mound.
- Incision line closure is performed in three layers. The superficial fascia is closed with 0 or 1 Vicryl, usually one per centimeter of incision length. The deep dermis is closed with buried interrupted 2-0 Vicryl, and the final intradermal closure is performed with 4-0 Monocryl. Steri-Strips are applied perpendicularly to the wound.
- Suction drains are placed and coiled laterally for final placement at the end of the procedure.
What Can I Expect on the Day of Lipobuttock lift Surgery?
Your buttock-lift Surgery may be performed in an office-based surgical suite or a hospital according to your doctor’s preference. Most lipobuttock lift procedures take at least three to six hours to complete but may take longer.
You will receive medications to keep you comfortable during the surgical procedure.
Local anesthesia combined with sedation may be a choice, but general anesthesia is more commonly used. An anesthesiologist will be present to administer sedatives or general anesthesia and aid in monitoring you during surgery.
After you are asleep, a breathing tube will be placed in your mouth to ensure that your airway is secure during position changes involved in the lipobuttock lift procedure.
For your safety during the surgery, I will use various monitors to check your heart, blood pressure, pulse, and the amount of oxygen circulating in your blood.
Your plastic surgeon will follow the working plan discussed with you before surgery. Once the operation has begun, they may combine various techniques or change a method to ensure the best result. You must feel comfortable and trust your doctor to make these decisions.
How will I be Immediately after Lipobuttock lift Surgery?
You can expect to be bandaged and wearing compression garments, and you may have some surgical drains in place. Once you learn how to take care of your pipes, feel comfortable walking and moving, and are comfortable with oral pain medications, you will be discharged.
When the anesthesia wears off, you may have some pain. You will also have some redness and swelling after the surgery. In some cases, the swelling will remain for weeks or even months. Contact your physician to decide if your pain, redness, and swelling are normal or a sign of a problem.
Ensure you continue to have lots of help at home − I cannot stress this enough. You’ll be tempted to help around the house soon after Surgery, but you won’t feel like yourself for at least two weeks, and you still should not do anything strenuous, including lifting, for four to six weeks. If you have small children, arrange for someone else to oversee their care for two weeks.
Ask your surgeon how to sit and sleep, including pillows, to lower the tension on your incisions, reduce pain, and ease a thinner scar.
Drains, which also control swelling, are placed to remove fluid that accumulates within the incisions. Your doctor will ask you to measure the fluid in your drains daily. Once the output falls low enough, I will remove your gutters in your doctor’s office. Pipes typically stay in place for two to three weeks but may be left longer.
Postoperative Lipobuttock Lift Care
- Our typical dressing is 1-inch paper tape over the incisions, with cuts in the tape every 5 cm to allow for swelling. The tape allows reinforcement of the closure and protection from shearing for the first 2–3 weeks and should be changed every 5–7 days.
- Due to difficulty with placement and replacement, no compression garments are used following this procedure. Patients may be placed flat and in a lateral decubitus position while recovering.
- Upon discharge, routine narcotic pain medication, as well as prophylactic antibiotics, are taken. During the healing period, patients are asked to sit very gently on a pillow or cushion instead of a hard surface and to limit their time sitting if possible.
- Periodic ambulation ensures pressure relief on the buttocks and reduces the likelihood of deep vein thrombosis (DVT).
- Frequent follow-up is performed within a few days to ensure healing is progressing as expected and to answer any questions that may arise.
- Drains are removed when the drainage amount decreases to less than 25 mL per 24-h period.
- When complete healing has occurred at approximately four weeks, the patient is released from activity restrictions.
How is the Recovery Period after a Lipobuttock lift Surgery?
Buttock-lift Surgery is extensive and will need two to three weeks of recovery before you can resume normal activities. Complete healing will take several months. Being in good health, not smoking, and having help after surgery will increase recovery speed, improve your results, and prevent complications.
What are the Limitations and Risks of Lipobuttock lift Surgery?
Fortunately, significant complications from buttock-lift Surgery are infrequent. You will discuss your specific risks during your consultation. All surgical procedures have some degree of risk. Some of the potential complications of all surgeries are:
Adverse reaction to anesthesia
- Hematoma or seroma (an accumulation of blood or fluid under the skin that may need removal) Infection and bleeding
- Changes in sensation
- Scaring Allergic reactions
- Damage to underlying structures
- Unsatisfactory results that may require more procedures
You can help lower certain risks after the advice and instructions of your doctor, both before and after your buttock-lift Surgery.
- Long-term buttock projection with the purse-string buttock lift is excellent. The suture maintains the shape and projection of the autologous augmentation and is quite durable.
- The most frequent complications are focal areas of wound dehiscence and superficial infection. Areas of dehiscence are treated with wet to dry dressings until healed. Small areas of incisional opening can often be treated with the removal of extruded suture material.
- Localized infections are treated with broad-spectrum oral antibiotics.
- As in any dissection with ample potential space, seroma or hematoma is possible but has been rarely encountered. Hematoma should be treated with immediate evacuation. Seroma is treated with serial aspiration until resolution.
- Finally, in the long term, inferior migration of the lateral scar onto the upper thigh is occasionally seen; and easily treated with a scar with scar revision and release of the lateral thigh zones of adherence inferior to the scar.
What does Lipobuttock lift Surgery Scar will look ?
Incisions are placed either on the top of the buttocks, in the back, or underneath the buttock. If liposuction is involved, there will be more minor scars that will fade and be mostly unnoticeable.
How Long Will Results of Lipobuttock lift Surgery Last?
Results from lipobuttock lifts are very long-lasting. If you keep a healthy lifestyle and avoid stretching the skin by gaining weight, you can enjoy a youthful contour for a long time. As with most surgeries, weight fluctuations, pregnancy, and aging will take a toll on the body and the consequences of your lipobuttock lift.
For safety and the most beautiful and healthy outcome, it’s essential to return to your plastic surgeon’s office for follow-up evaluation at prescribed times and whenever you notice any changes in your lipobuttock lift. Do not hesitate to contact your surgeon with questions or concerns.