Buttock Fat Transfer

Abstract

Buttock appearance is undeniably important to human attraction. A low (0.70) waist-to-hip ratio in women is regarded as ideal. Today, the Brazilian Butt Lift is one of the most requested cosmetic surgical procedures, even though it is a misnomer. Buttock implants were popularized over a decade ago. However, despite greater experience with this technique, problems persisted, including infection, seroma, wound dehiscence, and implant malposition, causing an unnatural and often asymmetric buttock appearance. Liposuction is an extremely popular cosmetic operation. Rather than discarding the aspirated fat, it may be transferred, reducing the role for thermal methods that destroy fat cells. The buttock is a suitable recipient site because it expands easily. Large syringes and cannulae have reduced the operating time. Centrifugation is unnecessary. A study using ultrasound to measure fat thickness found that the calculated fat retention is about 66%. Local complications such as infection, seromas, or oily cysts are rare. Overaggressive liposuction can produce contour deformities at the fat donor sites, and these problems are best avoided. Patients may benefit from a subsequent touchup fat injection procedure to achieve more volume. Flap transposition, sometimes done at the time of a body lift, provides no net increase in buttock volume but adds to the operating time and blood loss. Fat injection is a simpler option and can provide lateral gluteal augmentation. The most serious complication of buttock fat injection is fat embolism, which is often immediately fatal. This problem is caused by deep penetration of the cannula, with trauma to the gluteal veins. Surgeons may reduce the risk by injecting tangentially to the muscle, staying within the subcutaneous plane. The author does not use an incision in the gluteal fold and prefers side-to-side positioning in surgery.