Candidates:
Women and men with an absence of the projection and volume of the gluteal region. . Deformities can be congenital or acquired, occurring from childhood or appearing in adult life. Alterations in volume and projection are generally due to muscular hypotrophy and lack of fat in the upper gluteal region. With time the excess fat in the hip area, tummy and thighs together with the force of gravity and the limitations of flaccid skin means a concentration of fat develops in the lower third of the buttock, giving the appearance of heavy, flattened buttocks.

Objective:
To increase the projection of the gluteal region throgh the association of liposuction and fat grafting. There are two main body types gynoid, with a concentration of fat below the waistline and android, which concentrates fat above of the waistline. Both types can benefit from this type of surgery. The gynoid type in general needs liposuction of the hips, thighs, legs, tummy and fat injection in the buttocks. The android type needing liposuction of the arms, axylla, back, hips, tummy and breasts with fat injection of the buttocks and often the inner thighs as well.

Incisions and technique:
Technique: Usually three to six small incisions in the hip area and glutel folds. The great advantage of the liposculpture technique in these cases is the combination of aspiration the excess fat with the injection of this aspirated fat in the depressed areas. In most cases there is an accumulation of fat in the hip area, culottes and inner thighs and the removal alone of this excess fat with liposuction will bring improvement to the contour. This excess fat can be used as a graft to increase the volume of the gluteal region. Fat is injected subcutaneously or into the muscle depending on the area and the specific problem to be corrected.

Operating Time:
1 to 3 hours.

Anesthesia:
Local with sedation. Tumescent anesthesia made the procedure safer.

In/Outpatient:
Usually inpatient.

Recovery period:
Postoperatively we prescribe the use of an elastic girdle which helps maintain the new form and keep down the swelling. Lymphatic drainage, the light massage, is also encouraged, helping with the swelling in the liposuction areas avoiding the fat injection site. It can be started 24 hours post operatively. Walking is essential from day two, increasing the distance covered each day. From the third week low frequency ultrasound and endermology will help in the correction of any hardened areas that might develop. These postoperative procedures are done by a trained physiotherapist and always under the supervision of the surgeon. Strenuous exercise, running and weight lifting are allowed after 30 days. Walking a mile: two days. Temporary mild pain, especially in the first 48 hours can be treated with analgesics. Swelling, soreness, numbness, bruising usually last a few weeks. Dressings are applied on the small incisions. There will be a leak of the anesthetic fluid through the incisions in the first 24 hours. Dressings will be changed daily. Shower is allowed after 24 hours. You may have to wear a girdle for a few weeks. Stitches will be removed between the 5th and 7th day. Back to work: 2 to 3 weeks. Exercise and sunbathing: 4 to 6 weeks or more. Fading and flattening of the little scars: 3 months to 2 years.

Risks:
Significant complications from liposculpture are infrequent. Potential complications are asymmetry, rippling, and pigmentation of the skin, bleeding, infection and problems with anesthesia. Temporary numbness of the skin and hematomas (blood accumulations) are possible mild complications. Irregularities of the skin can happen in some patients, but can be treated if necessary. More serious complications involve loss of fluid or blood that can provoke shock, although this is now very rare with the tumescent anesthesia. Infection is very rare. Few patients have found the fat injection technique a disappointment, either because their re-absorption rate was high (estimated at 50-60%) or because they didn’t have enough fat for the increase in size they were looking for. We can inject up too 500ml of fat in each buttock, depending on the case, injecting into the muscle, subcutaneously, and into the existing fat as necessary.

Details:
Liposuction improves body contour and increases self-confidence. Sometimes the fat injection procedure has to be repeated because there is a limit to the amount of fat that can be injected in one stage. Occasionally, a secondary procedure, or "touchup" may be indicated to improve certain areas, most times under local anesthesia. A special massage, called manual lymphatic drainage helps with the swelling and bruising in the post-operative period, increasing comfort. Gluteoplasty includes several different procedures, from silicone implants to increase the volume, to resection of the skin at the waist line to lift the gluteal region and improve the gluteal fold. These are invasive techniques and as such involve scars with the associated higher risk and complications.

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