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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_994_Библиотеки_им_академика_М_И_Перельмана
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21 Natural Look inButtock Implants: Eight Step Hybrid Gluteoplasty
Image 21.11 Before and after (2years follow-up) prole view
295
Image 21.12 Same
patient (oblique view)
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H. U. Morelli
Image 21.13 Before and after (1year follow-up) back view
Image 21.14 Before and after (1year follow-up) right prole view
21 Natural Look inButtock Implants: Eight Step Hybrid Gluteoplasty
Image 21.15 Before and after (1year follow-up) left prole view
297
Image 21.16 Before and after (1year follow-up) oblique view
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Image 21.17 Before and after (3years follow-up) oblique view
H. U. Morelli
Image 21.18 Before and after (2years follow-up) oblique view
21 Natural Look inButtock Implants: Eight Step Hybrid Gluteoplasty
Image 21.19 Before and after (9months follow-up) back view
299
Image 21.20 Before and after change of implants from subcutaneous to intramuscular pocket (10
months follow-up) prole view
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H. U. Morelli
Table 21.2 Complications
Mild Pain
Dehiscence
Infection
Flipping
Skin Necrosis
Hematcma
DVT:
PE
Death
41
7
1
8
0
0
0
0
0
(28.4%)
(4.86%)
(0.7%)
(5.5%)
:(0%)
(0%)
(0%)
(0%)
(0%)
This surgery, as any other, is not free of complications. Complications related to
hybrid gluteoplasty observed in 8th years of experience with the eight-step technique can be seen in Table21.2.
21.4 Discussion
As mentioned before, nowadays gluteal surgery is a trend in the world of plastic
surgery, and we all must learn the technique if we want to be competitive especially
because only fat transfer in the subcutaneous plane cannot offer consistency and
stability of the results. And intramuscular fat is no longer accepted as a safe
procedure.
As in every surgical technique, a learning curve must be faced to achieve not
only good aesthetic outcomes but also to reduce the complication rates to nally
master the procedure. We wanted with our work to demystify and teach in an easier
way this procedure to surgeons who are just entering in to this fascinating world.
The eight steps are intended to achieve safety, consistency, natural results, and to
avoid the most common complications of the hybrid gluteal surgery.
This procedure can be done without the hybrid fat component but we believe that
fat came to stay in plastic surgery. Fat has proven to offer not only better and more
natural outcomes, but also to fulll extra spaces, to improve contouring and to
reduce complications. Since we need no longer big volume implants to achieve the
desire volume, we reduce the compression and tension-related complications such
as pain, dehiscence, and the fake look. Also the use of a ltration system (puregraft)
allows us to increase the predictability of the result by reducing fat-related complications such as fat necrosis, oil cysts, bruising, and loss by absorption.
21 Natural Look inButtock Implants: Eight Step Hybrid Gluteoplasty
301
The key concepts we believe are mandatory in this surgery to achieve
consistency are
• Intramuscular placement for better coverage: reduces the fake look, implant vis-
ibility, and palpability. (At least 1.5cm of muscle must cover the implant).
• Small implant volumes to eliminate the fake look and to reduce compression and
tension-related complications.
• Low and moderate implant projections to increase the base and reduce the ip-
ping probabilities and also to reduce the over-projected gluteus.
• Hybrid component (already explained above).
• Two incisions instead of 1 (reduces tension and communications between
both sides).
• High opening of the muscle (facilitates the posterior closure).
• Quilting sutures and drains (reduce death space and the risk of seroma).
The eight steps described in this work not only help the surgeon to understand
and to orient them better in where to start and where to nish, to make the procedure
easier and better structured, but also to reduce the complications rates increasing the
patients satisfaction.
Complications related to this procedure in the authors experience are much lower
today than in the rst years. Pain currently is easily controlled with the adequate
medications; dehiscence can be reduced with the use of two incisions and the
reduced tension of a small volume implant. Seroma can be reduced with the use of
quilting sutures and drains. Infection can be reduced with the proper surgical technique, antibiotic coverage, and the ltration of the fat. And ipping is reduced by
using moderate projection implants and a tight pocket.
Understanding the anatomy better and a strict eye and follow-up on the postoperative recovery nally will lead the surgeon to the desired consistency in the results.
21.5 Conclusions
Hybrid gluteal surgery is a reliable technique with excellent results when following
some simple rules and done properly. The combination of small volume and moderate projection implants with ltered fat will give a more natural appearance with a
reduced rate of complications. The eight step technique will lead you to a reduced
learning curve on this procedure.
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H. U. Morelli
References
1. Cárdenas-Camarena L, Trujillo-Méndez R, Díaz-Barriga JC.Tridimensional combined gluteo-
plasty: liposuction, buttock implants, and fat transfer. Plast Reconstr Surg. 2020;146(1):53–63.
2. Aslani A, Del Vecchio DA.Composite buttock augmentation: the next frontier in gluteal aes-
thetic surgery. Plast Reconstr Surg. 2019;144(6):1312–21.
3. Khouri RK Jr. Current clinical applications of fat grafting. Plast Reconstr Surg.
2017;140(3):466e–86e.
4. Del Vecchio DA, Villanueva NL, Mohan R, Johnson B, Wan D, Venkataram A, Rohrich
RJ. Clinical implications of gluteal fat graft migration: a dynamic anatomical study. Plast
Reconstr Surg. 2018;142(5):1180–92.
5. Condé-Green A, Kotamarti V, Nini KT. Fat grafting for gluteal augmentation: a systematic
review of the literature and meta-analysis. Plast Reconstr Surg. 2016;138(3):437e–46e.
6. Chopan M, White JA, Sayadi LR.Autogenous fat grafting to the breast and gluteal regions:
safety prole including risks and complications. Plast Reconstr Surg. 2019;143(6):1625–32.
7. Rodríguez-García F, Miranda-Villera C, Peynado-Vila Á, Prado-Cantillo D.Surgical anat-
omy of gluteus maximus muscle: FROD’S intramuscular space. Cir Plást Ibero-latinoam.
2016;42(2):149–56.
Chapter 22
Combining Fat andImplants forGluteal
Augmentation
AlexanderAslani andMiguelG.Bravo
One of the techniques with rising popularity in plastic surgery is gluteal augmentation. From 2002 to 2014, the number of gluteal augmentations performed had
increased from 614 to 21,446 [1]. Data from the International Society of Aesthetic
Plastic Surgery show that on a global scale, 31,330 augmentation procedures involving implant placement have been performed [2]. The global acceptance of gluteal
augmentation has resulted in a sharp increase of buttock augmentation with fatgrafting (“Brazilian Butt Lift-procedure”).
However, parallel to the rise in demand for gluteal fat-grafting surgery, safety
concerns have arisen due to lethal incidences of fat embolism associated to BBL
surgery. This has led to increased interest in the use of buttock implants in the surgical community, although the procedure has been brandmarked with a disproportionally high complication rate, with published values exceeding 38% [3].
Composite or “supercharged” solutions have been published and are established
for breast augmentation [4]. There is a wide range of advantages by combining both,
fat-grafting and silicone implants not only for breasts, but also for buttock reshaping
surgery. Recent publications have described robust surgical protocols to make it an
effective tool in buttock reshaping surgery at an acceptable complication rate [5].
While composite (“supercharged”) gluteal surgery is doubtlessly a more invasive
procedure as compared to implants only, the advantages are multifold.
Apart from the additional shaping effect of perigluteal liposuction, which in
itself improves buttock shape, and signicantly increases buttock projection, fatgrafting adds targeted volume into the central trochanteric depression area as well
Supplementary Information The online version contains supplementary material available at
https://doi.org/10.1007/978- 3- 031- 13802- 7_22.
A. Aslani (*) · M. G. Bravo
Cirumed Clinic Marbella, Málaga, Spain
e-mail: aaslani@cirumed.es
© Springer Nature Switzerland AG 2023
D. Del Vecchio, H. Durán (eds.), Aesthetic Surgery of the Buttock,
https://doi.org/10.1007/978-3-031-13802-7_22
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A. Aslani and M. G. Bravo
as additional soft-tissue padding around the gluteal edges. The size of the buttock
implants can be kept moderate, reducing the tension stress exerted by the implants
and therewith the incidence of “tissue-failure.”
22.1 Surgical Technique
22.1.1 Liposuction andFat Grafting
Shaping liposuction of the abdomen and the anks is key to achieve a good result in
gluteal augmentation as it will improve the waist-to-hip ratio. Special emphasis is
put on the so-called BIC zone (Below-Iliac-Crest). Some liposuction in this area
contributes to the impression of a “shorter and rounder” buttock, oversuction in the
area can create a “subiliac-hollow” appearance. The exact amount of liposculpting
is essential here (Figs.22.1 and 22.2). Caution must be taken not to overcorrect,
since this can lead to increased visibility of the the pelvic crest.
Fig. 22.1 Dissection of
subiliac fat pad in cadaver
specimen
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