Procedures - Buttock Augmentation / Buttock Implants

What is the surgery all about?

Although Gluteoplasty has been around for many years it has not gained popularity in the United States until recently. Therefore, only a handful of surgeons are offering this body contouring procedure.

Dr. Constantino Mendieta, who is a fellow of the American College of surgeons and a Diplomate of the American board of Plastic Surgery, has gained notoriety for the procedure. He has been featured on numerous national and international talk shows, as well as teaching plastic surgeons around the country on how to perform the operation. He explains that just like breast and calf implants that are used to reshape and augment these body parts. The glutei implants are used to improve the contour of the buttock, obviating the need for padded panties. The operation is fairly straightforward, a single well-hidden scar is placed strategically so that not even your closest friends can find, and through this the implant that is made of silicone is placed in the buttock area to improve size, shape and contour. Dr. Mendieta explains unlike the silicone breast implants which are made of a silicone gel, which can leak, rupture and ooze into the tissues, the buttock implant is made out of solid silicone, and so it cannot rupture or leak. The augmented buttock has a firm but natural feel almost as if you had been working out vigorously for many years. It does not affect your sitting since the implant is placed in an area that is well away from the bony aspect of your buttock that you actually use to sit on.

Dr. Mendieta has had an interest in total body contouring which has lead him to make an in-depth study of the subject, and train under the pioneers of this technique, acquiring the knowledge and experience to be able to offer this new advancement to many women or men that could benefit from this surgical procedure. The operation can be done under general, spinal, IV sedation or epidural block.

How to evaluate the buttock area?

The buttock is made of muscle, fat, skin and its underlying support is bone. The shape and contour of the butt depends greatly on the person's framework the so-called -bony structure. However, its main volume and definition comes from fat. It is how this fat is distributed that will make the difference between an attractive, and a not so attractive buttock. For the purpose of this section, we will address only the evaluation of the buttock shape. Please remember that there are other variable that need to be taken into consideration before making any determinations (size, shape, and skin quality). For a complete discussion please click here.

When evaluating the shape of the buttock, it is best to divide the anatomy into three sections; the upper buttock, the mid buttock and the lower buttock. Each area needs to be evaluated and addressed independently in order to provide the best gluteal harmony.

• The Upper Buttock: In this area, we need to address two factors: how much volume is present, and more importantly, how the fat is distributed. An aesthetic buttock has most of the fat located directly posterior on the buttock and has enough fullness superiorly to give it a lifted round look.

If more fat is located in the upper outer aspect, the so-called hip roles, then the buttock will look square and unattractive. Liposuction alone will improve the contour, but it will not add volume to the buttock. In order to increase the size, an implant or fat is required.

When a gluteal augmentation is performed, the implant is mainly addressing the upper buttock and the upper portion of the mid buttock. It will not address the other areas. In the majority of patients, a careful analysis of the middle and lower buttock needs to be made since complimentary procedures may be required in order to improve the overall shape.

• Mid-Buttock: In some patients, an indentation can be seen in the midsection of the buttock. This is a very subtle finding and needs to be closely examined. If this area is not properly addressed during the procedure, the defect may become more obvious after the augmentation since we have just made the buttock larger. The best way to address this problem, is to transfer a small amount of fat (about 30 cc), in order to fill this slight depression and give it a rounder appearance.
• Lower Buttock: This area typically has some excess fullness giving the buttock its droopy look. This fullness will be even more apparent immediately after the procedure since you are swollen. As the swelling begins to disappear the appearance improves, but the excess always remains. If this area is not addressed, it can give the appearance of dirty diapers or a droopy buttock. The key in improving this area is a careful examination to asses whether the problem is excess skin or fat. The treatment will be either liposuction or removal of the excess skin. In the vast majority of patients, the problem is usually some degree of excess fat. If this is the case, then conservative liposuction will improve the area. If the problem is excess skin, which is hardly ever the case, then it may require removal of the skin.

Now that we understand the areas that need to be evaluated, lets see what decisions need to be made.

What decision need to be made?

Although the operation is fairly straightforward, there are many technical aspects to the procedure that may be done differently depending on the surgeons training, experience, and philosophy. The operation involves placing an implant that is made of silicone (either cohesive silicone gel or solid silicone) in the buttock area to improve size, shape and contour.

In order to understand your options and the operation, let us go through the five decisions that will need to be made. The issues are the following:

1. Implant selection: The implant is either round or oval shaped (so-called anatomic implant). Like breast implants, it comes with either a smooth or a textured surface. In my opinion, neither the shape nor the surface texture of the implant makes much of a difference in the final result. The content of the implant can be either solid silicone or cohesive silicone gel. The most commonly used is a solid silicone implant. The fact that the implant is solid is excellent since it cannot rupture, spill, or deflate. The cohesive gel is not available in the United States. In my practice, I use the smooth round implant most often. The decision as to which type of implant is used will be heavily influenced by your surgeon's preference and philosophy. The augmented buttock has a natural feel, it can be somewhat firm to the touch, but it just feels like you have been working out for a long time.

2. Incision Location: Once the implant has been selected the next task is to decide the type of incision to be used for our buttock augmentation. The incision can be placed in several locations:

• Superiorly on both sides of the upper buttock - Although the scars can be hidden in your undergarment or bikini, it is not recommended since the scar can be quite visible when not wearing clothing, and it requires two incisions. Or it could be,
• Inferiorly in both of the gluteal creases where the "cheek" meets the back of the thigh. This choice will leave you with two scars that also can be quite visible. Or finally,
• One incision, which is, placed down the center of the sacrum - a small 4-6 cm vertical incision down the buttocks crease. This in my opinion is the best location, it is extremely well hidden and not even your closest friend can find it. (He or she won't want to be looking in that area). This approach only involves one scar. The only drawback is that it may have a higher infection rate than the other incisions. However, if this happens it is usually solved with antibiotics and wound care.

3. Above or below the muscle: Once the type of incision has been chosen, the next step is to decide on the placement of the buttock implant. Will it be below the muscle? Or on top of the muscle?

• This again will heavily depend on your surgeon's preference; many nice results have been attained with either position. However this will depend heavily on the person's anatomy. I have seen many implant that were placed above the muscle and later looked like a sack of potatoes. This is perhaps in patients that have a very droopy buttock or poor skin tone. In my practice I have preferred to place the implant within the muscle. This accomplishes several things:
  • First it gives the implant more support, and I believe, prevents it from descending too far down the buttock.
  • Secondly it gives it an extra layer of coverage so that the implant feels more natural to the touch and has a nicer shape.
  • Finally, the added tissue coverage also protects the implant from infection. If the implant is placed above the muscle and the wound becomes infected more than likely so will the implant. In this scenario the implant would have to be removed and left out for three months before inserting it again. Of course every surgeon will have his own philosophy and preference.

4. To liposuction or not to liposuction: The final decision will be weather liposuction is to be combined with the procedure in order to add further contour to the buttock.

• When I first learned the technique, my mentors were not performing liposuction with the procedure. Most of the patients that were having the operation had flat buttocks but they also had a role of excess fat in the upper-outer part of the buttock. They looked flat from the side but wide and flat from the back. After the augmentation the patients had a nice results, but they now had a large wide look from all angles. I began to combine the procedure with liposuction of the upper outer part of the buttock in order to improve the wide appearance. I noticed a tremendous change in the contour and shape of the buttock. In some patients, liposuction of the lower buttock and outer thigh is also needed to improve the droopy look. I will therefore combine most of my buttock augmentations with liposuction. You must remember that every plastic surgeon has his own philosophies therefore the decision to combine liposuction will depend on your desired goals and your surgeons philosophy.

5. What to do with the mid buttock area?: This may or may not be an issue, however, in some patients an indentation can be seen in the midsection of the buttock. This is a very subtle finding and needs to be closely examined. If this area is not properly addressed during the procedure, the defect may become more obvious after the augmentation since we have just made the buttock larger. The best way to address this problem, is to transfer a small amount of fat (about 30 cc), in order to fill this slight depression and give it a rounder appearance.

Now that we have made all the decisions how is the operation performed?

The operation itself.

Buttock augmentation is an outpatient procedure that takes about one hour to perform. If liposuction is being done, then it may take an additional hour.

The operation requires that you be placed in the face down position. A 5-6 cm vertical incision is made in the well-hidden buttock center crease (sacrum). The dissection continues on either side of the sacrum until the buttock muscle is reached. At this point the muscle is incised and with careful dissection the implant pocket is created within the muscle. Surprisingly there is very little bleeding. The implants are inserted into the newly created pockets and the muscle is closed over the implants, the midline incision is then closed in layers. If liposuction is to be done, this is performed through separate incisions.

Your new look.

You will need to wear a garment for about 2-3 weeks. This will provide support and help with the skin re-draping especially if liposuction was performed. At first you will notice a definite difference in the gluteus contour, but since you are swollen the buttock will appear very full, and will have a boxy appearance. You may also notice the implants are quite high on the buttock. This is all normal; you must remember that you are swollen. It will take at least 3 months for all the swelling to subside and for the implants to settle into their normal position. You may experience occasional temperature changes, and numbness over the buttock area, this also will improve over the next three months. You may feel a little timed and scared when sitting down, but remember the implant is much higher on the buttock than were you sit, so don't worry. See the frequently asked questions section for any further concerns you may have.