Procedures - Buttock Lift

If you're considering buttock lift...

As we age our buttock begins to droop and change shape, although in the past we were more focused on our face, the attention now seems to have shifted to the other end.

Throughout time the buttock area has always been one of the most important determinants of the female figure. Although our international colleges especially in Brazil and South America have always had an interest in body sculpting, the US was not as focused. As fashion trends progress there seems to be less and less clothing worn, exposing body parts that we ordinarily could cover with larger dresses, skirts or pants. The tight fitting body hugging garments that are being worn is also making us more aware of our bodies' imperfections. It is no wonder that the US surgeons are learning newer body procedures, and as techniques have evolved we are finding newer ways to lift or augment certain body parts that in the past we would let age gracefully. One of the areas in plastic surgery that is becoming the center of attention is the buttock area.

What are my options, what is best for me?

There are several different procedures that can be used to improve the buttock shape and appearance. The buttock can be: lifted, sculpted with liposuction, augmented with implants or fat, or a combination of any of the above. Obviously, the procedure of choice will depend on what your anatomy is and what your specific goals may be. One has to evaluate the size, shape, and the skin quality before making any determinations. It is these three factors that will help in arriving at the right procedure for you:

1. Size: The actual size of an attractive buttock is determined by the individuals preference, although cultural influences will play a major role in establishing the ideal gluteal size. The gluteal size can be improved in several ways.

• As long as the skin is of good quality, then liposuction of these three areas: upper/outer part of the buttock, the love handles, and the outer legs, will give the appearance of a younger larger lifted buttock. However, some patients may desire more fullness over the buttock area and in this particular case, we could
• Transfer the removed fat to the buttock. During fat transfers, the fat is placed deeply in the muscle in several different layers so as to create a smooth augmentation without irregularities. The great news about fat is that the results can be extremely natural and it is your own body substance. There is no chance of rejection since there is no foreign material in your body. The only drawback with this technique is that fat is unpredictable. By this we mean, that all the fat that is transferred may not survive and some of it will disappear, just how much will remain is what we can't predict. However, whatever remains after 3 months will remain permanently. An interesting observation has been that immediately after the procedure some swelling is present and as the swelling improves most patient feel the fat has disappeared but in reality it was the swelling. This is why we need to wait 3 months before making any final determinations. In patients that don't have much fat or are looking for a more predictable solution then
• An implant will be needed. What we have to keep in mind, is that it is not the size or the quantity of tissue present but the way it is distributed.

2. Shape: Although size may be important, traditionally it is the buttock shape that really attracts the eye. In order to understand what creates the shape we must first talk about what makes the buttock. 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 and attractive buttock and one that is not so attractive. It is amazing to note that these two patients can have the same amount of fat and yet look so different. 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 the fat is located in the upper outer aspect, the so-called hip roles, then the buttock will look square and unattractive .see photo In poorly distributed fat the patient will look wide and flat. The procedure that is best for you in order to improve the shape will depend greatly on the quality of the skin.

3. Skin Quality: It is the skin quality that will determine whether a buttock lift, or liposuction with or without implants is needed. The difference between these procedures will be the extent of scaring. If you have poor skin quality and a droopy buttock, then a buttock lift may be needed. Let us take several scenarios to discuss your options.

Good skin quality: no stretch marks, no droopy or excess skin, no cellulite, no skin irregularities, no looseness to the skin.

• If someone has a young buttock with excellent skin tone but poorly distributed fat, then liposuction alone may be the answer. A buttock augmentation could be done and this will definitely improve the result, since it further augments what is already naturally pretty. Since our concern was mainly shape and not volume, the augmentations in this case could be done with either fat or with implants, the choice will be up to you and your surgeon.



• If you have good skin tone but just not enough buttock volume then and implant is the answer. Fat would not be as good a choice since fat is unpredictable and may disappear. In this scenario we don't have much fat to remove and volume is the main concern. We therefore need something that is more predictable - an implant.

Average Skin Quality: Overall pretty good skin tone with very little skin looseness, you may have some stretch marks, mild irregularities, mild cellulite.

• In patients that have average skin tone, our options will depend on what the goals may be. If you have fatty deposits in the wrong area, then liposuction alone can improve the appearance. Many times fat transfers or an implant will add to the final results. The appearance can be improved without having to do a buttock lift.
• If you desire a larger buttock an implant will improve the appearance of your skin tone and will lend an overall nicer buttock shape. However, in this type of skin there is usually some droopiness in the lower buttock area. In these cases, a careful examination will determine if this is due to excess fat or excess skin. If we determine the cause is fat, then we can contour this area with liposuction, however, if the overhang is too severe or it is from excess skin, then we may need to excise that portion that is in excess. This does leave a scar which is placed in the buttock crease so it is camouflaged. Having to perform this tissue removal is very rare, most of the time it is improved with liposuction.

Poor Skin Quality: In this type of skin there is a great deal of skin looseness. You literally can grab the skin and lift it up a great distance. There is usually a great deal of cellulite and skin irregularities. Stretch marks are usually present. This type of skin is seen in patients that have had a massive amount of weight fluctuation either weight gain or loss. It is also seen in very sun damaged skin, and in the older patient.

• If loose and excess skin is present then no matter how much liposuction is done or what size implants we place, it will always look like a sack of potatoes or dirty diapers. This type of skin has only one solution, and that is the buttock lift. The excess skin that is droopy needs to be removed and lifted. The difference made will be tremendous, but the drawback is that it does leave extensive scars. The scars are placed in the upper buttock area and goes across the back area it can extend around to the sides of the abdomen. These scars are visible, but they can be hidden in the undergarment so that you can enjoy wearing bathing suits or sexy lingerie.
• The area that has the overhang needs to be carefully evaluated since it can be in three different areas. It can be in the lower buttock, the inner part of the buttock or on the sides of the buttock. Nearly all types of excess can be improved with the traditional buttock lift. (Placing the scar in the upper buttock area, all across the back). However sometimes if you have a localized area especially in the lower buttock area, then you can perform a limited excision of the skin in this area and these scars are placed in the buttock crease. If a larger buttock is desired an augmentation can be performed 3 months later.

Where your surgery will be performed.

This type of surgery is typically performed under general anesthesia. Where it will be performed will depend on your overall medical health and your current weight. The operation can be performed as an outpatient in an office based surgical center, an ambulatory surgical center or in a hospital base setting. However, in some patients it may require hospitalization for several days.

Safety is our primary concern, therefore, in our practice we have strict guidelines in selecting those patients that can be done in our surgical center and those that will require a hospital setting. The criteria that we use has two primary issues:

1. Your overall medical condition, and

2. Your Body mass index:

Body Mass index is a number that is determined by your height and your current weight and it is compared to the weight that you should be at. This number allows us to assess how much over your ideal body weight you may be and consequently, assess your risk factor for many medical conditions that overweight patients can develop.

• If you are in good health and your Body Mass index is below 31, then the operation can be safely performed in our surgical center as an outpatient basis. However,
• If you are over 30% of your ideal Body weight or your Body Mass index is greater than 31, then it needs to be done in the hospital. The reason is because you will require at least one or two night stay - over.

To see where you fall and see what your Body Mass index is please click here.

The Surgery.

We already know from the discussion above that the patient that needs a buttock lift has poor skin tone. Since there is a great deal of looseness to the skin, the only way to improve the shape will be to remove the excess skin and lift the buttock as high as we can. Don't worry the buttock won't end up on your back, (it is not the hunch back of Notre dame procedure). However it will create a tremendously different body shape.

Traditionally this procedure is performed on a patient that has already had a tummy tuck, or some other sort of body contouring procedure. Nevertheless, some patients do request the procedure despite not having one. You must remember that even though we will try and keep the scars as short and inconspicuous as possible, the nature of this operation necessitates long cuts and, inevitably, long scars. Also although every effort will be made to keep the scars symmetrical, perfect symmetry is not always possible. The length of the scar will depend on how much excess skin you have. Typically, the scar will be all across the upper buttock, it will extend to the sides and possible the front. The scar can be hidden in the undergarments, this way only those that have permission can see it. You will therefore be asked to bring your favorite bikini or undergarment so as to leave the scars within these boundaries. (You must be realistic and not bring us the new Brazilian sting bikini). Scars are permanent and can be very obvious. In body lifting surgery the scars tend to be thick and sometimes wide, everyone heals differently and it will be up to your own bodies' ability to heal as to the quality of your final scar.

The key to a nice result is in the evaluation of the problem. The area that has the overhang needs to be carefully evaluated since it can be in three different areas. It can be in the lower buttock, the inner part of the buttock or on the sides of the buttock. Nearly all types of excess can be improved with the traditional buttock lift. (Placing the scar in the upper buttock area all across the back). However, sometimes, if you only have a localized area of excess skin, especially in the lower buttock area, then you can perform a limited excision of the skin, and the scars are left in the buttock crease. In this scenario you are not really lifting the buttock but rather giving the illusion of it being lifted. This would obviate the need of long extensive scars in your back. Dr. Mendieta will evaluate your particular anatomy and discuss the various procedures that are available. As you can see the options are several, the buttocks can be lifted with upper scars or it can appear to have been lifted with lower scars. During the traditional operation elliptical segments of skin and underlying fat are removed from the buttock area. The remaining skin and tissue are lifted to achieve a tightening and smoothing effect. The operation is designed to improve skin and underlying tissues that had become loose and flabby. Although the operation is often combined with liposuction, it is aimed primarily at the tightening of skin and deep tissue. The operation takes about 2-3 hours. If a larger buttock is desired an augmentation can be performed 3-6 months later.

What is the recuperation period and what to expect after?

You will have tape placed over the incisions and a body garment which you will need to wear for 3-4 weeks. You will be able to shower the next day but most patients wait two days. After showering, pat the incision dry or blow it dry with a cool hair dryer. Small amounts of oozing and bleeding are very common but should be no more than a slow staining of the dressing. Applying cold compresses, or ice packs will reduce swelling and relieve discomfort. Early ambulation is encouraged. Surgical drains are placed and will be removed around 7 days. Swelling will be present for up to 3-4 months but a dramatic difference is seen at about one month after your surgery. If you bruise it will take 3-4 weeks to disappear. The recovery tables are the following: It will take one week to10 days to return to work, but It will take a month before you feel like your normal self. Returning to the gym will take one month. The sutures are mostly internal but any external sutures will be removed at around10 days. The final scar will not be fully mature until one two years after the surgery. Sometimes it is normal to feel frustrated, anxious and even depressed at around the 7-14 day mark. Don't be alarmed this will pass.

The discomfort after the procedure is moderate; you will be given plenty of medicines so this is not a concern.

Your new look.

You will notice the change in your body shape almost immediately, however you will still be swollen, and the swelling will take about 3 months to completely disappear. You will need to wear a garment for about 3-4 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. The scar appearance will not be final until about one year later. If your expectations are realistic, you will probably be very pleased with the results of your surgery.

All buttock lift surgeries carry some uncertainty and risk.

Like any surgical procedures, complications although as rare as they may be, still exist. The Complications are:

1. Bleeding or Hematoma - This is a collection of blood. This can occur but it is extremely rare, if it does occur this would require exploration of the wound along with drainage of the hematoma and control of any bleeding if it is still present.

2. Infection - Again extremely rare, however if is this occurs you will have to take antibiotics that are specific to your particular infection. Oral antibiotics will usually solve the problem, rarely will it require IV antibiotics.

3. Skin sensation changes - This is common, you can experience, decrease sensation with either numbness or sweating of the buttock area along with temperature changes in the buttock, the sensation of (feeling cool or warm). This usually resolves over a one to three month period, and it is usually from swelling. The sensation should return although it may take some time, up to one year. Rarely is it permanent.

4. Wound healing problems or Wound dehiscence - This is seen more commonly in smokers and patient with poor wound healing, although it can occur in anyone. The wound may open up, requiring dressing changes until it heals. The area in which the incision is placed which is across the upper buttock has tension and is in an area that has constant traction. Therefore, in some patients minor wound problems develop, like the wound opens or has persistent drainage. This problem usually resolves on its own and it just a matter of letting time heal the wound. The scars can heal thick and sometimes a scar revision is needed.

5. Prolonged fluid drainage from the incision site - This usually is localized fluid that is around the incision site. Many times it may require the wound to be explored and make sure it is not a more severe infection. Often it is a suture that has become infected and needs to be removed. The solution may be to either remove the suture and the problem is solved or it may require that the wound be left open and allow it to heal on its own over time with the aid of dressing changes.

6. Bad scaring - This is perhaps the biggest problem with the operation. The scars will be red for the first few months after surgery, but they will gradually fade. You should realize that the scars are permanent, and that their final width, height and color are not totally predictable and this will depend on your own healing properties. Typically the buttock lift heals with wide scars since the wound closure is placed under tension. We try to keep the scar within the bikini line, this way only those that have permission can see it. Sometimes a scar revision can improve the appearance of the scar but this is never guaranteed. Some clever tricks have been to place a tattoo over the scar camouflaging any surgery. Keloids, hypertrophic scars and wide scars are all possible.

7. Asymmetry, one side of the buttock looks different than the other side - This really is not even a complication since it is part of our normal anatomy to have one side of the body different than the other. When we perform the augmentation, you may become more aware of the differences. If you look at your photos before surgery you will see that the differences exited before. You can count on having the scar being at different levels; it is not usually a straight scar since we have to apply different tension levels at different points. This is part to the operation and you have to be prepared for this.

8. Recurrence of the droopiness - This can occur, although rare, it is seen more commonly in patients that were very overweight and continued to loose body fat, or in patients with extremely excess skin. The correction would be to perform another body lift.

9. Pulmonary Embolism - This is a rare complication but it can happen with any surgery, it is a blood clot from the legs that goes to the lungs. We try and prevent this by placing stocking in the lower extremity and encourage early ambulation.