Aesth. Plast. Surg. 15:85-91, 1991
Aesthetic _ Plasuc Surgery 9 1991 Springer-Verlag New York Inc.
Gluteoplasty: A Ten-Year Report Mario Gonz~ilez-Ulloa, M.D. Mexico City, Mexico
Abstract. In 1979 the author published an article on torsoplasty which included plastic reconstruction and augmentation of the deformed gluteal region. Several cases are presented in this article which are followups to the type of gluteoplasty described ten years ago. It was found that there was considerable postoperative improvement for the patient and satisfaction for the surgeon. Key words: Gluteal region - - Deformities - - Aesthetic reconstruction - - Augmentation
Ten years ago [1] we described the distress felt by women with h y p o t r o p h y of the gluteal muscles ("sad b u t t o c k s " ) (Fig. 1B) and the satisfaction of the women with correctly positioned gluteal muscles (Fig. 1A). We described how we correct hemiatrophy of that part of the body as well as how we correct hypotrophic gluteal regions. This article discusses the preliminary work, the selection of the adequate prosthesis, the construction of the adequate prosthesis, the design of the incisions to introduce the prosthesis, and its proper implantation on site. Approximately ten years ago we saw our first patient who suffered a serious hemiatrophy. (Fig. 2A). Prosthesis of different shapes and volumes were designed until one was obtained that would replace the underdevelopment of this area (Fig. 2B). The adequate thickness and resistance of the covering were found by observing the maximum weight the Address reprint requests to Mario Gonzfdez-Ulloa, M.D., Dalinde Medical Center, Tuxpan 16-10 Piso, Mexico City 7, Mexico, D.F.
Fig. I(A) The typical "happy buttock": gluteal muscles displayed in their adequate position. (B) Hypotrophic gluteal muscles showing the typical "sad buttock"
covering had to withstand when the patient sat down abruptly (Fig. 2C). The impact produced by a body of medium weight is 200 kg. Thus, after compression tests we decided that the prosthesis would have to resist the impact of 300 kg. Shape and volume were designed to adapt to the various sizes and weights of different individuals (Fig. 3A). The prosthesis had to have the same consistency as the area when palpated. The first prosthesis designed were ordered with ears at the ends of the ovoid for fixation (Fig. 3B). Compared with young tissues (Fig. 4A), in the course of aging, the individual suffers muscular atrophy and the absorption of adipose tissue and a simultaneous loss of volume (Fig. 4B). Individuals with severe psychological trauma were selected for
86
Gluteoplasty
Fig. 2(A) Patient with serious hemiatrophy. (B) Prosthesis with different shapes and volumes were designed to place volume in this area. (C) The prosthesis had to have adequate thickness and resistance to withstand the maximum weight of the body upon sitting abruptly
Fig. 3(A) Prosthesis designed to adjust to various sizes and weights of different individuals. (B) The first prosthesis were designed with fixation ears at the ends
the first series o f procedures. The results were indeed positively dramatic. We learned to take radiographs that revealed the thickness of the muscular layer and o f the adipose tissue (Fig. 4C). We compared these radiographs with postoperative ones, to
determine the increase in the volume in the gluteal region (Fig. 4D). We have also learned that in slight hypotrophies, the volume can be improved with p r o p e r exercises instead o f surgically. Over time, the number of " b o d y professionals"
M. Gonz~ilez-UIIoa
87
Fig. 4(A) Young tissues that in the course of aging will suffer muscular atrophy. (B) Muscular atrophy and absorption of adipose tissue, which corresponds to loss of volume. (C) Radiographs that reveal depth of the muscular layer and of the adipose tissue. (D) A postoperative radiograph shows the increased volume attained
Fig. 5(A) Fibrosis and deformation of the gluteal area due to silicone, collagen, and guayacol injections and recent adipose tissue transplantation. (B) Cutaneous and adipose iatrogenic corrections plus adequate prosthesis implant to correct problems of this sort
appearing for consultation has increased in our practice. Some of these patients have suffered severe damage due to silicone, collagen, and guayacol injections and, relatively recently, adipose tissue transplantations, which caused serious fibrosis of
the area and deformation of the gluteal region (Fig. 5A). First we wanted to make cutaneous and adipose iatrogenic corrections. Once the c o v e r had been corrected, placement of the appropriate prosthesis was performed (Fig. 5B).
88
Gluteoplasty
Fig. 6(A) Outlining the implant's site; the vertex of the most prominent part must correspond to a tangent of m o n s v e n e r e upper part. (B) The wide part of the ovoidal prosthesis should correspond to the lower internal part of the region; its position oblique. Fixation points must be carefully marked
Fig. 7(A-C) Incisions placed in three important areas: (A) on both sides of the coccigeal region to reduce adipose tissue thickness of the area; (B) in the infragluteal sulcus to ease drainage and leave the most inconspicuous scar possible; (C) in the prolongation of the medial gluteal sulcus to avoid scarring
Procedure Outlining the implant site is extremely important. The vertex of the most prominent part of the prosthesis must correspond to a tangent to the upper part of m o n s v e n e r e (Fig. 6A). The wide part of the ovoidal prosthesis is placed at the lower internal part of the region. Its position must be oblique. Fixation points must be carefully marked (Fig. 6B). We have used incisions placed in three different areas: (1) on both sides of the coccigeal region to reduce simultaneously the thickness of the adipose tissue of this area; (2) in the infragluteal sulcus to ease drainage and to minimize scarring; (3) in the prolongation of the medial gluteal sulcus to avoid scarring. All three have functioned adequately though we actually use the latter more frequently
(Fig. 7A-C). The level of dissection is over the thin aponeurosis of the gluteal muscle (Fig. 8A). Undermining must be sufficient to reach the limits of the marking where the prosthesis will be placed so that when the skin contracts after surgery the demarcation limits of the prosthesis do not become visible (Fig. 8B). The prosthesis is fixed i n s i t u by a perforating pilot stitch (Fig. 8C) which keeps the prosthesis's ear facing out passing through a sponge tied over a button (Fig. 8D). The skin is separated from the adipose tissue and the site where the prosthesis remains is sutured with vicryl 3-0. The skin is sutured with 4 and 5-0 dermalon. Once the operation is finished, the fixation sutures are tied over a sponge and button (Fig. 9A). Eight days after surgery the button and fixation points are removed (Fig. 9C). Fifteen days after surgery on this patient, the scar was invisible, the skin was adequately
M. Gonzalez-UIIoa
89
Fig. 9(A) Fixation sutures tied over sponge and button. (B) Another angle of the result obtained. (C) Eight days postoperative: fixation sutures removed at this time
Fig. 8(A) Level of dissection over the thin aponeurosis of the gluteal muscle. (B) Ample undermining reaching over the outline of the prosthesis site so that postoperative skin contraction of the prosthesis limits does not become visible. (C) Prosthesis fixed in situ by a perforating pilot stitch. (D) It keeps the prosthesis ear facing outward passing through a sponge tied over buttons
tense, and there was an i m p r o v e m e n t in the cellulitis problem, which was a m a r k e d problem preoperatively (Figs. 10, 11). The patient seen in Figure 12 had h y p o t r o p h y of the gluteal region and wanted to improve. We per-
90
Gluteoplasty
Fig. 11. Patient shown seated after six months Fig. 10(A) Two weeks postoperative: profile view. (B) Result shown from behind. The scar is invisible, skin adequately tense, cellulitis problem improved
Fig. 12(A) Patient suffering gluteal hypotrophy. Correction attained through a medial incision, ample skin undermining, and prosthesis implant. (B) Postoperative view
Fig. 13(A) Patient with severe iatrogenic problem caused by guayacol injections. This closeup shows the gluteal region condition after several interventions to correct this problem. (B) Result shown after plastic correction. (C,D) Postoperative views
M. Gonz~ilez-UIIoa
formed a medial incision, undermining the skin to introduce the prosthesis (Fig. 12A). The results are seen in Figure 12B. Figure 13A shows a "body professional" with a severe iatrogenic problem caused by guayacol (gadital iodico). This closeup shows the gluteal region
91
after several interventions to eliminate the damaged area. Figures 13B-D show the results of our work. Reference
I. Gonz(dez-Ulloa M: Torsoplasty. Aesth Plast Surg 3:357-368, 1979
Aesthetic _ Plasuc Surgery 9 1991 Springer-Verlag New York Inc.
Gluteoplasty: A Ten-Year Report Mario Gonz~ilez-Ulloa, M.D. Mexico City, Mexico
Abstract. In 1979 the author published an article on torsoplasty which included plastic reconstruction and augmentation of the deformed gluteal region. Several cases are presented in this article which are followups to the type of gluteoplasty described ten years ago. It was found that there was considerable postoperative improvement for the patient and satisfaction for the surgeon. Key words: Gluteal region - - Deformities - - Aesthetic reconstruction - - Augmentation
Ten years ago [1] we described the distress felt by women with h y p o t r o p h y of the gluteal muscles ("sad b u t t o c k s " ) (Fig. 1B) and the satisfaction of the women with correctly positioned gluteal muscles (Fig. 1A). We described how we correct hemiatrophy of that part of the body as well as how we correct hypotrophic gluteal regions. This article discusses the preliminary work, the selection of the adequate prosthesis, the construction of the adequate prosthesis, the design of the incisions to introduce the prosthesis, and its proper implantation on site. Approximately ten years ago we saw our first patient who suffered a serious hemiatrophy. (Fig. 2A). Prosthesis of different shapes and volumes were designed until one was obtained that would replace the underdevelopment of this area (Fig. 2B). The adequate thickness and resistance of the covering were found by observing the maximum weight the Address reprint requests to Mario Gonzfdez-Ulloa, M.D., Dalinde Medical Center, Tuxpan 16-10 Piso, Mexico City 7, Mexico, D.F.
Fig. I(A) The typical "happy buttock": gluteal muscles displayed in their adequate position. (B) Hypotrophic gluteal muscles showing the typical "sad buttock"
covering had to withstand when the patient sat down abruptly (Fig. 2C). The impact produced by a body of medium weight is 200 kg. Thus, after compression tests we decided that the prosthesis would have to resist the impact of 300 kg. Shape and volume were designed to adapt to the various sizes and weights of different individuals (Fig. 3A). The prosthesis had to have the same consistency as the area when palpated. The first prosthesis designed were ordered with ears at the ends of the ovoid for fixation (Fig. 3B). Compared with young tissues (Fig. 4A), in the course of aging, the individual suffers muscular atrophy and the absorption of adipose tissue and a simultaneous loss of volume (Fig. 4B). Individuals with severe psychological trauma were selected for
86
Gluteoplasty
Fig. 2(A) Patient with serious hemiatrophy. (B) Prosthesis with different shapes and volumes were designed to place volume in this area. (C) The prosthesis had to have adequate thickness and resistance to withstand the maximum weight of the body upon sitting abruptly
Fig. 3(A) Prosthesis designed to adjust to various sizes and weights of different individuals. (B) The first prosthesis were designed with fixation ears at the ends
the first series o f procedures. The results were indeed positively dramatic. We learned to take radiographs that revealed the thickness of the muscular layer and o f the adipose tissue (Fig. 4C). We compared these radiographs with postoperative ones, to
determine the increase in the volume in the gluteal region (Fig. 4D). We have also learned that in slight hypotrophies, the volume can be improved with p r o p e r exercises instead o f surgically. Over time, the number of " b o d y professionals"
M. Gonz~ilez-UIIoa
87
Fig. 4(A) Young tissues that in the course of aging will suffer muscular atrophy. (B) Muscular atrophy and absorption of adipose tissue, which corresponds to loss of volume. (C) Radiographs that reveal depth of the muscular layer and of the adipose tissue. (D) A postoperative radiograph shows the increased volume attained
Fig. 5(A) Fibrosis and deformation of the gluteal area due to silicone, collagen, and guayacol injections and recent adipose tissue transplantation. (B) Cutaneous and adipose iatrogenic corrections plus adequate prosthesis implant to correct problems of this sort
appearing for consultation has increased in our practice. Some of these patients have suffered severe damage due to silicone, collagen, and guayacol injections and, relatively recently, adipose tissue transplantations, which caused serious fibrosis of
the area and deformation of the gluteal region (Fig. 5A). First we wanted to make cutaneous and adipose iatrogenic corrections. Once the c o v e r had been corrected, placement of the appropriate prosthesis was performed (Fig. 5B).
88
Gluteoplasty
Fig. 6(A) Outlining the implant's site; the vertex of the most prominent part must correspond to a tangent of m o n s v e n e r e upper part. (B) The wide part of the ovoidal prosthesis should correspond to the lower internal part of the region; its position oblique. Fixation points must be carefully marked
Fig. 7(A-C) Incisions placed in three important areas: (A) on both sides of the coccigeal region to reduce adipose tissue thickness of the area; (B) in the infragluteal sulcus to ease drainage and leave the most inconspicuous scar possible; (C) in the prolongation of the medial gluteal sulcus to avoid scarring
Procedure Outlining the implant site is extremely important. The vertex of the most prominent part of the prosthesis must correspond to a tangent to the upper part of m o n s v e n e r e (Fig. 6A). The wide part of the ovoidal prosthesis is placed at the lower internal part of the region. Its position must be oblique. Fixation points must be carefully marked (Fig. 6B). We have used incisions placed in three different areas: (1) on both sides of the coccigeal region to reduce simultaneously the thickness of the adipose tissue of this area; (2) in the infragluteal sulcus to ease drainage and to minimize scarring; (3) in the prolongation of the medial gluteal sulcus to avoid scarring. All three have functioned adequately though we actually use the latter more frequently
(Fig. 7A-C). The level of dissection is over the thin aponeurosis of the gluteal muscle (Fig. 8A). Undermining must be sufficient to reach the limits of the marking where the prosthesis will be placed so that when the skin contracts after surgery the demarcation limits of the prosthesis do not become visible (Fig. 8B). The prosthesis is fixed i n s i t u by a perforating pilot stitch (Fig. 8C) which keeps the prosthesis's ear facing out passing through a sponge tied over a button (Fig. 8D). The skin is separated from the adipose tissue and the site where the prosthesis remains is sutured with vicryl 3-0. The skin is sutured with 4 and 5-0 dermalon. Once the operation is finished, the fixation sutures are tied over a sponge and button (Fig. 9A). Eight days after surgery the button and fixation points are removed (Fig. 9C). Fifteen days after surgery on this patient, the scar was invisible, the skin was adequately
M. Gonzalez-UIIoa
89
Fig. 9(A) Fixation sutures tied over sponge and button. (B) Another angle of the result obtained. (C) Eight days postoperative: fixation sutures removed at this time
Fig. 8(A) Level of dissection over the thin aponeurosis of the gluteal muscle. (B) Ample undermining reaching over the outline of the prosthesis site so that postoperative skin contraction of the prosthesis limits does not become visible. (C) Prosthesis fixed in situ by a perforating pilot stitch. (D) It keeps the prosthesis ear facing outward passing through a sponge tied over buttons
tense, and there was an i m p r o v e m e n t in the cellulitis problem, which was a m a r k e d problem preoperatively (Figs. 10, 11). The patient seen in Figure 12 had h y p o t r o p h y of the gluteal region and wanted to improve. We per-
90
Gluteoplasty
Fig. 11. Patient shown seated after six months Fig. 10(A) Two weeks postoperative: profile view. (B) Result shown from behind. The scar is invisible, skin adequately tense, cellulitis problem improved
Fig. 12(A) Patient suffering gluteal hypotrophy. Correction attained through a medial incision, ample skin undermining, and prosthesis implant. (B) Postoperative view
Fig. 13(A) Patient with severe iatrogenic problem caused by guayacol injections. This closeup shows the gluteal region condition after several interventions to correct this problem. (B) Result shown after plastic correction. (C,D) Postoperative views
M. Gonz~ilez-UIIoa
formed a medial incision, undermining the skin to introduce the prosthesis (Fig. 12A). The results are seen in Figure 12B. Figure 13A shows a "body professional" with a severe iatrogenic problem caused by guayacol (gadital iodico). This closeup shows the gluteal region
91
after several interventions to eliminate the damaged area. Figures 13B-D show the results of our work. Reference
I. Gonz(dez-Ulloa M: Torsoplasty. Aesth Plast Surg 3:357-368, 1979
