Buttock augmentation with fat
This technique has a great amount of appeal - we are using your own body fat and transferring it to your buttock. 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. Many of us like to work with fat because it has some very interesting properties. For example, wherever the fat is transferred to it takes on the same characteristics; if we inject fat into muscle it feels like muscle, if we place it next to bone it feels like bone, if we place it in fat well it feels like fat. 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. By now you can see why fat cells are very sensitive and it requires special techniques to make it work. The goal is to have the fat incorporate into the area that it is being injected too. In order to accomplish this, it has to be placed in different layers so that the blood supply can get to the fat and make the fat survive. This is why when we perform the procedure we place the fat deeply into the muscle and fat in several different layers so as to create a smooth augmentation without irregularities.
Immediately after the procedure some swelling is present and as the swelling improves most patients 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.
The fat is taken from wherever you have fat excess, the usual places will be: the flank area, the outer legs, the upper/outer buttock. Taking fat from these areas will give you the appearance as if the buttock had been lifted and reshaped, helping in defining the gluteus even further. The amount of fat needed will be different for everyone, but on the average we will need to inject about 250-350 cc’s of pure fat for each side. This amounts to almost 700 cc which is about ½-¾ of a pound of fat. This is a good amount of fat, therefore, if you are very thin, with very little fat and you want more buttock volume or better buttock shape, then you need something that is more predictable and an implant is the way to go. On the other hand, if you have some fat to spare and you were mainly interested in better contour of the buttock area, then fat transfer will be a great option. This way, if the fat does not all survive then you have achieved the goal you wanted. Remember that almost all buttocks will look better with some added volume. I have been amazed at how much nicer the gluteus looks when more is added. It is not the amount of fat present but where the fat is located that really defines the shape. I almost always suggest some form of gluteal augmentation to most patients that are interested in buttock contouring.
In order to dispel some fears about fat, it does not feel lumpy bumpy, it does not create cellulite, it does not cause irregularities. As a matter of fact, it is used to correct deformities and irregularities. Like we discussed, the feel is very natural and it will appear like it was always your own buttock, after all - it is, since the fat has incorporated and now has become part of your muscle and fat.
The recuperation period will center on how long it takes you to recuperate from the liposuction. The buttock area does not hurt; the discomfort is from the areas that were liposuctioned. The incisions are very small and are the same ones used for the liposuction. You will need to wear a body garment for about 3-4 weeks, you may return to work in about 3-5 days, but it will take one month before you feel completely normal. Sitting can be done the next day and returning to the gym will take 2-4 weeks.

  Buttocks Implants
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. Tavoussi - 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.
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 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.
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:
o 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,
o 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,
o 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?
o 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.
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?
Buttock augmentation is an outpatient procedure that takes about one hour to perform. If liposuction is being done, then it may take an additional ½ 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.
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.