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AESTHETIC FOCUS Transcutaneous scarless buttock lift via the Serdev Suture® Technique

BY NIKOLAY P SERDEV

hanging are visible even from he Serdev Suture® buttock lift Formerly results of body contouring surgery a frontal view (Figure 1) and shorten the presents a scarless surgical have been less than satisfying. A very small length of female lower limbs. The hanging procedure for the treatment of the number of techniques are available for buttocks is well recognised as flaccid, flat and ‘unhappy buttock’ correction of the form and the aesthetics of T ‘unhappy buttocks’ as distinct from the high form by a closed approach without any the buttocks. This is especially so for the lax, gluteal position known as ‘happy buttocks’. requirement for incision and excision ptotic and non-projected buttocks. Scarless . The outcome is a visual change in methods are preferred and demanded by buttock projection, roundness, tightness virtually all patients. Fixation of mobile to and elevates it into a higher position. The Classic methods are combinations immobile tissue buttock lift elongates the lower limbs and of liposuction, lipoinjections, implants The only useful mobile tissue for suture lift changes the proportions of the body. The for augmentation and lipectomy. The is the very fibrotic buttocks soft tissue. N.B. aim is to obtain a beautification of the outpatient buttock lift procedure by gluteus muscles and gluteus cannot be buttock form by creating a circumferential suture can satisfy patients’ requirements lifted. The only immobile structure to which lifting effect on the buttock’s subcutaneous for beautification of the buttock form and the suture can be fixed in order to produce tissue without scars. This is obtained position without scars. The postoperative buttock lifting and secure the buttock by the use of a suture that takes hold of period is both short and easily tolerated weight is the Serdev ‘sacro-cutaneous’ the inferiorly positioned deep fibrous while the outcome is durable and long- fascia (discovered by the author) which tissue, elevating and fixing it to the lasting. fixes the to the lateral edges of the sacro-cutaneous fascia (discovered by sacrum, located between the ‘dimples of the author). This fascia fixes the overlying Anatomy Venus’ at the sacro-iliac points and the upper point of the infra-gluteal fold, located skin to the lateral lines of the sacrum The well accepted gluteal position is the at the sacro-coccigeal point (Figure 2). N.B. and suspends the weight of the buttocks. location of the muscle. Sacro-coccigeal fascia is not useful for fixation. Essential equipment consists of a long, The muscle-sceletal framework is usually Any attempt to attach the buttocks weight curved, semi-elastic needle and Polycon well formed [5]. The female structure often to the sacro-coccigeal fascia can provoke an No 4, 6 or 8 (elastic Bulgarian antimicrobial includes an inferiorly positioned fatty tissue ‘ischiadic’ . polycaproamide threads). This operation deposit, elongating the female buttocks The gluteal fatty tissue is very fibrotic. can be performed either as a standalone in the inferior perspective [2,4]. Long and procedure or after ultrasonic assisted The fibrotic tissue represents a flexible liposculpture (UAL) that serves to reduce support for the soft framework of the body the amount of and weight of the [4]. It forms a stable network for subdermal buttocks [1-4]. and deep fat layers. We use this stable A stable improvement in the buttock fibrotic buttock soft tissue structure in position and form was observed in all order to elevate it securely by fixation to the patients. In the postoperative period the Serdev fascia on each side. complication rate was minimal and resolved in the first four to five postoperative days. Some pain in the sitting position for at least A five to 10 days has been reported. However, all other professional duties, social activities or obligations were possible. This outpatient procedure is effective in the correction of buttock laxity and ptosis. It also creates a new form along with improved body proportions that have been universally accepted as ’happy buttocks’.

Introduction B As more people seek body contouring Figure 2: The Serdev ‘sacro-cutaneous’ fascia fixes the surgery, we should use our expanding Figure 1A: ‘Unhappy’ sagging loose buttock soft skin to lateral edges of the sacrum in the lower part of the knowledge and surgical experience to tissue, drooping between the , can lead females ‘rhombus of Michaelis’. It is located on each side between to request buttock lifting. B: ‘Happy buttocks’ – the the ‘’ and the upper point of the intra- create new non-scarring surgical procedures outcome of lifting of the hanging buttocks is visually gluteal fold, i.e. between the sacro-iliac points and the for beautification in areas like the buttocks. elongated legs and more aesthetic body proportions. sacro-coccigeal point.

pmfa news | FEBRUARY/MARCH 2015 | VOL 2 NO 3 | www.pmfanews.com AESTHETIC FOCUS

Indications polycaproamide suture Polycon (as The procedure can be used for: preferred by the author) reduces the A beautification, aesthetic proportions, lifting possibility of trauma of the fibrotic tissue of ptosis, elongation of the lower limbs, and and reduces complications. shortening of the body length in proportion The buttock lift by suture requires 10 to to the legs. 15 minutes of operating time per side, no The primary indication for buttock blood transfusions, no stay at the clinic, no lift surgery by suture is the moderate to nursing care and no more than a day or two severe soft-tissue laxity in the lower trunk off work. with minimal or mild residual fat deposits. A minimum of three passes are necessary In patients with significant fat deposits to complete fixation of the buttock fibrotic we initially treat with UAL to reduce the soft tissue system to Serdev fascia, which volume and heaviness of the buttock fat realises a lift, roundness, projection and tissue. Then we can lift the reduced weight stable fixation of the mobile lower buttock B of the buttocks soft tissue and fix it to the to the immobile Serdev fascia. Two Serdev fascia in order to ensure a safe methods are presented: postoperative healing process. A. First pass from A to B1, then change The buttock lift by suture was created direction of the needle to B but higher than for aesthetic purposes with the intention the anus (B1 is only an orientation, not a skin of creating higher and more attractively perforation point). Thread is introduced into rounded and projected buttocks, while B-A. Second pass C-B to take the thread at the same time creating a visible at B. Third pass C-A takes the thread at A elongation of the legs and a change of the and fulfills the circle of the suture at C to correlation between body and lower be tightened and knotted on Serdev fascia. If no is attached to the suture, all length. True buttock sculpting demands a Figure 3: ‘Serdev fascia’ is marked in red colour. It is three-dimensional artistic appreciation of dimples at perforation points are easy to perpendicular to skin and sacrum and the suture with the anatomic and surgical adipose layers remove. buttock heaviness will hang on it. Arrows show the direction of needle passes. of the central trunk. This is essential in B. Sometimes it is easier for beginners preventing complications from the buttock to perform two passes at once – to start lifting where the fixation is done without from B to C and introduce the thread from and widened to avoid perforation with damaging neurovascular structures. C in direction to B, to change the direction the needle and introduction into the of the needle tip to A without to exit the suture. Otherwise its attachment to the The technique superficial fascia at B. This manoeuvre suture will produce dimpling. The author’s surgical technique consists of a prevents beginners from dimpling at point • Point C should be between both Serdev fixation of the complete buttock soft tissue B. After introducing the thread in lines , inside of the triangle of the fibrotic system to the sacro-cutaneous C-B-A, the third pass C-A introduces the sacral region. This will ensure that the fascia each side [4]. The suture technique thread in line A-C and fulfils the suture passes C-B and C-A both sides will cross uses the specially designed Serdev needles circle at C. The suture will be tightened the Serdev fascia from below and above from 170 to 250mm, and Polycon No 4, 6 or and knotted at C. Dimpling at a perforation and the suture will be fixed to the Serdev 8, depending on the degree of tissue volume point has to be removed. fascia. Serdev fascia is perpendicular to and heaviness. skin and sacral edges in the soft tissue The surgeon has to decide which of the Directions and the weight of the suture will be perforation points to start from, in what Mark skin perforation points A, B1, B and suspended on it. sequence the passes will be done, and in C. Point A should be located lateral at the • Perforation of sacro-coccigeal fascia and which point to tie the knot. The author midpoint of each buttock, near the place fixing the suture on it can produce an prefers the first step for fixation of the where the trochanter can be palpated. This ischiadic pain. subdermal fibrotic tissue to be initiated ensures equal distance to points B and C. • Do not fix gluteus fascia or gluteus from the lateral aspect of the buttock. It muscle to the suture. Both are immobile is easier for beginners to tie the suture at Tips and tricks and will not permit lifting. point C (Figure 3). Selection of thread type • Perforation point B could be located After anaesthetic infiltration intradermally is the surgeon’s responsibility. However, above the anus (preferable because and deep in planned perforation points A, B the elastic tightening of the Polycon of hygienic reasons) or below and and C, and deep in the soft tissue along the suture provides a stable support with a somewhat lateral from anus to secure marked suture circle, make small incisions short elasticity when lifting the buttock point B from contamination. at points A, B and C and open incision into a higher position and fixing it to the • If skin perforation point B is planned and deep subdermal fat in perpendicular stable sacro-cutaneous fascia. The suture higher than the anus, an imaginary point fashion with ‘mosquito’ haemostat. Take collects the buttocks fibrotic tissue and B1 should be taken into consideration sterile needle caps from an 18-guage its trabecular system into a superficially and when arriving from point A deep needle, cut part of the closed needle cap convex ‘bouquet’. This roundness is moved under point B1, the needle direction tip. Insert these plastic cannulae in twisting superiorly and fixed to the sacro-cutaneous should be changed to B as shown in perpendicular fashion until maximum fascia. The fixation of the suture to the Figure 3A. depth into perforation points A, B and C in stable inelastic fascia maximally ensures • If perforation point B is planned below order for the suture to stay deep in the fat the longevity of the aesthetic effect. The the anus, the superficial fascia at that fibrotic tissue (near but above the gluteus semi-elastic quality of the antimicrobial point B should be perforated very well fascia).

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Visit http://www.youtube.com/ Remove cannulae, tighten and knot at C. care and not more than a day or two off watch?v=mn0O2bNkG7o to access a video Remove dimpling. Tie the suture as closely work. of the technique. as possible to medium tension. This way The cosmetic results were evaluated the whole buttock tissue will be collected with preoperative and postoperative First pass A-B and projected like a ‘bouquet’ by the suture photographs and by patient satisfaction. It should be deep in the soft tissue, two and fixed higher to the Serdev fascia. Pull No patient was dissatisfied with the results higher than the infra-gluteal fold out all dimpling at points A, B and C using a and all of them considered their results as (see Figure 3) in order to stretch and flatten mosquito haemostat. excellent or very good. it when the buttock is lifted. Introduce a N.B. Do not perform suture triangles ABC. long Serdev needle 170mm or 230mm from The higher pressure in the angles will cut the Risks and complications point A to point B1 deep in the soft fibrotic tissue and the suture will become loose. The Risks are: higher pressure on one tissue fat tissue. N.B. The Serdev suture circle should circle of the suture should be round to apply being different from the tension in other be located deep above the gluteus maximus equal pressure at each point and minimise areas and points; contamination – skin fascia. Be sure not to be too superficial as it trauma of the tissue. perforation point B near the anus area. will cause skin / tissue dimpling on the way of The close proximity of the wounds to the Higher pressure should be prevented by the needle. If so, twist the needle backwards to anus area makes antibiotic prophylaxis and performing a circle – a round form suture free the superficial tissue and proceed deeper. strict hygiene obligatory. that equalises pressure on all points Stay near but above the gluteus fascia, which and prevents tension and trauma of the will block your needle if perforated. Arriving Warnings tissue. Infection can be prevented with deep at B1, turn the needle to B as shown in 1. Do not perforate gluteal fascia or better selection of point B and antibiotic Figure 3A. Find the deep positioned opening muscle. They cannot be lifted. prophylaxis. The Bulgarian thread is of the plastic cannula. Go out through the 2. Do not perforate at point C the antimicrobial. plastic hub. Load needle at point B with a sacro-coccigeal fascia or periosteum – In our patients we observed one case thread No 4, 6 or 8 (depending on buttock causes ischiadic pain. with a painful hardness in point B near size) and pull through. The thread will be 3. Make a circular suture to obtain equal the infra-gluteal fold and four other cases located deep in the soft tissue in the mobile pressure around all points. Do not with a local infection in one of the wounds. line B-A. N.B. Introducing the cannula deeply perform triangle sutures – tension The cause for the first complication was avoids engaging the dermis and fibrotic tissue on the angles will cut the tissue and the rigid nylon suture that we used in our in the suture and prevents dimple formation. produce pain. first patient. The hardness and inelasticity caused tissue trauma in the point of tension Second pass C-B Author’s experience on the soft tissue. After this complication Proceed from point C to B, deep in the fat More than 1000 buttock lifts have been we avoided this risk by changing the suture tissue, 1-2cm away from the gluteal fold performed by the author in the last 19 material and we now use the semi-elastic (without superficial skin / tissue dimpling). years in his clinic and during live surgery Bulgarian antimicrobial Polycon suture. N.B. If dimpling appears, the needle is too workshops around the world in cases of In all other cases the local infection was superficially located. Proceed deeper without ptotic buttocks between 1993 and 2011. easily treated in a matter of days. Infections perforating the sacro-coccigeal fascia (pain!) Patients ranged in age from 18 to 62 years. are very rare occurring mainly at the skin Find and exit through the plastic hub at We report our experience with patients perforation points and are easily treated. point B and load needle. Pull through from followed up to 10 years. No haematoma or damage has B to C. This way the suture has crossed the been observed. Pain is limited to the first Serdev fascia medially. Combined methods one to two weeks in a sitting position. In Sixty-three percent of the patients had limited cases patients forget about or Third pass has two options – A-C or C-A: moderate lower trunk and lower limb ignore the advice given to commence Pass A-C: Load needle tip at A. From A, cellulite and fat deposits which required physical activities gradually. In these few proceed to C – deep subdermally without additional ultrasonic liposculpture of the and limited cases abnormal friction and superficial dimpling and cross lateral lower body and limbs. In patients who trauma can cause pain that is usually on through the upper Serdev fascia. Perforate have had buttock lift in combination with one side. Palpation along the suture gives the Serdev fascia near the upper pole and ultrasonic assisted liposculpture, UAL information about the location of the pain, exit at point C through the plastic hub. was performed to reduce the volume usually near a perforation point. Unload the needle at C and pull back the and to sculpture the buttocks and other In very rare cases, we have opened the empty needle through point A. The suture areas for total leg or body beautification. skin perforation and some seroma or circle is finalised and both ends of the UAL additional positive qualities are skin blood drops have been evacuated with the suture are located at C. Remove cannulae, tightening and weight loss. When using disappearance of the pain. If there is no tighten and knot. Remove dimpling at the UAL for buttock sculpturing, our goal infiltration around the suture, slowing down perforation points. N.B. If you want to tighten is to minimise the fat deposits, buttock’s activities, non-steroid anti-inflammatory the knot at point A, proceed with an empty weight and to obtain a nice rounded and drugs and painkillers are enough. needle from A to C and load needle at C. higher positioned buttocks over the gluteus Antibiotics can be added if considered Introduce thread at C-A. Then you will have maximus muscle. necessary. both ends at A. Tightening and knotting the suture at A is somewhat difficult for beginners. Results Discussion Most doctors prefer to knot at C. As previously stated the buttock lift There is an increasing demand for surgical Pass C-A: From C, proceed to A, load by suture requires 10 to 15 minutes of correction of the body contour in modern needle tip at A and unload it at C. Both operating time per side, no blood loss or society. There are a limited number ends of the suture will be located at C. transfusions, no stay at the clinic, no nursing of operations that aim to correct non-

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Clinical cases A B C D

Figure 4A and C: Before UAL and buttock lift; B and D: Day one after ultrasonic liposculpturing of lower extremities, buttocks and flanks and simultaneous buttock lift by Serdev Suture®. Preoperative drawings are still visible. Very rare bruising verifies that surgery has been atraumatic. Tight higher buttocks and straight and elongated legs are demonstrated.

A B

Figure 6A: Before; B: After buttock lift by Serdev suture. Visible elongation of the lower extremities and shortening of the trunk after buttock lift. A B

Figure 5: Result after a buttock lift by suture in a dancer. Elongation of the legs is shown. Better projection and higher buttocks are visible even in anterior half-profile position. Profile view: Higher rounded buttock form is achieved. No incision scars persist. The puncture scar 1-2mm in diameter in the lateral area of the buttock isn’t visible. C D

RIGHT: Figure 7A and C: Before; B and D: Result after buttock lift by suture in a 62-year-old-patient. The buttocks are visibly lifted and a better-rounded form is obtained. There is improvement of the whole .

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aesthetic buttock form as part of total because of the poor vascularisation of are significant. Meticulous haemostasis, body contouring and proportions. The certain areas, the limited mobilisation of limited undermining, and the closure of , thighs and the lower back frame the the soft tissue, and the tendency toward dead space are factors that produce a buttock contours. Ethnic differences in poor scar formation. These factors limit more reliable procedure, both in terms the shape and proportions of the buttocks the surgical techniques available. The of postoperative problems and the final create a variety of aesthetic perceptions in tendency for the deformity to recur may results [15,23]. size and shape. However, high positioned necessitate several corrective procedures. In obesity suture lifts are not indicated. ‘happy’ buttocks and elongated legs have The deep planed - is The excision surgical procedures are always been in fashion. beneficial for treating gestation sequelae associated with risks. The undesired Flat and sagging buttocks are a common of the torso-, ptosis of sequelae of suction lipectomy are contour clinical condition. However, before the the , vertical and horizontal irregularities, hypaesthesia, oedema, suture butt lift there were no proven enlargements of the musculoaponeurotic ecchymosis and pigmentary deposits. The aesthetic and effective therapeutic options system, lipodystrophy, stretch marks, potential complications are blood loss, at . excision of skin cannot rhytidosis of the inguinal region, and ptosis haematoma, seroma, infection, greater perform a true lift of the heavy buttocks. of the external quadrant of the gluteus and saphenous vein thrombosis, fat emboli Subcision is a surgical technique that the external trochanter area in one surgical and skin slough. In excision procedures is used in treating advanced degrees of procedure. It creates pexy of the external additional complications are spreading cellulite [6]. To treat excesses of fat and quadrant of the gluteus region [23,24]. scars as a result of tension, and occasional skin tissue in that area, liposuction and / Muscle strength is the limiting factor delayed healing of tense wounds. Excision or dermolipectomy are mostly used [7]. in repetitive lifting. Lower body lift with buttock lifts have not gained widespread The indication for liposuction is restricted superficial fascial system suspension is acceptance because of problems such as to the conditions in which the overlying introduced to treat laxity of the entire large trauma and blood loss, prolonged skin is capable to retract and adapt itself lower trunk and regions in one stage postoperative period, early inferior scar to the new contour. If excess skin is the in selected patients. This procedure needs migration, and recurrence of ptosis. The cause of the deformity, a dermolipectomy three weeks off work and is expected to most frequent complaint is unacceptable is mostly indicated [8-15]. Liposuction of the result in a tightening of the , buttocks scarring and hypaesthesia. Lipoinjection buttock area is infrequently mentioned in and total thighs. Minor complications complications are gluteal temporal the literature and for some authors it is a are significantly higher than with the hyperaemia and erythema, corresponding forbidden zone. Two additional approaches component procedures alone and occur in to fat necrosis. Acceptance of bodily in suction lipectomy of the buttock region nearly 50% of patients. Another surgical proportions in races different from are described: liposuction of the ‘banana’ procedure, a circumferential torso excision those of Caucasians has to be foreseen. and liposuction of the ‘sensuous triangle’. was designed and utilised for a minimal Furthermore, Afro-Americans and Asians A common complication of liposuction number of patients [11,12]. This technique tend to hypertrophic scarring. of this area is ptosis of the buttocks dramatically reduces the lateral flank [16,17]. To improve buttock roundness, fat and posterior tissue rolls to improve the Conclusion transplantation and different implants, operative results. Contour improvement Redundant tissue in sagging buttocks can including mammary ones, were introduced of the buttocks and lateral thighs should be corrected by excision lifts. However, [16,18-22]. In trying to achieve symmetry be present as well. Belt lipectomy [13] these are seldom used procedures and better contour of the back torso and includes the traditional abdominoplasty because of postoperative problems such middle third of the body, the combination or panniculectomy with excision extended as unacceptable inferior displacement, of liposuction and lipoinjection has rapidly laterally around the entire trunk. This wide scars, early recurrence of ptosis, become known and is a procedure of choice technique yields a lateral thigh and buttock large trauma, blood loss and a prolonged for many authors [16]. Complications are lift, and when combined with liposuction is postoperative period. minimal. The quantity of fat infiltrated by used to improve contour of the thighs. In order to limit these complications most authors varies from 120 to 280cc per Correction of sequelae of primary in flat and sagging buttocks without gluteus, with a mean of 210cc. -buttock-thigh plasty has become a remarkable fat deposits, we developed a In obese patients the functional benefits common challenge in aesthetic plastic surgical technique using a circumferential of a combination ‘excision-suction’ surgery. Some authors have suggested suture of the soft tissue to the gluteus lipectomy outweigh the disadvantages of alternative techniques for dealing with this fascia. The circumferential suspension the scarring. If there is considerable excess problem, including denuding the skin at the gives strong vertical support with minimal of skin and tissue, excision procedures depressed area, pulling flaps upward and tension in each point and reduces the are performed to remove excess tissue outward, using dermal buried flaps, and complications traditionally associated by surgical resection via appropriately utilising liposuction [10,14,16]. Liposuction with such procedures. The author’s suture large incisions. Resulting scars are visible. can be used successfully in combination lift operation offers fewer complications Lipectomy with suction of the lower with classic hip-buttock-thigh plasty to than any others described. It is an extremities has been practised in recent enhance the aesthetic result [16]. Excision efficient and safe procedure to correct or years. Due to some authors the number of body lifts are surgical procedures that are enhance buttock contour. It has virtually overweight and bariatric patients seeking infrequently performed because the length eliminated blood transfusions and the dermolipectomy of the trunk and thighs is of operating time increases the risk to the major complications of liposuction increasing. The so-called ‘lower body lift’ patient as well as the likelihood of surgeon and dermolipectomies under general combines the transverse flank / thigh / fatigue. The other drawback of body lifts anaesthesia. buttock lift and the fascial anchoring medial is the long incision line. However, these In patients whose problem was excessive thigh lift in one operation. Secondary incisions are well accepted if they are well fat in conjunction with flabbiness, UAL of buttock corrections pose difficult problems placed and if the results of body change the buttocks combined with the buttock

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suture lift method completed the main References 16. Cardenas-Camarena L, Lacouture AM, Tobar-Losada A. Combined gluteoplasty: liposuction and goals of the procedure in one or more 1. Serdev NP. ‘Buttock lift. Two own methods.’ Presented at the 3rd International Congress of the South- lipoinjection. Plast Reconstr Surg 1999;104(5): stages. The combination of UAL and American Academy of Cosmetic Surgery; Buenos 1524-31. buttock lift by our suture technique is a Aires, Argentina; 19-21 October 2001. 17. Lawrence N, Coleman WP 3rd. The biologic basis of ultrasonic liposuction. Dermatol Surg minimally invasive procedure that can be 2. Serdev NP. Buttocks lift by ultrasonic assisted liposuction: My technique. International Journal of 1997;23(12):1197-200. used to reduce and lift the buttocks at the Aesthetic Cosmetic Beauty Surgery 1991;1(3):130-54. 18. Chajchir A. Fat injection: long-term follow-up. same time. 3. Serdev NP. ‘Buttocks lifting without implants - Serdev Aesthetic Plast Surg 1996;20(4):291-6. technique no visible scars.’ Aesthetic Surgery Course; 19. Agris J. Use of dermal-fat suspension flaps for thigh The Serdev Suture® buttock lift Sofia, Bulgaria; 26 November 2001. and buttock lifts. Plast Reconstr Surg 1977;59(6):817- technique is simple and low in cost with 4. Serdev NP. Suture Suspensions For Lifting Or Volume 22. minimal morbidity and very good results. It Augmentation In And Body (English version). Int 20. Niechajev I, Sevcuk O. Long-term results of fat J Aesth Cosm 2001;1(1):2561-8. transplantation: clinical and histologic studies. Plast is important to note that a good result does 5. Anikina TI. Soft framework of the . Arkh Reconstr Surg 1994;94(3):496-506. not depend on great surgery but rather on Anat Gistol Embriol 1980;78(3):5-15. 21. Pereira LH, Radwanski HN. Fat grafting of the more simple and acceptable procedures for 6. Hexsel DM, Mazzuco R. Subcision: a treatment for buttocks and lower limbs. Aesthetic Plast Surg 1996;20(5):409-16. the patients. Outcomes include harmonious cellulite. Int J Dermatol 2000;39(7):539-44. 7. Teimourian B, Adham MN. Anterior periosteal dermal 22. Peren PA, Gomez JB, Guerrerosantos J, Salazar CA. structuring and positioning of the form, suspension with suction curettage for lateral thigh Gluteus augmentation with fat grafting. Aesthetic lifting of the lower portion of the buttocks, lipectomy. Aesthetic Plast Surg 1982;6(4):207-9. Plast Surg 2000;24(6):412-7. augmentation in the upper gluteus part 8. Pitanguy I. Surgical reduction of the abdomen, thigh, 23. Lewis JR Jr. Body contouring. South Med J and buttocks. Surg Clin North Am 1971;51(2):479-89. 1980;73(8):1006-11. and better projection. Complications 9. Delerm A, Cirotteau Y. Cruro-femoro-gluteal or 24. Lockwood T. Lower body lift with superficial with suture lift of the buttocks are few circumgluteal plasty. Ann Chir Plast 1973;18(1):31-6. fascial system suspension. Plast Reconstr Surg 1993;92(6):1112-22. and patient satisfaction is high. The 10. Shaer WD. Gluteal and thigh reduction: reclassification, critical review, and improved result is a visual change in the buttock technique for primary correction. Aesthetic Plast Surg projection, roundness tightness and higher 1984;8(3):165-72. Nikolay P Serdev, positioning. The buttock lift elongates 11. Gonzalez M, Guerrerosantos J. Deep planed torso- abdominoplasty combined with buttocks pexy. MD, PhD, Honorary Professor the lower limbs and visibly changes the Aesthetic Plast Surg 1997;21(4):245-53. at the New Bulgarian proportions of the body. Indicated are 12. Carwell GR, Horton CE Sr. Circumferential torsoplasty. University, Sofia, Bulgaria. Ann Plast Surg 1997;38(3):213-6. patients of regular weight seeking higher, E: [email protected] rounded and projected buttocks with better 13. Heddens CJ. Belt lipectomy: procedure and outcomes. Plast Surg Nurs 2001;21(4):185-9, 199. proportions. Heavy buttocks and obesity 14. Pascal JF, Le Louarn C. Remodeling bodylift with high are contraindicated. lateral tension. Aesthetic Plast Surg 2002;26(3): Declaration of competing interests: 223-30. None declared. 15. Karnes J, Salisbury M, Schaeferle M, et al. Hip lift. Aesthetic Plast Surg 2002;26(2):126-9.

pmfa news | FEBRUARY/MARCH 2015 | VOL 2 NO 3 | www.pmfanews.com