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Autologous Gluteal Lipograft Aesth Plast Surg (2011) 35:216–224 DOI 10.1007/s00266-010-9590-y ORIGINAL ARTICLE Autologous Gluteal Lipograft Beatriz Nicareta • Luiz Haroldo Pereira • Aris Sterodimas • Yves Ge´rard Illouz Received: 14 January 2010 / Accepted: 15 July 2010 / Published online: 25 September 2010 Ó Springer Science+Business Media, LLC and International Society of Aesthetic Plastic Surgery 2010 Abstract In the past 25 years, several different tech- expressed the desire of further gluteal augmentation, 16 had niques of lipoinjection have been developed. The authors one more session of gluteal fat grafting. The remaining five performed a prospective study to evaluate the patient sat- patients did not have enough donor area and instead isfaction and the rate of complications after an autologous received gluteal silicone implants. At 12 months, 70% gluteal lipograft among 351 patients during January 2002 reported that their appearance after gluteal fat augmentation and January 2008. All the patients included in the study was ‘‘very good’’ to ‘‘excellent,’’ and 23% responded that requested gluteal augmentation and were candidates for their appearance was ‘‘good.’’ Only 7% of the patients the procedure. Overall satisfaction with body appearance thought their appearance was less than good. At 24 months, after gluteal fat augmentation was rated on a scale of 1 66% reported that their appearance after gluteal fat aug- (poor), 2 (fair), 3 (good), 4 (very good), and 5 (excellent). mentation was ‘‘very good’’ (36%) to ‘‘excellent’’ (30%), The evaluation was made at follow-up times of 12 and and 27% responded that their appearance was ‘‘good.’’ 24 months. The total amount of clean adipose tissue However, 7% of the patients continued to think that their transplanted to the buttocks varied from 100 to 900 ml. In appearance was less than good. At this writing, the average nine cases, liponecrosis was treated by aspiration with a follow-up time for this group of patients has been 4.9 years. large-bore needle connected to a 20-ml syringe, performed The key to successful gluteal fat grafting is familiarity with as an outpatient procedure. Infection of the grafted area also the technique, knowledge of the gluteal topography, and occurred for four patients and was treated by incision understanding of the patient’s goals. With experience, the drainage and use of antibiotics. Of the 21 patients who surgeon can predict the amount of volume needing to be grafted to produce the desired result. Although the aim of every surgeon is to produce the desired augmentation of the gluteal region by autologous fat grafting in one stage, the Presented in the 2nd Professor Illouz Association Meeting during the patient should be advised that a secondary procedure may 11th European Societies of Plastic Reconstructive and Aesthetic be needed to accomplish the desired result. Surgery Congress in Rhodes, Greece. Winner of the 1st Illouz Prize and awarded the amount of 5000 US$. Keywords Autologous fat transplantation Á Gluteal B. Nicareta augmentation Á Lipograft Á Liposuction Department of Plastic Surgery, Policlinca Geral, 38 Av Nilo Pec¸anha, Rio de Janeiro 22020-100, Brazil Fat injection reportedly started in 1893 when German L. H. Pereira (&) Á A. Sterodimas Department of Plastic Surgery, LH Clinic, Rua Xavier da physician Franz Neuber used a small piece of upper arm fat Silveira 45/206, Rio de Janeiro 22061-010, Brazil to build up the face of a patient whose cheek had a large pit e-mail: [email protected] caused by a tubercular inflammation of the bone [1]. In 1926, Dr. Conrad Miller warned that ‘‘the end-results in Y. G. Illouz Department of Plastic Surgery, Saint Louis Hospital, Avenue free fat transplantation depend, aside from various local Claude-Vellefaux, 75010 Paris, France and general factors, on the method and technique’’ [2]. 123 Aesth Plast Surg (2011) 35:216–224 217 With the advent of liposuction in the 1980s, it became possible to aspirate and reinject fat, allowing transplanta- tion of small volumes for soft tissue augmentation to cor- rect contour irregularities [3]. Initially, it was performed by using microcannulas and small 5- and 10-ml syringes. In the past 25 years, several different techniques of li- poinjection have been developed to correct various prob- lems such as those involving the buttocks (augmentation and reshaping), trochanteric depressions, breast augmen- tation, scar depressions, thighs and legs (calf and ankle augmentation), small wrinkles and depressions of the face (Romberg’s disease), the nasolabial fold, the upper outer breast quadrant, and liposuction sequelae [4–8]. In 1989, the senior author (LHP) started introducing autologous fat to different anatomic areas such as the buttocks, the trochanteric regions, and the inner aspect of Fig. 1 Marking of the areas to be liposuctioned and lipoinjected the thighs [9]. The authors performed a prospective study to evaluate patient satisfaction and the rate of complica- intravenous sedation. The patient is placed in the prone tions after autologous gluteal lipografting. position. Intraoperative intravenous (IV) cefazolin is administered. 3. After injection of the normal saline wetting solution Patients and Methods containing 1:500,000 of adrenaline by a small-bore cannula and a wait of 15 min, a 60-ml syringe attached A total of 351 consecutive women underwent surgery from to a 4-mm blunt cannula is inserted through small January 2002 to January 2008. The women ranged in age incisions in the intergluteal fold as well as two from 19 to 72 years (mean, 31.3 years). The preoperative incisions in the iliac crest and two additional incisions body mass index (BMI) of the patients ranged from 17.1 to in the gluteal fold. Each incision is less than 1 cm 25.6 kg/m2 (mean, 21.6 kg/m2), obtained at the first office long. visit. Of the 351 patients, 73 were smokers, who were 4. Fat is aspirated using the syringe method. The donor asked to refrain from smoking for 1 month before and after sites include flanks, thighs, and knee fat. Each the surgical procedure. All the patients included in the individual area to be aspirated is treated separately study requested gluteal augmentation and were candidates (Fig. 2a). for the procedure. No other surgical procedures were 5. The fatty tissue aspirated is treated in the following performed. manner. With the syringe held vertically, open end The overall satisfaction with body appearance after down, the fat and fluid are separated. Isotonic saline is gluteal fat augmentation was rated on a scale of 1 (poor), 2 added to the syringe. The fat and saline are separated (fair), 3 (good), 4 (very good), and 5 (excellent). The and the exudate discarded. The procedure is repeated patient satisfaction scale has been used already in pub- until the fat becomes yellow in color and free of blood lished papers and peer reviewed [10–12]. All the patients and other contaminants (Fig. 2b). underwent surgery by the same team of surgeons com- 6. At completion of the liposuction procedure, access to prising Luiz Haroldo Pereira, Aris Sterodimas, and Beatriz the buttock region is gained through the same incisions Nicaretta. The evaluation was made at follow-up office in the intergluteal fold. consultations at 12 and 24 months. 7. Initially, a deep plane to the gluteal muscles is created by the 4-mm cannula. Then other planes are created Surgical Technique of Fat Grafting using the same cannula in different trajectories, always from the deeper aspect to the gluteal surface. The fat is 1. Marking of the areas to be liposuctioned and fat inserted into these tunnels, beginning at the deep layer grafted are made while the patient is in the standing and working up into the intermediate fat compart- position (Fig. 1). The areas to be lipoaspirated are ments. The fat is injected as the cannula is withdrawn. parallel-line marked, and the areas to be fat grafted are Care should be taken to avoid injection of more fat in only hollow marked. the superficial fat compartment. Separate incisions, if 2. Preoperative sedation is administered in the surgical necessary, can be used to treat the whole gluteal region suite. Anesthesia consists of an epidural block and (Fig. 3). 123 218 Aesth Plast Surg (2011) 35:216–224 Fig. 2 a Liposuction using the syringe technique. b The ‘‘treated’’ fat ready to be inserted using 60-ml syringes Fig. 3 a–d Insertion of lipograft in the gluteal area 8. Immediate postoperative dressing is performed in the position when lying down, even when large amounts area that was lipoaspirated, avoiding any pressure in of fat are injected. Return to mild physical activities the gluteal area. is allowed after the third postoperative week, and 9. The patient remains hospitalized for 24 h. Analgesics lying down supine is permitted after 2 weeks. A and antiinflammatory medications are prescribed nonzippered pull-over female body vest is placed on during the following 7 postoperative days. The the second postoperative day and kept in place for patient is instructed to remain in the supine body 1 month. 123 Aesth Plast Surg (2011) 35:216–224 219 Results their appearance was less than good (‘‘fair’’ 6% and ‘‘poor’’ 1%) (Fig. 5). In this study, the total amount of clean adipose tissue At 24 months, 66% of the patients reported that their transplanted to the buttocks varied from 100 to 900 ml appearance after gluteal fat augmentation was ‘‘very good’’ (mean, 692 ml) (Fig. 4). Nine cases of liponecrosis small (36%) to ‘‘excellent’’ (30%), and 27% responded that their in volume (2.5%) developed in the grafted gluteal area. appearance was ‘‘good,’’ whereas 7% continued to think Liponecrotic lumps were palpated at postoperative evalu- that their appearance was less than good (‘‘fair’’ 6% and ation and after ultrasound confirmation.
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