Transcutaneous Scarless Buttock Lift Via the Serdev Suture® Technique
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AESTHETIC FOCUS Transcutaneous scarless buttock lift via the Serdev Suture® Technique BY NIKOLAY P SERDEV hanging buttocks 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 soft tissue 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 scars. 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 fascia 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 skin 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 gluteus maximus 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’ pain. 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 fat 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 thighs, can lead females ‘rhombus of Michaelis’. It is located on each side between to request buttock lifting. B: ‘Happy buttocks’ – the the ‘dimples of Venus’ 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 limb be tightened and knotted on Serdev fascia. If no dermis 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 fascias, 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.