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Circumferential approaches to truncal contouring: autologous buttocks augmentation with purse-string gluteoplasty
Synopsis
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Previous methods of buttock autoaugmentation have employed rotational flaps that are prone to complications due to poor vascularity. Purse-string gluteoplasty was developed as a unique method of buttock autoaugmentation that does not require any undermining or rotation of flaps, thus adding to its simplicity and safety.
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Key elements of the procedure are buttock lifting combined with autoaugmentation, no undermining of autoaugmentation tissue, and use of a purse-string suture to enhance projection of autoaugmentation tissue.
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Other options in these patients include buttock fat grafting, but this does not correct skin laxity, and fat is usually not present in sufficient quantities to harvest from massive weight loss patients. Traditional buttock lifting is an option, but lack of volume will not be well corrected. Lastly, buttock autoaugmentation with rotational flaps is effective, but this requires additional dissection, and flaps may not be reliable in terms of vascularity.
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The ideal patient for purse-string gluteoplasty has buttock deflation and ptosis and wishes to improve projection. Patients should be healthy enough for elective surgery and, as in any body contouring, must be accepting of the proposed scar.
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Buttock ptosis and atrophy are very common after weight loss or even normal aging. Purse-string gluteoplasty is a safe and effective technique to correct both of these problems.
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Introduction
Buttock atrophy and ptosis after massive weight loss or as part of normal aging is a common complaint of many patients. The purse-string gluteoplasty was first described in 2009 as an alternative to existing methods where rotation flaps had random vascularity of the tips and were fraught with tip loss. It is a method of autologous buttock augmentation, which uses the patient's own redundant soft tissues to augment the atrophic buttocks in conjunction with buttock lifting. Autologous buttock augmentation has been described by several authors. Previous methods typically involve undermining, rotational flaps, or flaps with a narrow base that are based on named perforator vessels.
The purse-string gluteoplasty was developed as a safe and straightforward method of autologous buttock augmentation. No undermining or rotation of the augmentation tissue is required, therefore the safety and simplicity of the procedure are high. This method provides complete vascular preservation. In addition, the purse-string suture lends shape and additional projection (3–5 cm) to the buttocks. The procedure can be done as an isolated buttock reshaping surgery, or in conjunction with circumferential abdominoplasty/bodylift.
Body contouring secondary to massive weight loss is experiencing ever-increasing demand worldwide. This is secondary to increasing obesity and increasing success of weight loss surgery. This patient population has been shown to have significant psychological distress due to the deformities of massive weight loss. It has also been suggested that buttock autoaugmentation during buttock lifting leads to higher patient satisfaction than buttock lift without autoaugmentation. These patients will continue to demand ever-improving and aesthetically pleasing body contouring results, as may be provided by offering the purse-string gluteoplasty.
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