Buttocks augmentation (Brazilian Butt) and reshaping (Gluteoplasty)

Gluteoplasty is used to enhance buttock contour by shaping and enlarging the buttocks. Women who desire fuller and more defined buttocks, who experience loose skin or a loss of volume in the buttocks can benefit from a buttocks lift or augmentation. Changes in the buttocks are often due to ageing, but may also be caused by hereditary factors, weight fluctuations and extreme weight loss.

Considerations

When to consider a buttock augmentation or reshaping:

• You want fuller or tighter buttocks.
• The buttocks are flaccid, flat or hang down.
• The buttock volume is insufficiently toned or has regressed over time.
• Excess skin has formed in the form of a fold at the lower buttock contour.
• The buttocks are shaped asymmetrically.
• Your wellbeing and self-esteem is affected by the changes in your buttocks.

A buttocks augmentation serves to increase buttock volume and to create a fuller buttock shape. A buttocks lift (reshaping) serves to remove local skin and possibly excess fat on the buttocks, which cannot be eliminated by other measures. Both operations are possible at any age and can be combined, as long as there are no serious underlying medical conditions which might increase the risk of surgery. The prerequisite for a buttock augmentation and reshaping is a stable body weight, as strong weight fluctuations may affect the surgical result. Planned weight loss should be considered before any gluteoplasty. Severe obesity may be a contraindication to a buttocks lift, increase the risk of surgery and significantly affect the expected result.

Consultation

A prerequisite for a successful operation is careful planning. This begins with a personal consultation in the AARE clinic.

• Communication of wishes and expectations ascertain what you would like to improve.
• Explanation of the potential, scope and limitations of the operation.

Examination:

• Medical history is taken.
• The buttocks and adjacent parts of the body are examined while standing.
• The firmness and elasticity of the skin and the thickness of the adipose tissue are determined.
• The strength of the buttock muscles is checked.
• If calf enlargement is required, then options with silicone implants or autologous fatty tissue will be discussed.
• During the physical examination, measurements are made and digital photographs are created that are subsequently used to ascertain the objective analysis of your buttocks and body contour.
• Individual factors and personal wishes help in jointly deciding the choice of the appropriate surgical technique, the position of incisions and the resulting scars.
• Based on this, an individual treatment plan is drawn up and goals of the operation are discussed and defined.
• Coupled with a buttock lift, you may also opt for an additional liposuction or buttock augmentation.
• Risks and possible complications are discussed and documented.

To plan the operation and to make a risk assessment we require:

• Full medical history (pre-existing conditions and previous surgery).
• Current diseases (high blood pressure, diabetes, thyroid dysfunction, etc.).
• Allergies or aversion to medications.
• Any important medical reports (please bring any important medical information).
• If you are intending to lose a significant amount of weight to get pregnant, this should be considered when planning a calf augmentation or reshaping
• It may be advisable to wait for the stabilisation of your weight or after pregnancy before surgery is undertaken.

Procedure

Individual factors and personal preferences determine the choice of the surgical procedure to improve buttock contour. There is a basic distinction between lifting of the buttocks with or without liposuction and enlargement (augmentation) of the buttocks with implants or autologous fat (lipofilling).

1. Buttocks lift (gluteoplasty):
With a buttocks lift, excess skin is removed, lifted and shaped mostly along the upper border of the buttocks. Rarely is excess skin removed from the lower buttock (infragluteal fold). Excess fat deposits on the buttocks or adjacent regions (hips/thighs) may be removed in the same session by a liposuction. Lack of buttock volume can be enhanced by a silicone implant, or be replaced by autologous fat injection (lipofilling), or dermis-fat-flap.

2. Buttocks reshaping with autologous fat injection (lipomodeling):
In this technique, excess fatty tissue from other regions, such as e.g. the abdomen, hips, thighs or knees is used to enlarge or shape the buttocks. Removal of fat deposits from elsewhere simultaneously contributes to a better overall body shape. Adipose tissue is suctioned from areas of excess, prepared and then injected with fine cannulas into the subcutaneous tissue and muscles of the buttocks in order to increase buttock volume and improve buttock contour. The advantages of adipose tissue are that it is the body’s own tissue, which is often available in sufficient quantity, does not carry the risks of a foreign body, and is malleable.

3. Buttocks enlargement with silicone implants (gluteal augmentation):
Silicone implants are especially useful when there is no other source of fatty tissue present elsewhere on the body. The advantages of this technique are precise planning and dimensional stability of the buttock implants, which are usually placed within or under the buttock muscles. Implants of different shapes and sizes are available and can be selected in the preoperative planning in accordance with the individual needs of the patient. Again, liposuction of the hips or thighs can be combined to achieve the best possible overall contour. The position of the scars is usually located in the crease between the buttocks where they are least visible.

4. Buttocks enlargement with dermis-fat-flap (gluteoplasty):
Particularly in patients who have lost a massive amount of weight, dermis-fat-flaps can be used for skin tightening and an enlargement of the buttocks with the body’s own tissue at the same time. After removal of excess skin, the underlying fat tissue is located, together with its vascular supply and used to build the buttocks volume. Unlike lipofilling, the flap uses adipose tissue that is nourished by its own blood supply, which has a higher rate of fat survival than injected fat. As with a straightforward buttock lift, the position of the scar is mostly positioned on the upper limits of the buttock contour.

Buttocks augmentation or reshaping is usually performed under general anaesthesia as an outpatient procedure or with an over-night stay at the AARE KLINIK. In individual cases, a short inpatient stay at an affiliated private hospital may be necessary. The surgery usually takes 2–3 hours. In some cases, drains are inserted at the end of the operation, to remove blood and wound fluid. These are removed after a few days.

Risks

Buttocks augmentation and reshaping are common cosmetic surgery procedures. Complications, such as infection, healing problems or circulation disorders of the buttock tissue are rare when surgery is conducted with the proper techniques and care. However, in individual cases a prolonged treatment or another operation may be required. Every patient should be informed of all the benefits, risks and possible complications involved.

Minor complications and side effects that usually resolve spontaneously include: bruising (hematoma), wound fluid accumulation (seroma) and swelling. Severe hematoma or seroma may require surgical evacuation to prevent further complications, such as delayed healing and infection. Some numbness of the buttocks skin is common after buttocks augmentation, but is usually temporary and improves with time.

The risk of severe complications such as circulatory disorders of the buttocks skin and wound healing problems along the suture lines is increased in smokers or patients with chronic diseases, such as diabetes. Combined interventions also increase the risk of complications. When using silicone implants, infections, scarring or defects of the implants are possible, which may require their removal in severe cases.

General risks

• Haematoma (bruising), bleeding and swelling
• Seroma (accumulation of wound fluid)
• Healing problems or infection
• Wound breakdown/dehiscence (separation of wound edges)
• Injury of nerves or vessels
• Numbness in area of operation (temporary or permanent)
• Circulatory problem in the buttock skin (skin slough)
• Slight asymmetry
• Unsatisfactory aesthetic result
• Secondary surgery
• Thrombosis or embolism

Overall buttock augmentation and reshaping are safe procedures when undertaken by an experienced plastic surgeon and patients are mostly satisfied with the results. You can help to minimise the risks by following the advice of your surgeon.

Preparation

Our aim is to make the time before and after your surgery as comfortable as possible. By following a few tips you can support our care:

• To aid the healing process, avoid smoking for two weeks before and after the operation.
• Avoid medication that increases the risk of bleeding, like aspirin, non-steroidal anti-inflammatory drugs, as well as vitamins and homeopathic remedies for two weeks prior to the operation.
• Buttocks augmentation and reshaping is usually performed as an outpatient procedure under general anaesthesia. Depending on the location and extent of liposuction and autologous fat injection, lipomodeling can be performed under local anaesthesia with sedation or under general anaesthesia.
• Make sure that you can be collected and cared for by someone for 24 hours after the procedure.

Day of surgery

Buttocks augmentation and reshaping is usually performed as an outpatient procedure at the AARE KLINIK. If the surgery is extensive or if there are pre-existing medical conditions, surgery may be undertaken as an inpatient treatment in an affiliated private hospital. This may be the case, if buttocks augmentation is combined with other procedures, such as extensive liposuction or skin tightening procedures (gluteoplasty).

• During surgery you will receive various medications for your wellbeing.
• For your safety, your heart rate, blood pressure, oxygen supply etc. are monitored during the operation.
• After surgery, you will be taken to the recovery room, where you will have continued monitoring until you awaken and are able to get up.
• Compression garments will be applied to aid the healing process and to promote uniform skin contraction.
• You will be taken to the recovery room, where you will have continued monitoring until you awaken and are able to get up.
• You will be allowed to return home after a few hours.
• If you are an inpatient, you will remain in hospital under surveillance until the following day.
• Already on the day of the surgery you should get up regularly for a few minutes in order to minimise the risk of thrombosis.
• The level of pain after a buttocks augmentation or reshaping is usually not severe and can be compared with muscle soreness. However, in individual cases, pain may be more severe and require intensified or prolonged pain medication.
• You are advised to take mild pain relief that reduces swelling and should be continued for several days after surgery.
• In case of an ambulatory procedure, you should have someone to care for you continuously for 24 hours postoperative.
• We also provide the option of an over-night inpatient stay at the AARE KLINIK in a single room with a personal nurse care, if needed.
• We also offer the possibility for a short inpatient stay at the AARE KLINIK in a single room with a nurse if required.

After surgery

• It is important to realise that recovery from an operation varies for every individual.
• Following buttocks augmentation or reshaping, you should rest in the first days after surgery and only walk short distances.
• You should avoid sitting.
• Only take prescribed painkillers and avoid any medication that contains aspirin or other blood-thinning substances.
• You will receive additional blood thinning injections for several weeks.
• Wear the customised compression garments continuously day and night. Notify us if they are too tight or there are any other problems.
• In the first 2–5 days after the procedure, a feeling of tension and light pain will be felt in the region of the surgery.
• Buttocks skin may feel temporarily numb and hypersensitive. This is usually temporary. However, it may take weeks or months, in some cases even longer to return to feeling completely normal.
• Slight swelling and bruising in the area of surgery usually subsides within 2–3 weeks.
• Typically you will be back on your feet a couple of days after surgery and be able to resume your daily activities.
• If used, drains are removed in the first days after the operation, after which you can take showers again.
• Full baths and excessive heat (e.g. sauna), however should be avoided for several weeks until swelling has receded.
• Most sutures will dissolve by themselves and do not need to be removed.
• Non-dissolvable sutures are removed after one week.
• After removal of the sutures, we recommend the start of an intensive skin and scar care with rehydrating creams and light massage.
• In individual cases it may be useful to have special treatment with silicone gel or silicone pads over a period of 2–3 months.
• The fresh scars should be protected from UV radiation for at least six months, in order to prevent increased pigmentation.
• Activities that require prolonged sitting can usually be resumed after 2–3 weeks.
• Compression garments should be worn for a total of 6-8 weeks.
• Physically demanding activities and sport should be avoided for several weeks.
• After surgery you will be examined at the AARE KLINIK at regular intervals, so that the healing process can be assessed until the final result is achieved.

Outcome

• Swelling and bruising may remain for some time after surgery.
• The healing process is gradual and it takes several months before the final result can be conclusively determined.
• Scars might be red or appear darker pigmented for several months, but this colour will fade with time.
• Nevertheless, scars may be permanent, even if they can be seen only as delicate lines.
• Fortunately, the scars are completely concealed normally through clothing.
• Swollen (hypertrophic) scars may require treatment with special silicone pads and cortisone injections.
• Buttocks augmentation and reshaping improves buttock shape and can enhance overall body contour.
• Patients often feel more self-confident and find it easier to wear certain clothes.
• The result of buttocks augmentation and reshaping is long lasting. However, the aging process and weight fluctuations, pregnancy and lifestyle can affect the outcome.
• After lipofilling the buttocks volume reduces over time in the first 2–3 months due to the initial swelling followed by a partial resorption of fat cells.
• If the desired buttocks volume is not fully attained after several months, another lipofilling can be performed.

Costs

Buttocks augmentation and reshaping is usually an aesthetic procedure, in which case the costs have to be carried by the patient. In exceptional cases, where there is functional impairment, (e.g. chronic infection or pain) due to significant amounts of excess skin and severe skin folds after massive weight loss, the surgical correction may be medically indicated. In these cases, the treatment costs may be covered by health insurance after a prior cost estimation is given. The decision for, or against reimbursement depends on the recommendation of the medical officer in each individual case.
The costs of an aesthetically motivated buttocks augmentation and reshaping are variable and mainly depend on the complexity of the operation and the facility in which the surgery is performed (hospital or AARE KLINIK). A more accurate cost estimate can therefore be made only after a personal consultation.

The costs are composed of:

• Surgical fee (including consultation and post-operative care)
• Anaesthesia fee
• Technical infrastructure costs (AARE KLINIK/hospital)
• Inpatient hospital costs
• Buttocks implants
• Compression garements
• Medication
• Diagnostics (laboratory, ECG, scans, etc.)

Appointments for buttock surgery with Dr. Scheufler in Bern

Before any breast surgery you should have a comprehensive consultation and additional examination. Only in this way can you be sure whether the type of surgery will lead to the result you expect. In addition, your consultation will give you a good impression of our experience in the field of breast surgery. Feel free to ask for before and after photos to get an idea of what the results look like.

Dr. med. O. Scheufler, specialist in plastic, reconstructive and aesthetic medicine and author of this website, is pleased to be at your service for a personal consultation. Besides his main work at the Aare Clinic, PD. Dr. Scheufler is also scientifically active and has habilitated at the University Hospital of Basel. He was therefore awarded the title of assistant professor by the University of Basel. In addition, he was honored by Duke University (USA) as a Visiting Professor. So do not hesitate to contact him if you wish a professional consultation!