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An ideal waist to hip ratio is a cardinal objective measurement of aesthetic appraisal amongst women of all ages. In recent years there has been an upsurge in demand for gluteal augmentation. Butt augmentation was initially discussed by Pitanguy in his report in 1964, and has undergone various modifications afterwards. The advent of lipoplasty widened the avenues for the management of buttock ptosis i.e. sagging of buttocks. BBL is a modern medicine technique of gluteoplasty with autologous fat tissue. Buttock sculpting via fat transfer in case of patients with ample donor sites, waves off the risks associated with silicone implants. Fat tissue graft is harvested from the donor site through liposuction and injected into the desirous areas of the buttocks. This procedure accounts for a harmonious way of fat elimination and modification.
• Management of aging skin: Fat mass has been shown to increase in relation with senescence. A wide array of molecular processes and gene expression modification bring about progressive and irreversible age changes in the buttocks. Menopause has been significantly associated with central fat deposition in the body, predominantly the buttocks and thighs. Hormonal changes may bring about an imbalance in lipoprotein metabolism affecting the adiposity that warrants a surgical correction. Consequently certain changes take place in the gluteal region with aging such as the loss of the inward curves at the level of the waist and the absence of inward depth in the mid-line of the lower back with elongation of the infragluteal crease. This makes the buttocks aesthetically unpleasant from the ideal proportions.
• Cosmetic enhancement and rejuvenation: Fat grafting involves the harvesting of fat tissue from unwanted areas of the body and utilizing it for fat augmentation with body contouring surgery. Autologous fat grafting plays a pivotal role in gluteal or buttock augmentation and may replace implant - based gluteal augmentation if the patient has enough quantity of aft at the donor sites. Body sculpting by merging the benefits of liposuction and lipofilling can improve the aesthetics of virtually the entire body, providing the desirous hour glass shape.
• Body contour improvement: There is some consensus about an aesthetically pleasing buttock area; few characteristics included are a round shape with smooth projecting curves and a short intergluteal crease which reaches the mid-thigh region. Toledo mentioned a waist to hip ration of 0.6 in South Americans and 0.7 in European females. Based on the configuration of buttock and influencing areas, and deformities, four shapes of buttock have been acknowledged; which are triangular, trapezoidal, round and square. Bone remodeling for buttock reshaping is an invasive and complex procedure. Whereas the technique of removal and addition of fat in requisite areas of the body, is a non invasive and patient friendly procedure. A short gluteal crease that does not extend beyond the medial third with no ptosis over this line is the ideal requisite.
• Reconstruction of scarred sites: Owing to the regenerative and remodeling properties of lipo-aspirate, it can be successfully injected for painful scars, chronic wounds and burns. Scar depression and adherence to deep planes are seldom associated with unpleasant scarring that hampers esthtics. Indecorous scarring represent a functional and aesthetic trouble that frequently requires surgical revision. Fat grafts may not only serve as fillers, but also have the additional benefit of improving the quality of aged and scarred skin.
• Conditions associated with fat atrophy: Lipodystrophy represents a rare condition of altered subcutaneous fat repartition in a generalized, partial or localized form. The condition can cause one or more depressions in the skin ranging from a few centimeters to greater than twenty centimeters in diameter. There can be partial or total loss of subcutaneous fat with atrophy of overlying skin. Gluteal augmentation is used as a therapeutic approach in such patients. Fat injections are performed in different planes to supplement the buttocks and lateral trochanteric regions of the body.
• Buttock ptosis (sagging): The gluteal crease forms a part of the supporting system that maintains soft tissue structures in place in the gluteal and thigh area. This gluteal crease elongates as the buttocks sag, weighed down by the volume gain or laxity leading to the sagging of gluteal tissue over the thigh. As the heavy gluteal tissues continue to sag, it begins to cover the thighs falling over it, which leads to the folds becoming quite conspicucous, and gluteal tissue hanging below the skin folds or infragluteal crease. Buttock ptosis may occur after significant weight gain following weight loss.
Establishment of the donor sites:-
Harvest of fat tissue:-
Processing of lipoaspirate:-
The harvested fat is processed in order to limit the blood, oil and debris within the lipoaspirate that yields pure fat as a soft tissue filler with enhanced vitality. The lipoaspirate is treated with an antibiotic solution mixed in saline. There are many techniques available for fat processing such as sedimentation by gravity, filtration and centrifugation. Sedimentation or simple decantation is the separation of the layers after sedimentation. It relies on gravity and is time consuming. Centrifugation is the most widely used technique for fat processing, which though more aggressive on adipocytes, yet it separates most of the blood remnants from fat as well as also maintains the highest concentration of stem cells within the processed lipoaspirate. These stem cells are angiogenic growth factors that play a key role in graft survival. The lipoaspirate is centrifuged at 3000 rpm for three minutes, after which three levels are observed in the tube. The lower level is formed by blood, debris and water; the middle layer consists of fat that will be injected; whilst the top layer is composed of the lighter weight oil formed by fatty acid breakdown. Right before the fat is to be injected back into the patient, platelet rich plasma (PRP) from patients’ own blood is mixed with fat.
Anesthesia of recipient site and graft placement:-
Delivery of the lipoaspirate is believed to be the most important step in fat grafting technique. The entry site of the recipient area is injected with local anesthesia. An infiltration cannula with a single hole is used to pump the lipoaspirate back into the patient’s buttocks. Tha fat lipoaspirate is grafted superficially above the muscle and away from the inferior and superior gluteal veins. Inadvertent injury to these veins can lead to fat emboli formation. A pressure controlled injection technique is preferred which cuts off automatically if it senses a higher than normal central venous pressure. 0.1 cc of lipoaspirate is injected with every pass, carried out at an intermittent retrograde pattern. A fan shaped reinjection is done at different levels to obtain a harmonious result while maintaining the normal anatomy of the site. This technique ensures that fat grafts have a maximal contact time with the vascularized tissues in the grafted area, which promotes a better survival of the graft.
Transplantation of fat is a minimally invasive and relatively safe procedure with a low rate of complications.
An ideal patient for BBL should be in good health with absence of cardiopulmonary or debilitating chronic diseases. Surgical augmentation of the gluteal region depends primarily on the quantity of fat available that can be harvested with liposuction and fat transfer. It also largely depends on the degree of laxity of the buttock skin. BBL is a preferable method of buttock augmentation in case of women who have excess amount of fat in the region of lower back, waist or abdominal area. Patient who lack projection in the gluteal region and are lean or have an athletic build with minimal or no gluteal ptosis, are advised to undergo aesthetic buttock correction via gluteal implants.
Depending on the type of anesthesia used the entire operation may take 1.5 to 2 hours. Patient may have a normal appearance after 3-5 days. The extraction zones may take few weeks to heal completely. Patient is advised to take rest for approximately 10-15 days and avoid any stressful or weight exercise during this period. Patient is advised to rest in the prone position for 7 days post-operatively. During the first 2-3 days avoid sitting for long hours and if sitting is necessary do it by flexing the trunk.
Approximately 80% of the fat cells have been proposed to survive following BBL. Technical advancements have eminently curtailed the complications thus providing a positive outlook towards achieving the realistic expectations from the procedure.
An approximate cost of BBL is around $4096. Cost might vary depending on multiple factors like; qualification and experience of surgeon, type of anesthesia, pre-operative diagnostic procedures, medications required and type of expectation of the patient.
MedcureIndia is a stalwart of medical tourism. We have a skillful team of highly proficient plastic and aesthetic surgeons well versed in handling cases of varying complexities, with ease. We help you achieve that infallible shape with minimal discomfort as well as provide guidance through the recovery process.
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