Obviously, fat transfer to the buttocks has become very popular and continues to be in high demand. Less than 2 years ago, there were close to 19,000 buttock augmentation procedures performed for the year. That number has probably doubled at the least and will continue to rise for many years to come. As with any surgical procedure there are risks, but performing the procedure with the safest techniques will always lead to the lowest probability of complications. Once the Plastic Surgeon masters comfortable thorough local tumescent anesthesia technique and no longer requires general anesthesia, avoiding fat embolism is the key to staying safe and not injecting into the muscle is the answer.
Anatomy of the buttocks must be understood in order to stay safe. The buttock fat is superficial to the muscles. The buttock muscles are grouped as superficial and deep and lie deep to the fat. The large superficial muscles include the gluteus group while the small deep muscle group collection includes the piriformis and others. The major arteries, veins, and nerves exist deep to the superficial muscle group. These important structures are found within a triangle bordered by the upper buttock dimple, the saddle bag point, and the sit bone. The most important nerve in this area is the sciatic nerve. Staying superficial to the muscles maintains a big safety net.
Donor transferrable fat can be taken from anywhere and remains equally viable from the abdomen, flanks, waist, love handles, lower back, thighs, arms, and knees. Precise fat removal using adequate numbing, soft cannulas, and gentle pressure improve fat integrity. Additional viability is potentially achieved by reducing fat exposure and avoiding centrifugation.
The preferred position of the patient during fat transfer to the buttocks is on the stomach with the hips flexed. This position is commonly referred to as a jackknife position and allows for more superficial fat placement and helps avoid deep muscular injection. To avoid major vessels and nerves, the level of fat transfer is superficial to the muscle and motion is continuous. Excessive fat transfer amounts lead to too much pressure which decreases oxygen availability and ultimately leads to less fat survival.
Aftercare includes includes compression of the donor areas, support of the buttocks, early light activity, and avoiding significant pressure of the newly shaped buttocks.
Justin Yovino, MD FACS
Double Board Certified Beverly Hills Plastic Surgeon