Buttock Augmentation Using Silicone Implants

Buttock Augmentation Using Silicone Implants

The desire to have a firm and sensuous buttocks, like that of Beyonce or Kim Kardashian, has sprouted over the past several years.  Unfortunately, exercise alone is not sufficient to acquire this voluptuous buttock that some women desire.  During the past decade, buttock augmentation has gained popularity in the United States.  Before one contemplates on having a buttock augmentation performed, whether with the use of silicone implants or with the use of fat grafts, one should be fully informed about these various procedures.  

Buttock Augmentation Techniques

• Buttock augmentation using a solid silicone elastomer implants
• Brazilian butt lift with the use of fat grafts
• Augmentation with autologous tissue by rearranging the tissues in one's buttock.  It's the typical procedure used for body contouring surgery after a massive weight loss.

Photograph by Paolo Brandao from Caldas de Reis, España (Courtesy of Wikimedia Commons)

Fast Facts about Buttock Augmentation Using Silicone Implants

• Associated  with a higher risk of dehiscence (wound separation) of the midline low sacral incision ~14-30%.  However, a recent study has shown a 1.5% risk of wound dehiscence.  
• Most common complication of buttock augmentation using silicone implants is formation of seroma (19-28%).
• Overall re-operation rate is ~13% in one study. 
• Infection rate is approximately 6.5% (subfascial and intramuscular implants.)
• One study showed that placing the buttock implants below or above the muscle did not show any significant difference with regards to complications.
•  If a patient has inadequate fat available, buttock implants may be the only choice available.

Disadvantages of Buttock Augmentation using Implants placed Sub- or Intramuscularly

•   Risk of sciatic nerve injury
•      Inability to enhance the lower buttock or lateral buttock since     the implant can only be placed in the upper to mid buttocks
•      Wound dehiscence/separation rate with implants which typically occur 1 to 2 weeks after surgery
•   Recurrent or chronic seromas around the implant (2-4%)

Emmanuel De La Cruz M.D.
The Woodlands Plastic Surgeon


References:
Bruner, et al. Complications of Buttocks Augmentation: Diagnosis, Management, and Prevention.  Clinics in Plastic Surgery. 2006, Vol 33 (3): 449-466
Gonzalez R. Augmentation gluteoplasty: the XYZ method. 
Aesthetic Plastic Surgery 2004;28:417-425
Mendieta CG. Gluteoplasty. Aesthetic Surgery Journal. 2003;23:441-455.
Senderoff, Douglas. Buttock Augmentation With Solid  
Silicone Implant.  Aesthetic Surgery Journal. 2011;31(3): 320


Date updated:  March 31, 2011
  

Tickle Liposuction

Does "Tickle Liposuction" Really Tickle?

Several liposuction techniques/machines, such as the VASER and Smart Liposuction, have been developed during the past decade which has drawn significant attention from the media.  Recently, a new liposuction technique, the "Tickle Liposuction", has emerged.   Does the "Tickle Liposuction" really tickle?  That is the question.

Photocredit: celebritylaserspa.com

Fast Facts about the "Tickle Liposuction"    

• Tickle liposuction is FDA-approved in the United States.
• It's a variation of the power-assisted liposuction (PAL).
• "Tickle liposuction" has a cannula that rotates through a small conical arc of motion.  This rotation of the cannula produce a "tickling sensation" that patients feel during the process of liposuction.  
• The patient is aware of this "tickling" sensation only when the patient is awake while the liposuction is being performed.
• Currently, there is no published clinical data or trial comparing this liposuction method with other techniques.

Is It Safe to Have Tickle Liposuction done in an Office Setting?

• A safe surgical facility for liposuction must be able to minimize the risks of surgical infections that may occur after your procedure.  These kind of procedures should be done in operating rooms that maintain high standards for cleanliness. All surgical instruments should be steam-sterilized since cold sterilization of liposuction instruments is below the standard of care.
• Your physician should maintain competency in Advance Cardiac Life Support (ACLS) when this procedure is being performed for safety reasons.

 Are there different levels of Office-Based Anesthesia?

• Yes.

Level I Services: Delivery of analgesics or anxiolytics by mouth, as prescribed for the patient on order of a physician, at a dose level low enough to allow the patient to remain ambulatory

Level II Services: Delivery of analgesics or anxiolytics by mouth in dosages greater than allowed at Level I and tumescent anesthesia, as prescribed for the patient on order of a physician

Level III Services: Delivery of analgesics or anxiolytics other than by mouth, including intravenously, intramuscularly, or rectally

Level IV Services: Delivery of general anesthetics, including regional anesthetics and monitored anesthesia care

What is the Standard of Care for these kind of Services?

Level I services:

1.      at least two personnel must be present, including the physician who must be currently certified at least in AHA-approved BCLS; and

2.      the following age-appropriate equipment must be present:

1.      bag mask valve;

2.      oxygen;

3.      AED or other defibrillator; and

4.      pre-measured doses of epinephrine, atropine, adreno-corticoids, and antihistamines.

Level II services:

1.      at least two personnel must be present, including the physician who must be currently certified at least in AHA approved ACLS or PALS, as appropriate;

1.      another person must be currently certified at least in AHA approved BCLS; and

2.      a licensed health care provider, who may be one of the two required personnel, must attend the patient, until the patient is ready for discharge; and

2.      a crash cart must be present containing drugs and equipment necessary to carry out ACLS protocols, including, but not limited to, the following age-appropriate equipment:

1.      bag mask valve and appropriate airway maintenance devices;

2.      oxygen;

3.      AED or other defibrillator;

4.      pre-measured doses of first line cardiac medications, including epinephrine, atropine, adreno-corticoids, and antihistamines;

5.      IV equipment;

6.      pulse oximeter; and

7.      EKG Monitor.

Level III services:

1.      at least two personnel must be present, including the physician who must be currently certified at least in AHA approved ACLS or PALS, as appropriate;

1.      another person must be currently certified at least in AHA approved BCLS;

2.      a licensed health care provider, which may be either of the two required personnel, must attend the patient, until the patient is ready for discharge; and

3.      a person, who may be either of the two required personnel, must be responsible for monitoring the patient during the procedure; and

2.      the same equipment required for Level II;

Level IV services:

Physicians who practice medicine in Texas and who administer anesthesia or perform a procedure for which anesthesia services are provided in outpatient settings at Level IV shall follow current, applicable standards and guidelines as put forth by the American Society of Anesthesiologists (ASA) including, but not limited to, the following:

1.      Basic Standards for Pre-anesthesia Care;

2.      Standards for Basic Anesthetic Monitoring;

3.      Standards for Post-anesthesia Care;

4.      Position on Monitored Anesthesia Care;

5.      The ASA Physical Status Classification System;

6.      Guidelines for Non-operating Room Anesthetizing Locations;

7.      Guidelines for Ambulatory Anesthesia and Surgery; and

8.      Guidelines for Office-Based Anesthesia.

I recommend to ask your plastic surgeon about different liposuction techniques when one is interested in liposuction.  Not everyone would be a candidate for liposuction.  The results of liposuction is not dependent on the machine but would be dependent by the skill and level of training of your plastic surgeon.  Remember that your safety is extremely important, and one should be fully informed before one undergoes any procedure.

Emmanuel De La Cruz M.D., PLLC

Reference:

Texas Medical Board

http://www.tmb.state.tx.us/professionals/physicians/licensed/oba.php

Smile Train of the Week ~ Philippines

With the emigration of physicians and lack of plastic surgeons in the Philippines treating children with cleft lip and palates, the need for surgeons performing this life-changing procedure becomes magnified when one visits the Philippines.  Non-profit organizations, like the Smile Train and Operation Smile, help millions of children all over the world who are born with cleft lip/palate.  Please visit Smile Train and "help ensure a child born with a cleft lip/palate has the same opportunities as one born without."

Emmanuel De La Cruz M.D.

The Woodlands Plastic Surgeon