Summary

Techniques for improving the appearance of the buttocks region are essential elements in body contouring. In all cultures and communities, this physique aspect holds a special place among the elements comprising the ideals of physical beauty. Recent studies described the aesthetics of the gluteal region in terms of shape, volume, and projection.  However, Prof Moawad noticed ten years ago the accumulation of fat at the supragluteal, lower paralumbar, infragluteal, and/or trochanteric areas often disturbs the natural shape of the buttocks. He decided to enhance the gluteal region by liposculpture of areas around the buttocks and when needed, lipo-injection to give volume and projection. There is a growing interest in aesthetic surgery of the buttocks and posterior body contouring with severe weight loss.  Weight loss often produces flat buttock deformities, which push the need for buttock lift surgery. Like breast surgery, buttocks surgery can be performed with several different techniques, all of which aim to make an aesthetically pleasing shape in or out of clothing. There is no single buttocks-lifting technique capable of solving all aesthetic problems.  Choosing the correct procedure, combining techniques, or even adding an implant or fat, is common. The treatment or combination of approaches that are right for each patient is discovered through consultation that focuses on understanding a patient’s goals and unique anatomy. It is essential to realize that the buttock reshaping surgery must address the whole back, flanks, hip, and thigh as one unit. It is fundamental to understand the differences between female and male buttocks.

There is a growing interest in aesthetic surgery of the buttocks and posterior body contouring. More and more patients are requesting buttocks reshaping. Re-contouring a flat and saggy buttock is not easy, but it can be advantageous for the surgeon. Like breast surgery, buttocks surgery can be performed with several different techniques, all of which aim to make an aesthetically pleasing shape in or out of clothing. There is no single buttocks-lifting technique capable of solving all aesthetic problems. Choosing the correct technique, combining techniques, or even adding an implant may be added. The treatment or combination of the suitable approaches for each patient is discovered through consultation that focuses on understanding a patient’s goals. To find the treatment(s) required by a patient, I must analyze their unique anatomy to find buttocks areas with excesses or deficiencies that I can successfully address in buttocks contouring.

It is essential to realize that the buttock reshaping surgery must address the whole back, flanks, hip, and thigh as one unit. In this way, it can be thought of as a back, buttock, and thigh remodeling procedure. No procedure should be carried out on the buttock area or the posterior contour without a full assessment and complete understanding of its complexity. Patients seeking treatment should be made aware of the potential risk factors associated with any surgical procedure. The high phenomenon in severe weight loss has increased the demand for body contouring. This has extended to buttock contouring. Weight loss often produces flat buttock deformities, which push the need for buttock enhancement surgery.

It is fundamental to understand the differences between female and male buttocks. A woman’s buttock is characterized by curvy lines, round volumes, and prominent projection, while a man’s buttock is characterized by straight lines, square volumes, and side depressions. Sagginess of the buttock should not be present, nor the entire gluteal crease which may indicate early ptosis. Suppose there is any fatty fullness under the crease (also known as banana deformity), cellulite, contour irregularity, or saddlebags present. In that case, I must also address these. Buttock contouring surgery should address the above points to produce desirable results that match the patient’s expectations.

Candidates for Buttocks Shaping:

• Flattened buttocks (developmental or post weight loss)
• Small buttocks
• Saggy buttocks
• Disproportionate buttocks.
• Large buttocks and thighs
• Large flanks
• No waist definition

Below are the Procedures We Offer at MSI:

• 1-Buttock lift
• 2-Buttock Augmentation
• 3-Buttocks reduction/reshaping with or without liposuction: for patients who have large buttocks.
• 4-Liposuction on the love handles: for fatty accumulation under the waist
• 5-Saddle Bag correction: for fat accumulation on the sides of the thighs
• 6-Banana fold deformity treatment
• 7-Gluteal retraction Treatment: for irregularity, depression, and hollows on the buttock surface caused by conditions of the subcutaneous tissue, fascia, or muscle.

The buttock area has received much media attention in recent years, which has produced increased patient demand for buttock reshaping. Four different anatomic variables:1. The underlying bony framework, 2. Gluteus maximus muscle,3. Subcutaneous fat topography, and 4. Skin influence the overall shape of the buttocks. The subcutaneous fat has the most significant impact in establishing the overall shape of the buttocks. Liposuction, the number one cosmetic surgery performed globally, is a procedure removing unwanted lumps, bulges, and areas of resistant fat deposits from specific areas of the body. Buttocks Liposuction is performed using a hand-held instrument (cannula) attached to a vacuüm-like machine or a syringe. By pushing and pulling the cannula, fat cells are broken up and then sucked out with a vacuüm what is called traditional Buttocks Liposuction. Today, I can use several liposuction techniques to improve the procedure’s ease and enhance the outcome. Based on the experience of Prof Moawad for the last 20 years, he prefers the tumescent technique assisted with a suction cannula for considerable buttocks reduction. If precise contouring is the goal, he prefers syringe liposculpture. Syringe liposuction is a must when fat transfer is needed. Thorough anatomic analysis and surgical technique and constant communication with patients to determine their aesthetic preferences are encouraged.

Buttocks Lift Surgery

With a buttock lift, I can drastically improve excess skin and fat from aging, heredity factors, or after dramatic weight loss in the gluteal area. Not to be confused with a “Brazilian butt lift,” which adds volume using fat transfer, this procedure involves only removing skin and fat through surgical excision and liposuction.  A buttock lift is a cosmetic surgical procedure to improve the appearance of the buttocks. It may be done as part of a tummy tuck (belt lipectomy) or lower body lift to contour the buttocks, groin, thighs, and abdomen. A buttock lift alone won’t add any volume to the buttocks. But sometimes, a buttock lift is combined with an augmentation procedure to alter the shape or size of the buttocks with implants or fat grafts. During a buttock lift, excess skin and fat are removed from the buttocks. The remaining skin is then repositioned to create a more toned look.

High Definition Back Liposuction

Back liposuction applies to individuals who have localized fat in the upper and lower back. Liposuction of the back can decrease fullness in the upper back by reducing subcutaneous fat and can result in skin retraction, particularly with power-assisted ultrasound liposuction (U-PA)L. Liposuction of the upper back is an excellent complement to the arm, breast lifts, while liposuction of the lower back will complement the abdomen, buttocks, and thigh lifts. Liposuction of the upper and lowers back secondarily unmasks and enhances the buttock region as well. The sacrum often has a fatty deposit that responds well to liposuction and helps contour the buttock. Liposuction of the back is not a procedure often applied to massive weight loss patients who have achieved a body mass index of less than 30. Their issue is more skin redundancy and lax tissue than subcutaneous fat.

Brazilian Butt Fat Injection

Buttocks augmentation can be performed through various surgical techniques, but there are substantial advantages to gluteal fat transfer compared with other methods. Principles of buttocks augmentation with autologous fat transfer have evolved from solely buttock augmentation to global, whole-body, 360° contouring and shaping, thereby producing an optimal, highly defined body/ buttocks balance, without implant-related complications.  A Brazilian Buttocks lift is a specialized fat transfer procedure that augments the size and shape of the buttocks without implants. Excess fat is removed from the hips, abdomen, lower back, or thighs with liposuction, and a portion of this fat is then strategically injected into the buttocks. A skilled cosmetic surgeon can improve the proportions of the entire lower body with Brazilian Buttocks lift surgery, helping a patient lose fat in common “problem areas” and enhance the buttocks, with results lasting many years. Autologous fat grafting is associated with the lowest rate of complications. It is ideal for correcting finite asymmetries and volume deficiencies. Moreover, I can combine it with liposuction of the waist, lower back, and lateral thigh. Prof Moawad calls it “horseshoe liposuction” to create the universal perfect proportions of the female torso and meet the specific ethnic ideals of beautiful buttocks in one operation.

There is an increasing number of transcutaneous energy delivery devices currently available. They are classified according to the type of energy they deliver to their target—mechanical (e.g., suction, massage), radiofrequency, ultrasound, cryolipolysis, and laser. Of these, radiofrequency devices are the most popular. Adverse outcomes following noninvasive treatments are uncommon but may include thermal injuries and temporary dysesthesia.

Unwanted local fat deposits negatively affect body shape and image. Diets, exercise, medications and/, liposuction, or gastric surgeries may effectively control obesity. Surgical or minimally invasive body shaping can dramatically improve the shape and proportion of your body, enhancing your appearance and boosting your self-confidence. For patients who require minor improvement or are unwilling or unable to undergo a surgical procedure, nonsurgical fat reduction is an alternative for surgical procedures. Nonsurgical and minimally invasive options for fat reduction use various modalities, including freezing, ultrasound, radiofrequency, infrared light, vacuum massage, and injectable medication. Realistic expectations on the part of patients and the appropriate application of technologies by surgeons are the key to achieving patients’ aesthetic goals.

Radiofrequency Skin Treatment

Minimally invasive procedures to tighten and lift skin give natural results with minimal risk and recovery time. Monopolar radiofrequency deliver a high-frequency electric current—tissue resistance to electrical current, results in volumetric heating to the deep dermis and underlying tissue. The resulting heat leads to immediate collagen contraction and a delayed wound healing response, with new collagen formation up to 4 to 6-month post-treatment.  The FDA initially approved monopolar radiofrequency (RF) devices to treat periorbital wrinkles. Since then, they have been used to treat laxity of the forehead, cheeks, nasolabial folds, marionette, lines, jawline, and neck. Although the results of RF are not as dramatic as a facelift, over 90% of patients obtain noticeable tightening of the treated areas, and it never looks “pulled.” Another benefit of radiofrequency is its ability to reduce fat and tighten the skin by directing energy to target collagen. For example, a patient with flabby upper arms may have more loose skin than fat in this area. In this instance, Prof Moawad might use radiofrequency to tighten the skin first and then remove excess fat. However, if he determines that there is fat primarily in an area, he will remove the fat first and then tighten the skin afterward. “Radiofrequency is a very versatile procedure that can be used on any area of the body – from large areas like the abdomen to minimal areas such as the chin – with the same degree of success.

Stretch Marks Treatment

Many things change after you have a baby: schedules, sleep time, and a sense of freedom, to name a few. Along with, there are many physical changes you’ll see. Chief among them is stretch marks. Stretch marks or striae are a form of scarring on the skin with an off-color hue. Stretch Marks are the result of the dermal tear, which over time may diminish, but will not disappear completely. Stretch marks are often the result of the rapid stretching of the skin associated with rapid growth or rapid weight changes. Stretch marks may also be influenced by hormonal changes associated with puberty, pregnancy, bodybuilding, hormonal replacement therapy, etc. Stretch marks formed during pregnancy, usually during the last trimester. It generally appears on the belly and commonly on the breasts, thighs, hips, lower back, and buttocks. For the treatment of red stretch marks, clinicians may consider the PDL, 1,064-nm Nd: YAG laser, and 532-nm KTP laser, which would likely improve the redness (vascular component) of red stretch marks. Recently, several emerging treatment modalities, including fractionated micro-needling RF, ultrasound, and PRP and micro-needling, have reported good clinical improvement of stretch marks.  Stretch marks prevention and treatment stay a clinical challenge. Physicians should set realistic expectations with patients seeking stretch marks treatment and informing patients that the appearance and texture of stretch marks may improve but will not completely resolve to be an integral part of setting these expectations.

Cellulite (dimpled skin) Treatment

The term cellulite refers to the ‘orange peel,’ ‘mattress,’ or ‘dimpling’ appearance on the thighs, buttocks, and sometimes lower abdomen and upper parts of the arms of otherwise healthy women. Approximately 85% of post-pubertal woman has a form of cellulite. This appearance is much more common in women than in men because of differences in how fat, muscle, and connective tissue are distributed in men’s and women’s skin. Although rarely observed in men, those men presenting with cellulite are commonly deficient in male hormones. The lumpiness of cellulite is caused by fat deposits that push and distort the connective tissues beneath the skin, leading to characteristic changes in the appearance of the skin. The causes of cellulite are not well understood. Theories include genetics, circulatory problems, inflammation, hormonal disturbances, tight clothing, and lifestyle factors. Although being overweight is not a prerequisite for cellulite, excess body fat makes cellulite more visible. The aging process can worsen the appearance of cellulite, as skin loses elasticity and is less able to resist irregular tension created by the fibrous bands. Despite many treatments available—all of which claim to work somehow—few do work, and many works with unpredictable results.  The new minimally invasive techniques of power liposuction (without suction) and fat transfer are rewarding to achieve acceptable results.