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Bringing Up the Rear

By Beth Landman
Posted On Sep 21, 2016
Bringing Up the Rear

Kick that pancake posterior to the curb—buttocks enhancement will give your bottom a boost and bring your summer look full circle.

Pop culture certainly touts the popularity of a generous derriere. In music, artists like Nicki Minaj, Meghan Trainor, Jennifer Lopez, and Iggy Azalea have all cashed in on the boost of their booty. The internet exploded when Paper magazine released Kim Kardashian’s cover photos, highlighting her ample posterior. According to the American Society for Aesthetic Plastic Surgery, buttocks augmentation saw an increase of 21 percent from 2015, with buttocks lifts showing a significant increase of 32 percent.

Backside, Front and Center

It is indeed the year of the rear, but it’s not just trend-seeking augmentation; it’s also those with the desire to retain their youthful figures. “As we age, we lose fat from our bottoms as well as our faces, hands, and breasts,” explains Constantino Mendieta, M.D., a Miami-based plastic surgeon specializing in buttocks augmentation. “Everything  starts drooping. It’s in vogue to re-shape and lift the butt.”

“People now come in asking for one of four types of butt,” explains Dr. Mendieta. “There is the perky Jessica Biel, the in-between Jen Selter, the more ample Kim Kardashian or J. Lo, and, the most extreme, Nicki Minaj. Three years ago I was performing about 200 gluteal augmentations a year; now I’m doing about 350.”

Choice Cuts and Butts

So what are the options for a designer derriere? The gold standard for buttocks enhancement is gluteal fat transfer, also known as the Brazilian Butt Lift. It involves the removal of fat using liposuction from the stomach, love handles, or other areas of excess and then re-implanting the fat into the buttocks. It can be done under local anesthesia in two to three hours. The result? A rounder, fuller looking derriere.

“Transferring fat is not 100 percent predictable in terms of how much will remain after it’s been injected, and how long it will last,” reports Z. Paul Lorenc, M.D., an aesthetic plastic surgeon in New York City who performs fat transfer. “It has a 50 to 75 percent retention rate, but there is some individual variability. We are getting good results-—but I’d be happier if we got it to 100 percent.”

These results have improved over the years due to refinements in the procedure, such as adding more stem cells to the fat. Cell-assisted fat transfer involves removing fat from one area of the body and dividing it into equal parts. Stem cells are obtained from one part using a series of procedures that separates them from the fat and then is reintroduced into the fat graft. This technique, perfected by Dr. Kotaro Yoshimura in Tokyo, Japan, has demonstrated 35 to 40 percent greater volume retention compared to traditional fat transfer.

Richard Greco, M.D., a Savannah, Georgia-based plastic surgeon, says sculpting the back and flanks above the buttocks, along with the hips and legs, enhances the operation’s results. “That helps improve the harmony and shape,” says Greco. “By carving above and below the buttocks, you create the appearance of more prominence. You would have to make the buttocks much bigger to get the same overall appeal if you didn’t sculpt.”

Injection technique is another key to the operation’s success, according to Howard Sobel, M.D., a Manhattan cosmetic dermatologist. “It’s important that the doctor layers the fat properly so you don’t get irregularities,” he maintains. “Layering also helps the fat develop a blood supply, which improves its retention. Over time, 10 to 30 percent of the fat will be re-absorbed,” he notes.

“You have to warn patients that they will look a little bigger at first,” he says. “You don’t want to overfill too much to compensate for fat loss, because then they will look ridiculous.”

Other gluteal augmentation options are more invasive and include implants or a buttocks lift. Buttocks implants (silicone) are inserted via incisions in hidden areas of the backside. A buttocks lift is performed under general anesthesia and it removes excess backside or thigh skin. Both surgeries require more recovery time and are more costly than fat transfer.

Rear Recovery

Risks from buttocks implants include infection, opening of incisions, implant rupture or migration, scarring, nerve damage, and fluid accumulation. Fat transfer is a relatively safer procedure with less recovery time. However, in inexperienced hands, the risk of a fat embolism is possible. A fat embolism occurs when fat is injected into the bloodstream and causes inflammation in the lungs.

Dr. Lorenc says he stopped using implants five years ago: “They have a significant complication rate and a complex recovery.”

Recovery time for buttocks enhancement is about one week for fat transfer and up to three weeks for surgical procedures. For about two weeks after the procedure, it is recommended that you wear a control garment, avoid prolonged periods of sitting, use a cushion, and sleep face down or on your side to reduce pressure on the surgical site and promote better results.

As always, due diligence in selecting a provider is key. Make sure your choice is a board-certified cosmetic or plastic surgeon with experience in buttocks enhancement. Research the provider and the facility. Ask to see before and after photos and speak to patients who have had the procedure. Expect to pay anywhere from $5,000 to $15,000 for your designer derriere. If it’s glamorous glutes you seek, it is possible (and just in time for swimsuit season)!