**6.3 Formal incisional buttock lifting technique**

 As previously mentioned, this procedure is common in the massive weight loss patient. It is used to address the damage to collagen and elastic fibers which have been severely

#### **Figure 20.**

*A 5cm midline skin incision is used for placement of both butt implants followed by initial blunt dissection within the gluteus maximus muscle to create the implant pocket. After lighted retraction and hemostasis assured, implants are then introduced into the pocket through the small incisions using a Keller funnel®.* 

#### **Figure 21.**

*The position of gluteal implants should be verified from multiple angles. After positioning, the muscle can be sutured primarily over the implant. Often, a Latino female may want her implants slightly lower than would be preferred by an African American female.* 

### *Creating the Ideal Buttock (Lifting, Implanting or Fat Grafting) DOI: http://dx.doi.org/10.5772/intechopen.84660*

stretched. The typical "V" shape appearance of the massive weight loss patient is due to excess skin and lack of skin elasticity. The lack of projection is due to the loss of volume.

 The incisional butt lift is a procedure that can be perfumed by itself to address the skin laxity and the ptosis of the skin. But it could also be combined with autogenous fat grafting and/or gluteal implants. The first step in this technique is to place the most superior incision along the iliac crest while the patient is standing in the upright position. This upper incision is marked from the mid-line and it ends laterally on the most lateral portion of the iliac crest. This creates a wide "M" shaped incision marking just above the underwear line. Then, a pinch test is performed in order to determine where the lower incision will be marked. The excess skin and fat excision is performed in a "Gull Wing" fashion (**Figure 22**). The patient is prepped and draped in a sterile fashion. Upper incision is made following the markings. No undermining above this incision is recommended. The only undermining of skin and subcutaneous

#### **Figure 22.**

*The most superior incision for a formal butt lift is along the iliac crest while the patient is standing in the upright position. Then, a pinch test is performed in order to determine where the lower incision will be marked. The excess skin and fat excision is performed in a "Gull Wing" fashion. Minimal undermining is required and liposuction can be performed simultaneously along with occasional fat grafting or implants when indicated.* 

#### **Figure 23.**

*The patient shown is before and after a standard skin excisional buttock lift with the addition of fat grafting to improve final shape and projection.* 

## **Figure 24.**

*The patient shown had complications from what appears to have been poor planning as well as technique. Correction focused on restoring a better hip to waist ratio by scar revision and fat grafting along with removal of fat at the true waist line.* 

fat is carried out in a caudal direction below Scarpa's fascia (**Figure 23**). Once the desired fat and skin has been excised, further undermining in a caudal direction takes place in order to be able to advance the lower skin and subcutaneous tissues up to the upper incision and close with the least tension as possible. Liposuction of the flanks and thighs is done only as needed. Another common procedural adjunct to an incisional but lift is a gluteal tuck which is also known as a posterior thigh lift.

In certain cases when fullness to the upper buttocks is desired, the surgeon should consider the rotation of a dermal pedicle inferiorly to give the upper buttocks more volume and projection. This could eliminate the need for a gluteal silicone implant. Planning is critical and one much keep correct proportions, maintain the superior incision at the iliac crest and avoid a thin flap to prevent unwanted complications (**Figure 24**).
