**3. Ethnic variations for an attractive buttock**

 It is fair to say that all cultures find a female body with a waist-to-hip ratio around 0.7 to be very attractive. However, there are significant ethnic differences when it comes to the ideal shape of a buttock. The senior author has performed well over 1000 gluteal augmentations including fat grafting, gluteal lifts and gluteal implants. It is our experience that patient's satisfaction depends heavily on what their ethnicity perceives as an attractively shaped buttock and did the surgeons results match what they hoped to achieve. If the surgeon does not understand how significant the buttock shape is based on ethnicity, a good result from the surgeon's standpoint may be a terrible result for the patient. This observation is based on over 22 years' experience performing gluteal surgeries in many parts of the world and on an extremely large number of ethnically diverse patients (**Figure 8**). With the United States and the world as a whole becoming much more diverse due to immigration patterns and medical tourism, it is important for the surgeon to take into consideration ethnic background of the patient when doing this type of surgery. It is also important to go over before and after photos with patients to assess what it is that they consider ideal for their body. The major differences noted among ethnic groups are:

1.**Caucasian female** patients prefer an average fullness but not extremely large in most cases as a general rule of thumb. They like their fullness in the upper

#### **Figure 8.**

*Ethnic diversity regarding buttock shape is particularly significant for differences seen between Caucasian, Latinos, and African American women. Maximum projection location is one difference among this group as shown and lateral fullness is another area where Caucasian vary greatly from Latinos or Black women.* 

 to middle third of the buttocks and like an overall upside-down heart shape. However, most Caucasian patients do not like the fullness in the lateral thigh and if it is present, they often request liposuction of this area the call the lateral thigh fat immediately below the greater trochanter depression, "saddlebags". This same area may be referred to as "hips" by a Latino or Black patient which may be confusing if not understood. Typically, Caucasians like a slimmer and more athletic look to their buttocks (**Figure 9**).

#### **Figure 9.**

*BBLs for Caucasian women often require removing a portion of the convexity as shown in the lateral thigh fat not typically removed in Latinos or Blacks. Fat can be grafting into the lateral greater trochanter depression but more grafting in general is focused centrally versus laterally.* 

#### **Figure 10.**

*BBLs for Latino / Hispanic women typically involves significant fat grafting to the mid and lower 1/3 of the buttock as well as major grafting in the lower lateral buttock. Even when a large implant is used, many Hispanic women will also want additional fill laterally with fat to accentuate the upside-down heart shape.* 

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

 2. Patients of **Hispanic or South American** decent prefer a buttock that is very full (larger volumes than most Caucasians) with significant additional fullness in the lateral buttocks and also in the lateral thigh area (**Figure 10**). For the most part, they prefer their maximum point of projection in the lower one half to one third of the buttocks. The preferred shape among this ethnic group is an extreme upside-down heart with more fullness in the lateral thigh area. Unlike Caucasian patients, liposuction of the lateral thigh area is almost never desired in Black or Hispanic women (**Figure 11**).

#### **Figure 11.**

*This figure demonstrate the fat grafting pattern commonly seen with differing ethnicities from a more lateral view. Black and Hispanic females generally prefer larger volumes than Caucasian women but Black women like more rounded appearance with a more accentuated Lordotic curve from back to buttock.* 

#### **Figure 12.**

*BBLs for Latino / Hispanic women typically involves significant fat grafting to the mid and lower 1/3 of the buttock as well as major grafting in the lower lateral buttock. Even when a large implant is used, many Hispanic women will also want additional fill laterally with fat to accentuate the upside-down heart shape.* 

#### **Figure 13.**

*Most Black females who desire BBLs have very consistent cultural request of a large, round buttocks that is almost "shelf-like" at the top. On average, women of this culture request a large, round buttocks with major fullness of the lateral buttocks and lateral thighs, as well as a substantial lordotic curve.* 

3. **Black female** patients have a very consistent cultural request of a very large and round buttocks (**Figure 12**). Another popular request in this ethnic group is a high "take-off" which is also known as a "shelf-like butt." In general, women of this culture request a very large, round buttocks with major fullness of the lateral buttocks and lateral thighs, and a major lordotic curve (**Figure 13**).

Of note, these ethnic variations are valid for most cases. However, interracial relationships may play a role in what patient's desire. Some Caucasian, Hispanic and Asian women may request the look of an African-American shape if they are in a significant relationship with an African-American male or if they socialize predominantly with that ethnic group. In a similar fashion, Black and Hispanic females in significant relationships with Caucasians may request reduction of the lateral thighs. Care must be taken to discuss details of what each individual patient hopes to achieve and what their specific preferences are regarding perigluteal shape and size.
