Our world is shrinking thanks to the communication revolution, now in its fifth decade. We are all becoming aware that the cultural emphasis on beauty varies around the world. Once, a near monopoly, the Caucasian model of beauty has given way to a more diverse set of qualities. It is important to note that, in every culture, what is considered beautiful is a prevailing, common trait. To feel that beauty is a rare phenomenon misses the point that cultures, composed of large groups of people, seem to democratically arrive at standards of normalcy. Whomever, or whatever appears to resemble the common standard is deemed aesthetically pleasing. Blue eyes, thin, small noses, large breasts and small buttocks are some Caucasian standards of normalcy. Wider noses, thicker lips, and fuller buttocks are standards from a different culture but are rapidly assimilating into the worldwide standard. As athleticism has become an accepted norm, more muscular upper extremities now fall within the beauty norm for both sexes.
With this in mind, we can wonder less about why women may now want fuller backsides than it seems that they did in the past. Men are also beginning to pay attention to that portion of their own anatomy. Now, proper diet and regular exercise go a long way towards beauty if we accept that beauty is a standard of normalcy. Aging and genetics are two things; however, which are not mitigated. So, some of us are born with a genetically-programmed underwhelming backside. Others had a nice bottom in youth, but no more. It it is a distraction to feel under-endowed or saggy, what are the ways we can lose the distraction?
Let’s take the genetic problem first: some people appear to have a fuller buttock contour, one which contains a combination of muscle and fatty tissues which curve outwards from the base of the spine and the tops of the thighs. Others seem to have thighs proceed right up to the back, with only the natal cleft to remind us that there is a buttock at all. This is an oversimplification of human buttock variation, of course. To take this variation further, look at the publication by Constantino Mendieta entitled, “The Art of Gluteal Sculpting”. (Quality Medical Publishing, 2011). Dr. Mendieta catalogs and categorizes buttocks comprehensively, and then points to specific solutions for each variation. The tools many of us have learned from Dr. Mendietta, and others are comprised of: liposuction to remove fat from areas of excess, grafting fat to areas which appear to require it aesthetically, and lifting of fallen skin and fat by means of carefully placed surgical incisions.
In some countries, buttock augmentation is achieved by the use of implants, as breast augmentation is commonly done in this country. Not FDA approved in the US, buttock implants have fairly high infection and extrusion rates. Malposition is also a problem, possible due to the extremes of motion this part of the body undergoes. Here, and thanks to Dr. Sydney Coleman, as well as Dr. Mendietta, liposuctioned fat is obtained, not only from unwanted areas in the gluteal region, but from body excesses elsewhere. Currently, the fat used must be the patient’s own. This can be a problem for very thin individuals. The future may provide fat grown in labs, or other suitable biologic or inert substitutes. The grafting of fat appears to be technique-dependent and recipient site-dependent. It is very helpful to have an artistic, or Right-Brained approach to the graft placement. Using hollow tubes, or “cannulas”, the fat is placed in small amounts into the appropriate anatomic zones of the buttock, almost like the brushstrokes used in Impressionist-Style painting. “Take” or survival of the grafted fat is variable in humans, and in large studies, different averages for take are seen. Even the world’s experts agree that this field is in its infancy. There appears to be much promise.
Sometimes, grafting of fat is not the answer. If the skin has fallen or sagged to enough of a degree, no amount of fat placed will lift the buttocks back into place. This is the province of the “buttock lift”. Unlike the inappropriately named “breast lift” (should be called, “breast push-up”), the buttock lift really is what the name says. A curvilinear incision is designed at the top of the buttocks well within the underwear lines. Through this incision, undermining and /or skin removal are done, lifting the fallen remainder back up onto the gluteal muscular structures. In the case of significant weight loss, such as after Bariatric surgery, both lifting and grafting are need to obtain a normal-appearing result.
As with all procedures in so-called, “cosmetic surgery” (I do not call it that. I might say “restorative” or “reparative”, or “normalizing”), the aim of an experienced plastic surgeon is to achieve harmony, so that the parts of the patient all appear to belong together. These relatively new procedures of buttock lifting and augmentation now harmonize nicely with the ones with which most of us are already familiar.