Purpose: Anatomic features that make the female buttocks attractive include adequate projection and a defined infragluteal fold. Lower body lifts strive to mimic this beauty in patients with massive weight loss after gastric bypass by removing excess skin and lifting sagging buttocks. However, this typically results in gluteal flattening. Procedures designed to augment the inferomedial aspect of the gluteal region restore projection and help define the infragluteal crease. We describe our technique of lower body lift with gluteal autoaugmentation using the superior gluteal artery perforator flap.
Methods: Five consecutive female patients (age 33-55) with massive weight loss after gastric bypass (maximum BMI 44-76) had lower body lifts performed by one surgeon. Pre-operative Doppler indentified superior gluteal artery perforator signals along a line between the posterior superior iliac spine and the greater trochanter. Semicircular flaps were designed around the perforators and within the lower body lift incisions.
Results: In each patient, superior gluteal artery perforator flaps approximately 15 x 8 x 4 cm were de-epithelialized and transferred into an inferomedial pocket in the lower buttock while the patient was prone. The procedure added 30 minutes to the overall procedure time and there were no intra-operative complications. Post-operatively patients were overall satisfied (Figure 1).
Conclusion: Superior gluteal artery perforator flaps can reliably be transferred during lower body lifts to add volume and projection to the buttocks.