Autologous gluteal augmentation after massive weight loss: Aesthetic analysis and role of the superior gluteal artery perforator flap

Background: Anatomical features that make the buttocks attractive include adequate volume, projection, and a defined infragluteal. fold. The gluteal region in patients with massive weight loss after gastric bypass is characterized by excessive skin and exaggerated fat loss. Lower body lift procedures remove excess skin and lift sagging buttock tissue, but they typically result in further gluteal flattening. Procedures designed to augment the inferomedial aspect of the gluteal region restore projection and help define the infragluteal crease. The authors describe their technique of lower body lift with gluteal autologous augmentation using the superior gluteal artery perforator flap. Methods: Eighteen consecutive patients with massive weight loss after gastric bypass had lower body lifts with autcraugmentation performed by one surgeon. Superior gluteal artery perforator flaps were designed within the lower body lift markings, raised lateral to medial, and transferred to the inferomedial quadrant of the buttocks. Results: Patients with a median age of 41 years (range, 24 to 56 years) had lower body lifts 2.8 years (range, 1.2 to 4.9 years) after gastric bypass after losing an average of 141 pounds (range, 92 to 272 pounds). Median body mass index decreased from 49 to 29 at the time of contouring. The autoaugmentation procedure added approximately 60 minutes to the overall buttock lift procedure time; there were no intraoperative complications. Postoperatively, patients were surveyed anonymously and reported noting substantial improvement in the volume and contour of the buttocks. Conclusions: Superior gluteal artery perforator flaps can be transferred reliably during lower body lifts to add volume and projection to the buttocks. Key anatomical landmarks for vascular anatomy and aesthetic design are emphasized.