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En este reporte presentamos tres pacientes en quienes ocurrieron condiciones inflamatorias perianales tardías, luego de la administración de sustancias modeladoras no identificadas en los glúteos. El diagnóstico inicial y supuesto no fue correcto, ya que no se investigó durante la evaluación preliminar el antecedente de la administración de elementos modeladores. Recomendamos que los pacientes con patologías inflamatorias del ano, sobre todo aquellos cuyo curso es extraño, se les pregunte acerca de la administración de agentes modeladores en los glúteos. Esta práctica puede contribuir a la eficacia del diagnóstico de manifestaciones perianales caracterizadas por flogosis, que se presentan de forma inusual. (AU)

In this report we present three patients in which late perianal inflammatory conditions occurred after administration of unidentified modeling agents to the buttocks. The initial diagnosis was not correct because of the administration of modeling agents was not investigated during the initial eval-uation. We recommend inquiring patients with inflammatory pathologies of the anus, especially those whose course is unusual, about the adminis-tration of modeling agents to the buttocks. This approach can contribute to the efficiency of the diagnosis of perianal complaints characterized by inflammation, but rare in its appearance. (AU)

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The most distinguished feature of the female silhouette is the buttock. As such, the Brazilian Butt Lift (BBL) has become the most popular plastic surgery procedures in recent years. Despite the popularity of this buttock reshaping and augmentation procedure, there remains no prevailing standard for evaluating, planning surgical design, and objectifying buttock size and shape outcomes. In fact, we have observed a wide range of preferred buttock size and shapes among our patients. We have previously published the BBL assessment tool that serves to guide patient communication of their preferred buttock size and shape. In this study, we demonstrate how the BBL assessment tool can serve to optimize Brazilian Buttock Lift results. We present 25 case studies of how the BBL assessment tool can serve to optimize BBL results by providing a guide for evaluation, surgical design, and objectification of outcomes.Level of Evidence IV Therapeutic study. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors   www.springer.com/00266 .

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INTRODUCTION: Enhancing and altering body contours has increasingly been the focus of new technologies and techniques in aesthetic treatments. The buttocks are seen as a symbol of beauty, sensuality, and attraction. PATIENTS AND METHODS: The authors described a technique for female and male gluteal augmentation. It uses a special marking, a safe plan, and a specific product. The patients chosen for this technique wanted to have an augmentation or projection effect on the buttocks, but were not willing to undergo surgery. The product used was Sofiderm Subskin Aeskins. The plan of injection was the subcutaneous as no major blood vessels were found. RESULTS: The authors report good aesthetic results with the proposed technique. The patients reported a high degree of satisfaction. DISCUSSION: The product chosen has a high G prime and a larger molecule size, which accounts for resistance to deformation and a high lifting power. Thus, result can be visible in a large body area. As the anatomy between male and female buttocks are different, different techniques were used for each gender. CONCLUSION: The LL body contour technique for gluteal augmentation proved to be a minimally invasive technique, with quick results, without major risks and downtime.

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BACKGROUND: The BAAPS advice against Brazilian butt lift (BBL) surgery in the UK was set in October 2018. A Delphi study conducted by BAAPS highlighted the importance of defining current practice and perceptions amongst UK surgeons, as this is currently unknown. OBJECTIVES: To evaluate BAAPS members' current practice and perceptions around BBL surgery to ensure patient safety and propose better recommendations. METHODS: A BAAPS-commissioned survey was emailed to all BAAPS members through an on-line link. The survey collected quantitative and qualitative information in several domains. RESULTS: This survey received a 44% response rate. Of 102 respondents, 32 surgeons undertook BBL surgery before the BAAPS advice to halt it. There was a wide variation in actual fat volumes injected, and in perceptions of what constituted a small or large volume. Virtually all respondents (96.9%) performed only subcutaneous fat injections. There were differences in fat harvest techniques. The majority (66.7%) felt that BAAPS should maintain its recommendation against undertaking BBL surgery until further data became available. Nearly a quarter of 102 respondents (20.6%) had been treated for BBL complications, the majority as a result of surgical tourism. CONCLUSIONS: The survey provides member-reported perception and experience with regard to BBL surgery in the UK. The demand for BBL surgery and its provision should be reassessed in the UK. This information will be analysed with further national and international data to better define and shape the scope of the safety of BBL surgery in the UK. BAAPS will use such data towards the production of future guidance and support for surgeons and patients.

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Resumen Objetivo: Describir las características clínicas, demográficas, resultados y complicaciones de una serie de pacientes operados de aumento de glúteo con implantes de silicona por medio de la técnica XYZ. Materiales y Método: Serie de casos retrospectiva de pacientes sometidos a gluteoplastía de aumento con implantes de silicona por medio de técnica intramuscular. Se describe la técnica quirúrgica, datos demográficos, antecedentes médico quirúrgicos y complicaciones posoperatorias. Resultados: Entre diciembre de 2014 y junio de 2017 se operaron 19 pacientes. La complicación más frecuente fue dehiscencia de herida operatoria, presentándose en 5 pacientes. Un paciente tuvo hematoma posoperatorio. Dos pacientes tuvieron seroma posoperatorio. Una paciente presentó rotación de un implante. Una paciente se perdió de seguimiento luego del control de retiro de puntos a la 6a semana. Una paciente necesitó reinternación para manejo del dolor. Ningún paciente necesitó reoperación. Ningún paciente presentó infección de herida operatoria. Ningún paciente presentó extrusión ni pérdida de implantes. Discusión: La técnica XYZ es un método efectivo para el tratamiento estético y reconstructivo de la región glútea especialmente en pacientes que no presentan zona dadora suficiente para injerto graso. Las complicaciones descritas son acordes a la literatura, por lo que se recomienda la técnica de gluteoplastía de aumento con prótesis de silicona intramuscular como una técnica reproducible y segura.

Objective: Describing the clinical features, demographics features, outcomes and complications from a serie of patients underwent buttock augmentation with silicone implants with XYZ technique. Material and Methods: Retrospective case series of patients underwent buttock augmentation with intramuscular technique. It Is described the surgical technique, demographics data, comorbidities and post operative complications. Results: Since December 2014 to June 2017 were operated 19 patients. The most frecuent complication was wound dehiscence, it was present in 5 patients. One patient had a postoperative hematoma. Two patients presented seroma. One patient presented implant rotation. One patient left controls after removal the suture in the sixth week. None of patients needed revisional procedures. None of patients presented wound infection. None of patients presented extrusión or implant removal. Discussion: The XYZ technique is a efective method to aesthetic and reconstructive treatment of buttock area, especially in patientes without a suficient donor area to fat graft. The complications described are accord with literatura, that is why buttock augmentation with intramuscular silicone implant is recomended as a reproducible and safe technique.

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Introducción: El aumento de glúteo con implantes ha tomado fuerza en los últimos años con la aparición de la técnica intramuscular, que sugiere la creación de un bolsillo en el espesor del músculo glúteo mayor a 3 cm de profundidad. Por diferencias étnicas en el glúteo de pacientes chilenas, es necesario realizar mediciones para caracterizar el grosor del músculo glúteo mayor en nuestra población. Nuestro objetivo es conocer el espesor promedio del músculo glúteo mayor en mujeres chilenas. Material y método: Se diseñó un estudio descriptivo, retrospectivo, midiendo el espesor del músculo glúteo en todas las tomografías de abdomen y pelvis en prono, en mujeres entre 18 y 65 años, desde el 1 de enero al 31 de diciembre del año 2015 en el Hospital Clínico de la Universidad de Chile. Se determinó la asociación con la edad, el peso, la talla, el índice de masa corporal (IMC) y el espesor de la grasa abdominal y glútea de las pacientes. Resultados: El promedio del espesor del músculo glúteo derecho fue de 3,85 cm (IC 95%: 3,76-3,95) y el del glúteo izquierdo fue de 3,84 cm (IC 95%: 3,75-3,92). Existió asociación positiva entre el peso y el espesor del músculo, y entre el IMC y el espesor del músculo. Estas asociaciones fueron estadísticamente significativas. Discusión: Por las características de nuestra población, en la que el espesor del músculo glúteo mayor es menor que el descrito en la literatura, el bolsillo en el músculo debe ser realizado con precaución y a una profundidad menor a la descrita.

Introduction: Buttock augmentation with implants has become more frecuent in recent years with the emergence of the intramuscular technique, which suggests creating a pocket in the thickness of the gluteus maximus muscle, 3 cm deep. Ethnic differences in the gluteus of Chilean patients, makes measurements necessary to characterize the thickness of the gluteus maximus muscle in our population. Our objective is to know the average thickness of the gluteus maximus muscle in Chilean women. Material and method: A descriptive, retrospective study was designed by measuring the thickness of the gluteal muscle in all abdominal CT scans in prone position, in women aged 18 to 65, from January 1th, to December 31, 2015 at the Clinical Hospital the University of Chile. Association with age, weight, height, body mass index (BMI) and abdominal and gluteal fat thickness of patients was determined. Results: The average thickness of the right gluteal muscle was 3.85 cm (95% CI: 3.76-3.95) and the left gluteal muscle was 3.84 cm (95% CI: 3.75-3.92). There was a positive association between weight and thickness of the muscle, and between BMI and thickness of the muscle, these associations were statistically significant. Discussion: In our population, the thickness of the gluteus maximus is less than described in the literature, pocket in the muscle should be done with caution and shallowest than described.

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BACKGROUND: The purpose of this study was to evaluate the results of gluteal suspension with polypropylene strips. PATIENTS AND METHODS: Ninety healthy female patients between the ages of 20 and 50 years (mean, 26 years), who wished to remodel their buttocks from December 2004 to February 2013 were studied retrospectively. All 90 patients were treated with 2 strips of polypropylene on each buttock using the following procedures: 27 (30 %) patients were suspended with polypropylene strips; 63 (70 %) patients were treated with tumescent liposuction in the sacral "V", lower back, supragluteal regions, and flanks to improve buttocks contour (aspirated volume of fat from 350 to 800 cc); 16 (18 %) patients underwent fat grafting in the subcutaneous and intramuscular layers (up to 300 cc in each buttock to increase volume); 5 (6 %) patients received implants to increase volume; and 4 (4.4 %) patients underwent removal and relocation of intramuscular gluteal implants to improve esthetics. RESULTS: Over an 8-year period, 90 female patients underwent gluteal suspension surgeries. Good esthetic results without complications were obtained in 75 of 90 (84 %) cases. Complications occurred in 15 of 90 (16.6 %) patients, including strip removal due to postoperative pain in 1 (1.1 %) patient, and seroma in both subgluteal sulci in 3 (3.3 %) patients. CONCLUSION: The results of this study performed in 90 patients over 8 years showed that the suspension with polypropylene strips performed as a single procedure or in combination with other cosmetic methods helps to enhance and lift ptosed gluteal and paragluteal areas. LEVEL OF EVIDENCE IV: This journal requires that the authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

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BACKGROUND: Dissecting through the gluteus maximus muscle by splitting its fibers, instead of complete sectioning of the muscle, is faster, involves less damage to tissues, and diminishes recovery time. The objective of the current paper is to present a clinical series of sciatic nerve lesions where the nerve was sufficiently exposed via the transgluteal approach. METHODS: We retrospectively selected 18 traumatic sciatic nerve lesions within the buttock, operated upon from January 2005 to December 2009, with a minimum follow-up of 2 years. In all patients, a transgluteal approach was employed to explore and reconstruct the nerve. RESULTS: Ten males and eight females, with a mean age of 39.7 years, were studied. The etiology of the nerve lesion was previous hip surgery (n = 7), stab wound (n = 4), gunshot wound (n = 3), injection (n = 3), and hip dislocation (n = 1). In 15 (83.3%) cases, a motor deficit was present; in 12 (66.6%) cases neuropathic pain and in 12 (66.6%) cases sensory alterations were present. In all cases, the transgluteal approach was adequate to expose the injury and treat it by neurolysis alone (10 cases), neurolysis and neurorrhaphy (4 cases), and reconstruction with grafts (4 cases; three of these paired with neurolysis). The mean pre- and postoperative grades for the tibial nerve (LSUHSC scale) were 1.6 and 3.6, respectively; meanwhile, for the peroneal division, preoperative grade was 1.2 and postoperative grade was 2.4. CONCLUSIONS: The transgluteal approach adequately exposes sciatic nerve injuries of traumatic origin in the buttock and allows for adequate nerve reconstruction without sectioning the gluteus maximus muscle.

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El polimetil-metacrilato es un polímero de alta resistencia al impacto, ampliamente utilizado en diferentes campos de la medicina, sin embargo, aún no está clara su indicación como relleno glúteo. A pesar de su aparente inocuidad, se han presentado complicaciones durante su uso como granulomas y nódulos palpables. Se han reportado casos de embolismo pulmonar por polimetil-metacrilato posterior a vertebroplastias. Sin embargo, no se encontró reporte bibliográfico de casos de embolismo pulmonar con su uso en procedimientos estéticos. Presentamos caso de paciente femenino de 31 años de edad, quien 4 horas luego de la inyección de 500 cm3 de polimetil-metacrilato en cada región glútea, presenta disnea en reposo de aparición súbita con tos seca y palpitaciones, disminución de agudeza visual y petequias generalizadas. Se diagnostica probable embolismo pulmonar por polimetil-metacrilato y retinopatía de Purtscher. Existe similitud clínica e imaginología del caso en estudio con embolismo por silicone, y las imágenes del fondo de ojo semejan la obstrucción de pequeñas arteriolas retinianas compatibles con este diagnóstico. Se sugieren nuevas investigaciones en el uso de polimetil-metacrilato como procedimiento estético en pro de la seguridad y en beneficio de los pacientes

Polymethyl-methacrylate is a high impact resistant polymer, widely used in different medicine fields, however its indication in buttock implants is still not clear. Even though its apparent innocuity, it has presented complications like granulomas and palpable nodules. There have been reported cases of pulmonary embolism caused by polimetil-metacrilato secondary to vertebroplasties. However, there have been no bibliographic cases of pulmonary embolism due to its use in aesthetic procedures. We present a case of a woman patient of 31 years old, who 4 hours after 500 cc injection of polymethyl- Methacrylate in each buttock, presents rest dyspnea with abrupt dry cough and palpitations, reduction in visual acuity and generalized petechiae. It is diagnosed probable pulmonary embolism by polimetil-metacrilato and Purtscher retinopathy. There is a clinical and imaginological similitude between this case and silicone embolism and the images of fondoscopy are similar to those of small retinian arteriole obstruction compatible with the diagnosis. Thereby, it is suggested new investigations in the use of polymethyl-methacrylate as esthetic procedure in favor of the patient’s security and benefit

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