Top

Published in:

Open Access 01-02-2024 | Fat Grafting | Original Articles

Danger Zones of the Gluteal Anatomy: Improving the Safety Profile of the Gluteal Fat Grafting

Authors: Ana Cristina Seabra Robalo Gomes Jorge, You-Shan Feng, Adelana Santos Stahl, Gerd Grözinger, Konstantin Nikolaou, Matthias Glanemann, Adrien Daigeler, Stéphane Stahl

Published in: Aesthetic Plastic Surgery | Issue 8/2024

Abstract

Introduction

Knowledge of the vascular anatomy is critical to performing safe gluteal surgery. To date, only the course of the main blood vessels within the muscles has been outlined. These findings are based on MRI and CTA images that do not conform to a topographically standardized and normalized probability distribution.

Objectives

The aim of this study was to develop a three-dimensional mapping of the gluteal zones of high vascular density in relation to anatomical landmarks.

Materials and Methods

This single-center retrospective cohort analysis comprised all consecutive patients who underwent cone-beam computed tomography (CBCT) scans between January 2016 and October 2021. The location of blood vessels in the gluteal region was allometrically normalized in relation to anatomical landmarks. Moreover, the caliber and area of the blood vessels were assessed.

Results

CBCT scans of 32 patients with an average age of 64 ± 12 years (range 34–87 years) were included. Fifty-three percent were female. The median [IQR] caliber of the intramuscular gluteal vessels was 1.47 [1.15–1.88] mm, significantly greater than that of the subcutaneous vessels 1.09 [0.72–1.44] mm (p < 0.001). Vascular density was higher intramuscularly, as 4.5% of the area of the muscle was occupied by blood vessels, as opposed to 0.3% in the adipose tissue.

Conclusion

The analysis of the CBCT scans showed a higher vascular density and larger vessels intramuscularly. We, therefore, recommend the injection of autologous fat merely to the subcutaneous plane.

Level of Evidence II

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.

Woo SJ, Koo HT, Park SO, Suami H, Chang H (2021) Evolution of anatomical studies on the arterial, venous, and lymphatic system in plastic surgery. Archiv Plast Surg 49(6):773–781. https://doi.org/10.1055/s-0042-1758636CrossRef

Vigato E, De Antoni E, Tiengo C, Porzionato A, Tortorella C, Governa M et al (2018) Radiological anatomy of the perforators of the gluteal region: the “radiosome” based anatomy. Microsurgery 38(1):76–84. https://doi.org/10.1002/micr.30214CrossRefPubMed

Chopan M, White JA, Sayadi LR, Buchanan PJ, Katz AJ (2019) Autogenous fat grafting to the breast and gluteal regions: safety profile including risks and complications. Plast Reconstr Surg 143(6):1625–1632. https://doi.org/10.1097/PRS.0000000000005617CrossRefPubMed

Cansancao AL, Condé-Green A, David JA, Vidigal RA (2019) Subcutaneous-only gluteal fat grafting: a prospective study of the long-term results with ultrasound analysis. Plast Reconstr Surg 143(2):447–451. https://doi.org/10.1097/PRS.0000000000005203CrossRefPubMed

Turin SY, Fracol M, Keller E, Markl M, Collins J, Krochmal D et al (2020) Gluteal vein anatomy: location, caliber, impact of patient positioning, and implications for fat grafting. Aesthet Surg J 40(6):642–649. https://doi.org/10.1093/asj/sjz260CrossRefPubMed

Ordenana C, Dallapozza E, Said S, Zins JE (2020) Objectifying the risk of vascular complications in gluteal augmentation with fat grafting: a latex casted cadaveric study. Aesthet Surg J 40(4):402–409. https://doi.org/10.1093/asj/sjz237CrossRefPubMed

Tillo O, Nassab R, Pacifico MD (2023) The British Association of Aesthetic Plastic Surgeons (BAAPS) gluteal fat grafting safety review and recommendations. Aesthet Surg J 43(6):675–682. https://doi.org/10.1093/asj/sjac316CrossRefPubMed

Villanueva NL, Del Vecchio DA, Afrooz PN, Carboy JA, Rohrich RJ (2018) Staying safe during gluteal fat transplantation. Plast Reconstr Surg 141(1):79–86. https://doi.org/10.1097/PRS.0000000000003934CrossRefPubMed

Wall S, Delvecchio D, Teitelbaum S, Villanueva NL, Dayan E, Durand P et al (2019) Subcutaneous migration: a dynamic anatomical study of gluteal fat grafting. Plast Reconstr Surg 143(5):1343–1351. https://doi.org/10.1097/PRS.0000000000005521CrossRefPubMed

10.

Condé-Green A, Kotamarti V, Nini KT, Wey PD, Ahuja NK, Granick MS, et al. (2016) Fat grafting for gluteal augmentation: a systematic review of the literature and meta-analysis. Plast Reconstr Surg 138(3):437e–446e. https://doi.org/10.1097/PRS.0000000000002435CrossRefPubMed

11.

Klein A, Nagel K, Gührs J, Poodendaen C, Püschel K, Morlock MM et al (2015) On the relationship between stature and anthropometric measurements of lumbar vertebrae. Sci Justice 55(6):383–387. https://doi.org/10.1016/j.scijus.2015.05.004CrossRefPubMed

12.

Zhang K, Chang YF, Fan F, Deng ZH (2015) Estimation of stature from radiologic anthropometry of the lumbar vertebral dimensions in Chinese. Leg Med 17(6):483–488. https://doi.org/10.1016/j.legalmed.2015.10.004CrossRef

13.

Fischer B, Mitteroecker P (2017) Allometry and sexual dimorphism in the human pelvis. Anat Rec 300(4):698–705. https://doi.org/10.1002/ar.23549CrossRef

14.

Saluja S, Tigga SR, Das SS, Thakur A (2023) Determination of sexual dimorphism of the human sacrum based on receiver operating characteristic curve analysis of morphometric parameters. Cureus 15(5):e38629. https://doi.org/10.7759/cureus.38629CrossRefPubMedPubMedCentral

15.

Waduud MA, Sucharitkul PPJ, Drozd M, Gupta A, Hammond C, Ashbridge Scott DJ (2019) Validation of two-dimensional vertebral body parameters in estimating patient height in elderly patients. Br J Radiol 92(1104):20190342. https://doi.org/10.1259/bjr.20190342

16.

Gocmen-Mas N, Karabekir H, Ertekin T, Edizer M, Canan Y, Duyar I (2010) Evaluation of lumbar vertebral body and disc: a stereological morphometric study. Int J Morphol 28(3):841–847CrossRef

17.

Mofid MM, Teitelbaum S, Suissa D, Ramirez-Montañana A, Astarita DC, Mendieta C et al (2017) Report on mortality from gluteal fat grafting: recommendations from the ASERF task force. Aesthet Surg J 37(7):796–806. https://doi.org/10.1093/asj/sjx004CrossRefPubMedPubMedCentral

18.

Del Vecchio DA, Rohrich RJ (2020) A changing paradigm: the Brazilian butt lift is neither Brazilian nor a lift-why it needs to be called safe subcutaneous buttock augmentation. Plast Reconstr Surg 145(1):281–283. https://doi.org/10.1097/PRS.0000000000006369CrossRefPubMed

19.

Del Vecchio D, Kenkel JM (2022) Practice advisory on gluteal fat grafting. Aesthet Surg J 42(9):1019–1029. https://doi.org/10.1093/asj/sjac082CrossRefPubMed

20.

Alvarez-Alvarez FA, González-Gutiérrez HO, Ploneda-Valencia CF (2019) Safe gluteal fat graft avoiding a vascular or nervous injury: an anatomical study in cadavers. Aesthet Surg J 39(2):174–184. https://doi.org/10.1093/asj/sjy237CrossRefPubMed

21.

Chia CT, Theodorou SJ, Dayan E, Tabbal G, Del Vecchio D (2018) “Brazilian butt lift” under local anesthesia: a novel technique addressing safety concerns. Plast Reconstr Surg 142(6):1468–1475. https://doi.org/10.1097/PRS.0000000000005067CrossRefPubMed

22.

Meng BL, Pang A, Li M (2013) Principle of relative positioning of structures in the human body. Neural Regen Res 8(9):853–856. https://doi.org/10.3969/j.issn.1673-5374.2013.09.010CrossRefPubMedPubMedCentral

23.

Ma Z, Gai J, Sun Y, Bai Y, Cai H, Wu L et al (2021) Measuring the ratio of femoral vein diameter to femoral artery diameter by ultrasound to estimate volume status. BMC Cardiovasc Disord 21(1):506. https://doi.org/10.1186/s12872-021-02309-7CrossRefPubMedPubMedCentral

24.

Cansancao AL, Condé-Green A, Vidigal RA, Rodriguez RL, D’Amico RA (2018) Real-time ultrasound-assisted gluteal fat grafting. Plast Reconstr Surg 142(2):372–376. https://doi.org/10.1097/PRS.0000000000004602CrossRefPubMed

25.

Astarita DC, Scheinin LA, Sathyavagiswaran L (2015) Fat transfer and fatal macroembolization. J Forensic Sci 60(2):509–510. https://doi.org/10.1111/1556-4029.12549CrossRefPubMed

26.

Pane TA (2019) Experience with high-volume buttock fat transfer: a report of 137 cases. Aesthet Surg J 39(5):526–532. https://doi.org/10.1093/asj/sjy191CrossRefPubMed

27.

Comley K, Fleck NA (2010) A micromechanical model for the Young’s modulus of adipose tissue. Int J Solids Struct 47(21):2982–2990. https://doi.org/10.1016/j.ijsolstr.2010.07.001CrossRef

28.

Janssen I, Heymsfield SB, Wang Z, Ross R (2000) Skeletal muscle mass and distribution in 468 men and women aged 18–88 yr. J Appl Physiol (Bethesda, Md. : 1985) 89(1):81–88. https://doi.org/10.1152/jappl.2000.89.1.81

29.

Morgan PT, Smeuninx B, Breen L (2020) Exploring the impact of obesity on skeletal muscle function in older age. Front Nutr 7:569904. https://doi.org/10.3389/fnut.2020.569904

30.

Kubarewicz KJ, Ustymowicz A, Czyzewska D, Kaminski MJ, Sledziewski R, Krejza J (2020) Normal tolerance limits for side-to-side differences in diameters of major lower limbs arteries of 228 healthy subjects. Adv Med Sci 65(1):30–38. https://doi.org/10.1016/j.advms.2019.10.001CrossRefPubMed

31.

Hashimoto Y, Matsushige T, Ogawa T et al (2020) Impact of cone-beam computed tomography angiography on visualization of Sylvian veins. World Neurosurg 143:e206–e214. https://doi.org/10.1016/j.wneu.2020.07.118CrossRefPubMed

32.

Grosse U, Syha R, Ketelsen D, Hoffmann R, Partovi S, Mehra T et al (2018) Cone beam computed tomography improves the detection of injured vessels and involved vascular territories in patients with bleeding of uncertain origin. Br J Radiol 91(1088):20170562. https://doi.org/10.1259/bjr.20170562CrossRefPubMedPubMedCentral

33.

Posadzy M, Desimpel J, Vanhoenacker F (2018) Cone beam CT of the musculoskeletal system: clinical applications. Insights Imaging 9(1):35–45. https://doi.org/10.1007/s13244-017-0582-1CrossRefPubMedPubMedCentral

34.

Floridi C, Radaelli A, Abi-Jaoudeh N, Grass M, De Lin M, Chiaradia M et al (2014) C-arm cone-beam computed tomography in interventional oncology: technical aspects and clinical applications. Radiologia Medica 119(7):521–532. https://doi.org/10.1007/s11547-014-0429-5CrossRefPubMed

35.

Tacher V, Radaelli A, Lin M, Geschwind JF (2015) How I do it: cone-beam CT during transarterial chemoembolization for liver cancer. Radiology 274(2):320–334. https://doi.org/10.1148/radiol.14131925CrossRefPubMed

36.

Cadour F, Tradi F, Habert P, Scemama U, Vidal V, Jacquier A et al (2020) Prostatic artery embolization using three-dimensional cone-beam computed tomography. Diagn Interv Imaging 101(11):721–725. https://doi.org/10.1016/j.diii.2020.05.002CrossRefPubMed

37.

Chiaradia M, Radaelli A, Campeggi A, Bouanane M, De La Taille A, Kobeiter H (2015) Automatic three-dimensional detection of prostatic arteries using cone-beam CT during prostatic arterial embolization. J Vasc Interv Radiol 26(3):413–417. https://doi.org/10.1016/j.jvir.2014.11.009CrossRefPubMed

38.

Khouri RK, Khouri RER, Lujan-Hernandez JR, Khouri KR, Lancerotto L, Orgill DP (2014) Diffusion and perfusion: the keys to fat grafting. Plast Reconstr Surg Glob Open 2(9):e220. https://doi.org/10.1097/GOX.0000000000000183CrossRefPubMedPubMedCentral

39.

Chung NN, Ransom RC, Blackshear CP, Irizarry DM, Yen D, Momeni A, Lee GK et al (2019) Fat grafting into younger recipients improves volume retention in an animal model. Plast Reconstr Surg 143(4):1067–1075. https://doi.org/10.1097/PRS.0000000000005483CrossRefPubMedPubMedCentral

40.

Özalp B, Çakmakoğlu Ç (2017) The effect of smoking on facial fat grafting surgery. J Craniofac Surg 28(2):449–453. https://doi.org/10.1097/SCS.0000000000003356CrossRefPubMed

41.

Sirinoglu H, Yesiloglu N, Kaya Ö, Ercan F, Filinte G (2017) Effects of tumescent solution on fat survival. Facial Plast Surg 33(3):339–346. https://doi.org/10.1055/s-0037-1602164CrossRefPubMed

42.

Lee HJ, Kim EK (2014) Effects of long-term cryopreservation on fat grafts: an experimental study. Archiv Aesthet Plast Surg 20(2):70–74. https://doi.org/10.14730/aaps.2014.20.2.70CrossRef

43.

Shukla L, Yuan Y, Shayan R, Greening DW, Karnezis T (2020) Fat therapeutics: the clinical capacity of adipose-derived stem cells and exosomes for human disease and tissue regeneration. Front Pharmacol 11:158. https://doi.org/10.3389/fphar.2020.00158CrossRefPubMedPubMedCentral

44.

Travnickova M, Pajorova J, Zarubova J, Krocilova N, Molitor M, Bacakova L (2020) The influence of negative pressure and of the harvesting site on the characteristics of human adipose tissue-derived stromal cells from lipoaspirates. Stem Cells Int 2020:1016231. https://doi.org/10.1155/2020/1016231CrossRefPubMedPubMedCentral

45.

Kalaaji A, Dreyer S, Vadseth L, Maric I, Jönsson V, Haukebøe TH (2019) Gluteal augmentation with fat: retrospective safety study and literature review. Aesthet Surg J 39(3):292–305. https://doi.org/10.1093/asj/sjy153CrossRefPubMed

46.

Rosique RG, Rosique MJF (2018) Augmentation gluteoplasty: a Brazilian perspective. Plast Reconstr Surg 142(4):910–919. https://doi.org/10.1097/PRS.0000000000004809CrossRefPubMed

47.

Swanson E (2016) Prospective controlled study of buttock fat transfer using ultrasound and photographic measurements. Plast Reconstr Surg Glob Open 4(5):e697. https://doi.org/10.1097/GOX.0000000000000700CrossRefPubMedPubMedCentral

Title: Danger Zones of the Gluteal Anatomy: Improving the Safety Profile of the Gluteal Fat Grafting
Authors: Ana Cristina Seabra Robalo Gomes Jorge
You-Shan Feng
Adelana Santos Stahl
Gerd Grözinger
Konstantin Nikolaou
Matthias Glanemann
Adrien Daigeler
Stéphane Stahl
Publication date: 01-02-2024
Publisher: Springer US
Keyword: Fat Grafting
Published in: Aesthetic Plastic Surgery / Issue 8/2024
Print ISSN: 0364-216X
Electronic ISSN: 1432-5241
DOI: https://doi.org/10.1007/s00266-023-03824-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Danger Zones of the Gluteal Anatomy: Improving the Safety Profile of the Gluteal Fat Grafting

Abstract

Introduction

Objectives

Materials and Methods

Results

Conclusion

Level of Evidence II

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Objectives

Materials and Methods

Results

Conclusion

Level of Evidence II

Please log in to get access to this content

Other articles of this Issue 8/2024

Rejuvenation in Men Facial Aging: A Combined Approach

Can ChatGPT be the Plastic Surgeon's New Digital Assistant? A Bibliometric Analysis and Scoping Review of ChatGPT in Plastic Surgery Literature

Impact of Incisional Access Site in Primary Breast Augmentation: Evaluation of Patient Satisfaction with SCAR-Q

Comprehensive Assessment of the Functional Outcomes of Partial Turbinectomy: A Prospective Clinical Trial

Complete Preservation of Orbital Fat by Restoration of Attenuated Orbital Septa Using an Acellular Dermal Matrix in Lower Blepharoplasty

Exploring the Potential of ChatGPT-4 in Responding to Common Questions About Abdominoplasty: An AI-Based Case Study of a Plastic Surgery Consultation