PEER-REVIEW | BODY CONTOURING |
The volume of the implant depends on the
measurements performed. The pocket is limited between the iliac crest, trochanter, sacrum and a line drawn from the posterior iliac spine to the lateral edge of the gluteus maximus. Taking these measurements into account, the author chooses an implant that is 2 cm smaller to take into account the space inside is smaller than the surface. It is an extrapolation similar to one the author makes for breast implants. The author follows Vergara’s technique2, 3
, which means intramuscular
placement. The implants are placed in the upper two thirds of the buttocks. The patient is placed in the ventral decubitus position,
with a small pillow under the pelvis to flex the hips slightly. The muscles should be very relaxed so the author prefers general anaesthesia and the use of muscle relaxants. With the patient standing up the author marks the bony landmarks, such as the iliac crest, coccyx, and
Figure 3 Chest enhancement with custom-made implants. (A, B, C) Before and (D, E, F) after
Figure 2 Pectoral implants, 190 cc (Polytech Health & Aesthetics, Dieburg, Germany). (A, B, C) Before and (D, E, F) after
greater trochanter. The author then draws a line from coccyx to greater trochanter which is the caudal limit of the dissection. The markings are checked again, as they move slightly in relation to the bony landmarks. A 7 cm incision is performed in the intergluteal sulcus,
approximately 2–3 cm above the coccyx. An intact strip of skin, of 3–4 mm, is left in the centre of the incision. This strip is de-epithelialised and used to anchor the closing stitches. This prevents wound dehiscence, which is the main complication of the procedure in the author’s experience. A short tunnel is created under the skin and over the fascia to expose the gluteus maximus fibres. The author creates a window between the muscular fibres and creates an intramuscular pocket with blunt dissection, taking into account the need to leave enough thickness above the implant. It is very important not to make the pocket parallel to the surface (it should be oblique, following the axis of the pelvis, 30–45°
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July/August 2014 |
prime-journal.com
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