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Buttocks Contouring

  • Author: Neal R Reisman, MD, JD; Chief Editor: Jorge I de la Torre, MD, FACS  more...
 
Updated: Dec 29, 2014
 

Background

Aesthetic surgery of the buttocks encompasses many forms. Patients may seek to enhance buttock shape with buttock implants, autologous fat transfer, autologous tissue flaps, excisional procedures, or liposuction. Patients with traumatic buttock injuries and contour deformities from injections also require reconstruction, often with fat injections, autologous tissue flaps, and alloplastic implants. The dramatic increase in body contouring after massive loss associated with bariatric surgical treatments for obesity has also extended to buttock contouring. Skeletal and weight loss–associated gluteal deformities are often severe in nature and have also increased interest in these procedures.

The function of the buttock musculature in stability and gait is an important consideration and often has an impact on the procedure chosen for correction in reconstructive procedures. Its impact on aesthetic procedures is less clinically relevant. The history, definition, frequency, etiology, pathophysiology, clinical presentation, aesthetics, classification, and surgical treatment options are discussed in this article.

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History of the Procedure

Throughout history, artistic endeavors have documented our preoccupation with the human form as a representation of femininity and fecundity. Careful analysis, mathematical interpretation, and recreation of the human form have remained popular pursuits. Recent studies in evolutionary biology have suggested a strong correlation between the "hour-glass" figure and not only female reproductive potential but also general physical health and psychological health. This correlation is best summarized by an ideal waist-to-hip ratio of 0.7 that transcends cultures, is temporally stable, and is cross-generational. The callipygian form best represents this history.

Buttock contour surgery, in contrast, has a short history compared with the field of plastic surgery or art history. Pressure sores and traumatic deformities of this area have been treated for some time, but buttock contour improvement has become an acceptable and frequent request as demands for body improvement have increased. Patients' desire to look their best and the increased safety of liposuction and other body contouring techniques have dramatically increased the awareness of contour problems of the buttock. Recently, demographic changes in the United States coupled with changing societal fashion preferences, codification of aesthetic norms, as well as procedural improvements have increased interest in buttock contouring surgery by patients and surgeons alike.

The first reported attempts to surgically contour the buttock region in the medical literature were described by Bartels and colleagues in 1969. A mammary implant was placed unilaterally in the subcutaneous plane of the gluteal region to correct a deformity. This was closely followed by bilateral placement for aesthetic correction of platypygia. Problems associated with implant migration, capsular contracture, and migration quickly led to alternative placement in a submuscular plane between the gluteus maximus muscle and the gluteus medius muscle. A small submuscular space and anatomic constraints limited significant augmentation with a round implant. The inherent limitations of this procedure led to the development of intramuscular as well as subfascial planes for gluteal contouring with both silicone gel and silicone elastomer implants with more anatomic shapes.

Contemporaneously, liposuction emerged as the most popular body contouring technique. Liposuction was used to reduce the accumulation of fat in all regions of the body. Specifically, it was successfully applied to the flanks and back and the surrounding aesthetic units of the gluteal region. The success of these interventions in improving buttock contouring quickly led to its adoption as the primary form of contouring this region. Increasing reports of success with autologous fat transfer techniques and the popularity of liposuction led to adoption of aesthetic gluteal contouring with fat injections. The popularity of fat grafting in the buttock region has grown, including such specific methods and names such as "Brazilian butt lift" and others, all designed to enhance the shape of the buttocks using fat grafting techniques..

Recently, the dramatic increase in body contouring after massive weight loss associated with bariatric surgical treatments for obesity has also extended to buttock contouring. These severe deformities have accelerated the recent development of various autologous tissue flaps and excisional body contouring procedures to treat this patient population. The limitation of implant design availability in the United States and associated complications have limited the widespread adoption of implant augmentation of the gluteal region.

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Problem

Buttock contour defects are common, and patients often seek some form of correction. The treatment choices must match the patient's concerns while not interfering with the necessary function of this area. Long-term approaches are an important consideration, as are scarring and unreasonable expectations. The patient may be concerned with a cellulite-contour irregularity of the skin and desire correction that may not be obtainable. Superficial corrections should be performed with great care to avoid further contour irregularities and detachment of the skin from underlying structures. The inferior fullness below the infragluteal crease or fold is one problem area. Many patients seek contouring of this area, yet excess removal may result in buttock ptosis, which is difficult to correct.

Patients seeking augmentation or enhancement of the buttock should recognize the consequences of implants that are required to withstand a person's weight and activity requirements. The same concerns apply to corrections of traumatic depressions and treatment by fat injections. Lastly, a round buttock with a convex surface demonstrates a groove and depression if a scar crosses the convexity. Restoring the projection and smooth characteristics of the buttock is difficult when normal curvature is distorted.

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Epidemiology

Frequency

Body contouring of the buttock increased dramatically from 1997 to the present. Gluteal augmentation has increased 10% in the last few year, but statistics have only recently been collected. Buttock lifts have increased 142%, and body lifts have increase 459% over this same period. The refinement of liposuction, autologous fat transfer, autologous flaps, excisional procedures, and alloplastic implants has contributed to the increase in the number of successful treatments. Liposuction and its progeny of ultrasonic-assisted and superficial liposuction have also had an impact. Codification of gluteal aesthetic standards has added the finesse necessary to achieve the balance between form and function.

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Etiology

The etiology of buttock contour defects can be genetic, traumatic, or acquired. A disproportionately large buttock significantly affects some young men and women; often, these persons are unable to wear fitted clothes or participate in desired activities. The genetically absent buttock (often as significant a genetic defect as a disproportionately large buttock) is also equally undesirable because it does not adequately fill out clothing. Uncommonly, genetic lipodystrophies also affect the gluteal region.

Traumatic defects of the buttock that produce contour problems obscure the curve of the buttock and often create a notch or groove that is clearly visible in swimwear and knit fabric clothes. The patient seeks correction and states a desire to return to the preinjury form. Automobile and workplace accidents and animal bites are common etiologies of contour defects. Iatrogenic deformities caused by failure to accurately repair all anatomic layers during surgical procedures in the trochanteric and gluteal region are also commonly seen.

A scar or defect that crosses the curvature of the buttock usually leaves a depression and groove that requires some form of correction. Furthermore, contour irregularities and overresection associated with liposuction are common causes of gluteal deformities. The authors still see patients with depressions from steroid injections and undrained, resolving hematomas of the buttock. Gluteal compartment syndrome is also a rare but serious clinical condition associated with traumatic injuries.

Acquired gluteal deformities are often associated with aging, menopause, weight gain, sun damage, skeletal deformities associated with obesity, and massive weight loss associated with bariatric surgical procedures. Aging, sun damage, and massive weight loss usually lead to skin laxity and buttock ptosis. Menopause and skeletal changes associated with obesity usually leads to a diminished gluteal aesthetic that is more refractory to surgical interventions.

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Pathophysiology

The pathophysiology of the traumatic defect is relatively simple. A hematoma that remains unrecognized produces a pressure point from within, which reduces the normal fat levels of the buttock form. When the hematoma is drained or resorbed, a depression remains. Traumatic defects from loss of tissue that is either surgically closed or allowed to secondarily resolve often result in contour irregularities. Steroid injections placed within the fatty portion of the buttock can cause absorption and atrophy of fat cells, which also produce a marked depression and thinning of the skin.

Contour defects of the buttock include the above conditions and genetic increases, decreases, and asymmetries that reflect society's range of shapes.

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Presentation

The patient seeks a plastic surgeon to correct contour deformities of the buttock. The discussion may involve an overly large buttock or a buttock that does not adequately fill out jeans. The range of superficial contour irregularities, from an absent buttock crease or infrabuttock fold to a square buttock, also may include the patient declaring that his or her cellulite creates an uneven and unsmooth buttock. The surgeon should listen intently to the patient's comments and expectations of results.

Often, patients seeking liposculpture of the body ask about the buttock, unaware of the many possibilities of correction available to reshape the buttock. Emphasize and discuss the proportions of the patient, and attempt to maintain the patient within a proportional frame.

The large buttock that severely affects a young woman, preventing her from feeling comfortable in swimwear and knit clothing, and the small buttock that prevents the patient from filling out jeans are examples of culture's negative physiques. The patient may vocalize more on the superficial components of the buttock shape with absent definition and asymmetry. The surgeon must be cautious about specific demands regarding a matched symmetric shape.

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Indications

Indications for treatment include a prominent, deficient, or misshapen buttock. As expertise in minute corrections has improved, indications have also increased to allow minor asymmetries, absent creases and folds, and square shapes. All of the above situations are appropriate indications for treatment.

Use caution with superficial irregularities that are more confined to the skin and superficial levels. The patient may describe this as cellulite. Many attempts to correct these deformities have failed and may actually worsen the other initial defects. Caution also must be emphasized concerning the fullness just inferior and parallel to the buttock (the so-called banana deformity). Many patients seek liposuction of this area to create a better fold and contour. However, this area often supports the buttock, and removal leads to further ptosis that is difficult to correct. The surgeon must be cautious in accepting these indications for treatment.

Common indications include large and prominent buttocks, deficient and flat buttocks, lack of or an uneven buttock crease and fold, depressions in the buttock, square buttock shapes, and an irregularly shaped buttock. Possible indications include superficial irregularities and asymmetric or uneven minor ptosis of the buttock.

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Contraindications

Because buttock contour surgery is an elective procedure, significant medical problems that could increase the surgical risk are relative contraindications.

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Contributor Information and Disclosures
Author

Neal R Reisman, MD, JD Chief of Plastic Surgery, St Luke's Episcopal Hospital; Clinical Professor of Plastic Surgery, Baylor College of Medicine

Neal R Reisman, MD, JD is a member of the following medical societies: American Society of Plastic Surgeons, American College of Surgeons, American Society for Aesthetic Plastic Surgery, Lipoplasty Society of North America, Texas Medical Association, Texas Society of Plastic Surgeons

Disclosure: Nothing to disclose.

Coauthor(s)

Azita Madjidi, MD, MS Clinical Assistant Professor in Plastic Surgery, Baylor College of Medicine

Azita Madjidi, MD, MS is a member of the following medical societies: American Society of Plastic Surgeons, International Association of Oral and Maxillofacial Surgeons, World Medical Association, Harris County Medical Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Alan Matarasso, MD, FACS PC, Clinical Professor of Plastic Surgery, Albert Einstein College of Medicine; Immed Past President of New York Regional Society of Plastic and Reconstructive Surgery

Alan Matarasso, MD, FACS is a member of the following medical societies: American Society of Plastic Surgeons, American College of Surgeons, American Medical Association, International College of Surgeons US Section, New York Academy of Medicine, New York County Medical Society, Pan America Medical Association of Central Florida, Pan-Pacific Surgical Association

Disclosure: Nothing to disclose.

Chief Editor

Jorge I de la Torre, MD, FACS Professor of Surgery and Physical Medicine and Rehabilitation, Chief, Division of Plastic Surgery, Residency Program Director, University of Alabama at Birmingham School of Medicine; Director, Center for Advanced Surgical Aesthetics

Jorge I de la Torre, MD, FACS is a member of the following medical societies: American Burn Association, American College of Surgeons, American Medical Association, American Society for Laser Medicine and Surgery, American Society of Maxillofacial Surgeons, American Society of Plastic Surgeons, American Society for Reconstructive Microsurgery, Association for Academic Surgery, Medical Association of the State of Alabama

Disclosure: Nothing to disclose.

Additional Contributors

Gregory Gary Caputy, MD, PhD, FICS Chief Surgeon, Aesthetica

Gregory Gary Caputy, MD, PhD, FICS is a member of the following medical societies: Wound Healing Society, American Society for Laser Medicine and Surgery, International College of Surgeons, International College of Surgeons US Section, Pan-Pacific Surgical Association

Disclosure: Receive salary from Advantage Wound Care for employment. for: On the speaker's bureau for Smith and Nephew for Santyl Ointment.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author Robert F Centeno, MD, MBA, to the development and writing of this article.

References
  1. Flores-Lima G, Eppley BL. Body contouring with solid silicone implants. Aesthetic Plast Surg. 2009 Mar. 33(2):140-6. [Medline].

  2. De Meyere B, Mir-Mir S, Peñas J, et al. Stabilized hyaluronic acid gel for volume restoration and contouring of the buttocks: 24-month efficacy and safety. Aesthetic Plast Surg. 2014 Apr. 38(2):404-12. [Medline].

  3. Camenisch CC, Tengvar M, Hedén P. Macrolane for volume restoration and contouring of the buttocks: magnetic resonance imaging study on localization and degradation. Plast Reconstr Surg. 2013 Oct. 132(4):522e-529e. [Medline].

  4. Sozer SO, Agullo FJ, Palladino H. Autologous augmentation gluteoplasty with a dermal fat flap. Aesthet Surg J. 2008 Jan-Feb. 28(1):70-6. [Medline].

  5. Le Louarn C, Pascal JF. Autologous gluteal augmentation after massive weight loss. Plast Reconstr Surg. 2008 Apr. 121(4):1515-6; author reply 1516-7. [Medline].

  6. Centeno RF, Young VL. Clinical anatomy in aesthetic gluteal body contouring surgery. Clin Plast Surg. 2006 Jul. 33(3):347-58. [Medline].

  7. Cuenca-Guerra R, Lugo-Beltran I. Beautiful buttocks: characteristics and surgical techniques. Clin Plast Surg. 2006 Jul. 33(3):321-32. [Medline].

  8. Avendano-Valenzuela G, Guerrerosantos J. Contouring the gluteal region with tumescent liposculpture. Aesthet Surg J. 2011 Feb 1. 31(2):200-13. [Medline].

  9. Ali A. Contouring of the gluteal region in women: enhancement and augmentation. Ann Plast Surg. 2011 Sep. 67(3):209-14. [Medline].

  10. Fischer JP, Wes AM, Serletti JM, et al. Complications in body contouring procedures: an analysis of 1797 patients from the 2005 to 2010 American College of Surgeons National Surgical Quality Improvement Program databases. Plast Reconstr Surg. 2013 Dec. 132(6):1411-20. [Medline].

  11. Aiache AE. Gluteal re-contouring with combination treatments: implants, liposuction, and fat transfer. Clin Plast Surg. 2006 Jul. 33(3):395-403. [Medline].

  12. Babuccu O, Gozil R, Ozmen S, et al. Gluteal region morphology: the effect of the weight gain and aging. Aesthetic Plast Surg. 2002 Mar-Apr. 26(2):130-3. [Medline].

  13. Bachuk L. Complications with gluteal prosthesis. Plastic Reconstr Surg. 1986. Jun (77):1012.

  14. Baroudi R. Body sculpturing. Clin Plast Surg. 1984 Jul. 11(3):419-43. [Medline].

  15. Baroudi R, Moraes M. Philosophy, technical principles, selection, and indication in body contouring surgery. Aesthetic Plast Surg. 1991 Winter. 15(1):1-18. [Medline].

  16. Bartels RJ, O'Malley JE, Douglas WM, Wilson RG. An unusual use of the Cronin breast prosthesis. Case report. Plast Reconstr Surg. 1969 Nov. 44(5):500. [Medline].

  17. Bruner TW, Roberts TL, Nguyen K. Complications of buttocks augmentation: diagnosis, management, and prevention. Clin Plast Surg. 2006 Jul. 33(3):449-66. [Medline].

  18. Cardenas-Camarena L, Lacouture AM, Tobar-Losada A. Combined gluteoplasty: liposuction and lipoinjection. Plast Reconstr Surg. 1999 Oct. 104(5):1524-31; discussion 1532-3. [Medline].

  19. Cardenas-Restrepo JC, Ahmed JA. Large-volume lipoinjection for gluteal augmentation. Aesthetic Surg J. 2002. 22(1):33-8.

  20. Centeno RF. Autologous gluteal augmentation with circumferential body lift in the massive weight loss and aesthetic patient. Clin Plast Surg. 2006 Jul. 33(3):479-96. [Medline].

  21. Centeno RF. Gluteal aesthetic unit classification: A tool to improve outcomes in body contouring. Aesthetic Surg J. 2006. 26:200-8.

  22. Chajchir A, Benzaquen I, Wexler E, Arellano A. Fat injection. Aesthetic Plast Surg. 1990. 14(2):127-36. [Medline].

  23. Cocke WM, Ricketson G. Gluteal augmentation. Plast Reconstr Surg. 1973 Jul. 52(1):93. [Medline].

  24. Da Rocha RP. Surgical anatomy of the gluteal region's subcutaneous screen and its use in plastic surgery. Aesthetic Plast Surg. 2001 Mar-Apr. 25(2):140-4. [Medline].

  25. de la Pena JA, Lopez-Manjardin H, Gamboa-Lopez F. Augmentation Gluteoplasty: Anatomical and Clinical Considerations. Key Issues Plast Cosmet Surg. Basel, Karger. 2000. 17:1-17.

  26. de la Pena JA, Rubio OV, Cano JP, et al. History of gluteal augmentation. Clin Plast Surg. 2006 Jul. 33(3):307-19. [Medline].

  27. de la Pena JA, Rubio OV, Cano JP, et al. Subfascial gluteal augmentation. Clin Plast Surg. 2006 Jul. 33(3):405-22. [Medline].

  28. de Pedroza LV. Fat transplantation to the buttocks and legs for aesthetic enhancement or correction of deformities: long-term results of large volumes of fat transplant. Dermatol Surg. 2000 Dec. 26(12):1145-9. [Medline].

  29. Douglas WM, Bartels RJ, Baker JL. An experience in aesthetic buttocks augmentation. Clin Plast Surg. 1975. 3:471-6.

  30. Erni D, Banic A. [Body contouring by removal of skin and fatty tissue]. Ther Umsch. 1999 Apr. 56(4):206-11. [Medline].

  31. Ford RD, Simpson WD. Massive extravasation of traumatically ruptured buttock silicone prosthesis. Ann Plast Surg. 1992 Jul. 29(1):86-8. [Medline].

  32. Gonzalez R. Buttocks lifting: how and when to use medial, lateral, lower, and upper lifting techniques. Clin Plast Surg. 2006 Jul. 33(3):467-78. [Medline].

  33. Gonzalez-Ulloa M. Gluteoplasty: a ten-year report. Aesthetic Plast Surg. 1991. 15(1):85-91. [Medline].

  34. Guerrerosantos J. Autologous fat grafting for body contouring. Clin Plast Surg. 1996 Oct. 23(4):619-31. [Medline].

  35. Guerrerosantos J. Secondary hip-buttock-thigh plasty. Clin Plast Surg. 1984 Jul. 11(3):491-503. [Medline].

  36. Hidalgo JE. Submuscular gluteal augmentation: 17 years of experience with gel and elastomer silicone implants. Clin Plast Surg. 2006 Jul. 33(3):435-47. [Medline].

  37. Hunstad JP. Body contouring in the obese patient. Clin Plast Surg. 1996 Oct. 23(4):647-70. [Medline].

  38. Illouz YG. Body contouring by lipolysis: a 5-year experience with over 3000 cases. Plast Reconstr Surg. 1983 Nov. 72(5):591-7. [Medline].

  39. Illouz YG. Illouz's technique of body contouring by lipolysis. Clin Plast Surg. 1984 Jul. 11(3):409-17. [Medline].

  40. Kesselring UK. Body contouring with suction lipectomy. Clin Plast Surg. 1984 Jul. 11(3):393-408. [Medline].

  41. Kinney BM. Body contouring with external ultrasound. Plastic Surgery Educational Foundation DATA Committee. Device and Technique Assessment. Plast Reconstr Surg. 1999 Feb. 103(2):728-9. [Medline].

  42. Lack EB. Contouring the female buttocks. Liposculpting the buttocks. Dermatol Clin. 1999 Oct. 17(4):815-22, vi. [Medline].

  43. Lewis JR Jr. Body contouring. South Med J. 1980 Aug. 73(8):1006-11. [Medline].

  44. Lockwood T. Lower body lift with superficial fascial system suspension. Plast Reconstr Surg. 1993 Nov. 92(6):1112-22; discussion 1123-5. [Medline].

  45. Lockwood TE. Transverse flank-thigh-buttock lift with superficial fascial suspension. Plast Reconstr Surg. 1991 Jun. 87(6):1019-27. [Medline].

  46. Maxwell GP, Gingrass MK. Ultrasound-assisted lipoplasty: a clinical study of 250 consecutive patients. Plast Reconstr Surg. 1998 Jan. 101(1):189-202; discussion 203-4. [Medline].

  47. Mendieta CG. Classification system for gluteal evaluation. Clin Plast Surg. 2006 Jul. 33(3):333-46. [Medline].

  48. Mendieta CG. Intramuscular gluteal augmentation technique. Clin Plast Surg. 2006 Jul. 33(3):423-34. [Medline].

  49. Mladick RA. Male body contouring. Clin Plast Surg. 1991 Oct. 18(4):797-813. [Medline].

  50. Montreal J. Fat tissues as a permanent implant. new instruments and refinements. Aesthetic Surg J. 2003. 23(3):213-6.

  51. Pascal JF, Le Louarn C. Remodeling bodylift with high lateral tension. Aesthetic Plast Surg. 2002 May-Jun. 26(3):223-30. [Medline].

  52. Peren PA, Gomez JB, Guerrerosantos J, Salazar CA. Gluteus augmentation with fat grafting. Aesthetic Plast Surg. 2000 Nov-Dec. 24(6):412-7. [Medline].

  53. Raposo-Amaral CE, Ferreira DM, Warren SM, Magna LA, Ferreira LM. Quantifying augmentation gluteoplasty outcomes: a comparison of three instruments used to measure gluteal projection. Aesthetic Plast Surg. 2008 Mar. 32(2):333-8. [Medline].

  54. Roberts TL, Toledo LS, Badin AZ. Augmentation of the Buttocks by Micro Fat Grafting. Aesthetic Surg J. 2001. 21(4):311-9.

  55. Roberts TL, Weinfeld AB, Bruner TW, Nguyen K. "Universal" and ethnic ideals of beautiful buttocks are best obtained by autologous micro fat grafting and liposuction. Clin Plast Surg. 2006 Jul. 33(3):371-94. [Medline].

  56. Robles JM. Re: Massive extravasation of traumatically ruptured buttock silicone prosthesis. Ann Plast Surg. 1993 Jan. 30(1):94. [Medline].

  57. Rohrich RJ, Beran SJ, Kenkel JM, eds. Ultrasound-Assisted Liposuction. St. Louis, Mo: Quality Medical Publishers; 1998.

  58. Rohrich RJ, Raniere J Jr, Kenkel JM, Beran SJ. Operative principles for optimizing results in circumferential body contouring with ultrasound-assisted lipoplasty. Clin Plast Surg. 1999 Apr. 26(2):305-16; x. [Medline].

  59. Singh D. Universal allure of the hourglass figure: an evolutionary theory of female physical attractiveness. Clin Plast Surg. 2006 Jul. 33(3):359-70. [Medline].

  60. Springer RC. Liposuction: an overview. Plast Surg Nurs. 1996. 16(4):215-22; quiz 223-4. [Medline].

  61. Teimourian B. Ultrasound-assisted liposuction. Plast Reconstr Surg. 1997 Nov. 100(6):1623-5. [Medline].

  62. Toledo LS. Syringe liposculpture: a two-year experience. Aesthetic Plast Surg. 1991. 15(4):321-6. [Medline].

  63. Vergara R. Intramuscular gluteal implants: fifteen years' experience. Aesthetic Surg J. 2003. 23(2):86-19.

 
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Body contouring with buttocks surgery. Preoperative (left) and postoperative (right) photographs.
 
 
 
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