Anatomy of the gluteal region and its implication in liposculpture

Objective To study the morphological characteristics and important anatomical structures of each soft tissue layer of gluteal region, and discuss the recommended levels and safe areas for liposculpture in this region. Methods Twenty-eight specimens of unilateral buttocks from 14 adult cadavers, including 16 specimens of unilateral buttocks from 8 fresh cadavers and 12 specimens from 6 formaldehyde fixed cadavers were dissected. Among the cadavers, there were 2 males with an average age of 49 years, and 12 females from 23 to 72 years old, median age 46 years. Through anatomy study of soft tissue layers of gluteal region, the morphological features of each layer were observed and documented, and the characteristics of fascia system and adipose tissue, as well as the relationship between the blood vessels and nerves with corresponding layers. Results The layers of the gluteal region that range from superficial to deep are skin, subcutaneous fat, superficial fascia system, deep fascia system, muscle and fascia compartments. Subcutaneous fat is distributed in superficial and deep layers; the superficial fascia system is well developed and dense with a layered structure; the deep fascia is thin with the characteristic of epimysium. There is a danger zone for deep fat graft in the gluteal region, with its apex at the first sacral vertebra, and its base goes along the gluteal fold, compromising the thighs′ medial two-thirds. Nearly all important blood vessels and nerves of gluteal region are located in deep layer of this danger zone. Conclusions Based on the characteristics of buttocks of Chinese people, liposuction is mainly performed in the iliolumbar region and posterolateral thigh, which can significantly increase the relative height and fullness of buttocks. For full buttocks, deep fat can be sucked appropriately, which should be longitudinal and gentle to reduce the damage to the superficial fascial system. There is a high risk for fat graft in the buttock. It is recommended to use a blunt needle with an inner diameter of more than 3 mm parallel to the fiber orientation of gluteus maximus for uniform fan-shaped injection with needle withdrawal. Satisfactory result can be obtained by injecting most fat into the subcutaneous adipose layer. Deep injection of grafts into dangerzoneis forbidden. Key words: Gluteal region; Anatomy, regional; Suction lipectomy; Fat granule injection grafting