Our latest webinar (watch full video) delved deeper into understanding the Gluteal Anatomy for safe augmentation using Genefill Hyaluronic Acid Dermal Fillers. Led by experts Dr. Lina Triana – ISAPS President-Elect, Anatomist Professor Sebastian Cotofana (USA), Plastic Surgeon Dr. Athanasios Christopoulos (Greece), and Dr. Fabio Fantozzi (Italy), the interactive episode gave crucial insight to the trending procedure of non-surgical buttocks augmentation.
If you missed the live event, the recording has been made available so you can watch it on-demand at your convenience. Further, all questions asked during the session have also been answered below by the experts.
Q1. In which cases is it recommended to inject fat and when are fillers advised?
In general, fat grafting is the election procedure for patients who have enough fat (only 1/3 of the fat aspired will remain after one month), who want a permanent result, and who don’t mind undergoing a surgical procedure with a longer recovery time.
Injecting HA is also recommended when you need to correct small defects, or after lipofilling to correct irregularities due to the fat reabsorption process.
The patient should be advised about the following differences:
With fat grafting, there is an initial period of fat reabsorption that can last from 3 weeks to 1 month and depending on the patient, could end in the reabsorption of a large amount of the injected fat, sometimes up to 70%. Also, during this month, the body may accept or reject the implanted fat (like an organ transplant). The final results will be seen after this month and this result can be considered permanent, as long as the patient has no further weight loss.
Hyaluronic Acid fillers are much faster with almost no downtime and safer as it is a non-surgical procedure and in the rare cases of adverse effect, we can use hyaluronidase to degrade the injected HA. They are biocompatible and resorbable. GeneFill Contour has an immediate volumizing effect and a slight increase with a maximum volume reached at 2-4 weeks, and lasts up to 18 months. This also depends on the injection technique, volume injected, and the patient’s metabolism and lifestyle.
Q2. Can I calculate the thickness of the skin by ultrasound guidance?
Yes, with ultrasound and also with the formula Dr. Cotofana presented on the webinar.
Q3. What are the areas to mark for injection?
This depends on the individual need for correction and/or projection for each patient.
BUTTOCKS AUGMENTATION PROCEDURE
Q4. Which layer is recommended for the injection of Body Fillers in the gluteus in terms of expansion capacity – deep fat, superficial fat, or both?
Superficial almost subdermal if the filler allows to not be visible on the skin surface
Q5. What is the maximum and minimum amount of Hyaluronic Acid which can be injected safely in one sitting? Or is it recommended to split into several appointments?
The maximum amount recommended per session is 150 mL. After 3-5 weeks the doctor may decide to perform a touch-up volume that could be approximately 40/60 mL or more depending on the patient’s body and needs.
There is not a minimum amount.
Q6. How can we know we are in the right plane and depth while injecting? And how much product you would advise?
The angle of incidence state the level of the infiltration. The angle of 45° reach the deep layer of subcutaneous tissue / fat under the camper’s fascia, the 20° angle is over the camper’s fascia. This can have a different behaviour in the tissue. The more superficial we are injecting the more increase the vascularity and can create more inflammatory response. On the contrary, the deeper the infiltration the less inflammation it produces. From the point of view of the result the superficial infiltration gives more volume, and less volume when we inject deeper. Avoid downward angulation of cannula.
Never inject intramuscular. Avoid insertion from the lower buttocks. If you are not an experienced practitioner, we also recommend to use an ultrasound to guide the cannula in the correct layer. The amount of product depends on the patient need, we recommend a maximum amount per session of 150 mL. After 3-5 weeks the doctor may decide to perform a touch-up volume that could be approximately 40/60 mL or more depending on the patient’s body and needs.
Q7. Can this product be injected in specific areas with a small needle such as the one used in the face?
Our recommendation is to inject GeneFill Contour with an 18G cannula. However, particularly in the case of superficial injections with a small product amount, using an 18G – 22G needle is at the discretion of the physician.
Q8. Is asking patients to wear a corset or tight underwear instead of taping recommended after a Hyaluronic Acid Filler treatment?
The product doesn´t migrate so easily, if located in the lateral or superior buttocks. Wearing a corset or tight can help. However, we suggest to use tapping if the patients will pass long periods seated, or not respecting the recommendations.
Q9. What pain control regimen do you use for the procedure?
For pain control during the procedure, our suggestion is to use Zylocaine or lidocaine or mepivacaine + epinephrine with a 30G needle. Small amount at the entry point and 10cc with 22G cannula in the injected area. In the case of pain after the procedure, it can be managed with Ibuprofen 600mg each 8 hours. It is better to use anti-infammatory than corticosteroids for the management of early events.
Q10. Is the use of antibiotics after the procedure recommended?
Our suggestion is not to use antibiotic treatment as prophylaxis after buttock augmentation, but only in case of adverse reactions.
Q11. How long after the procedure do we need to wait for a touch-up?
In general, 3-5 weeks.
Q12. Do you recommend massage before or/and after the treatment and how it affects the result of the treatment?
Massage after treatment could help achieve an even distribution in case of irregularities.
Q13. What is the latest best-recommended treatment of Lipodystrophy in the gluteal region that might have occurred after vaccination in childhood?
The treatment depends on the degree of lipodystrophy. It is necessary to see the case and then evaluate the therapy, which can be surgical or with the use of fat or hyaluronic acid.
Q14. Is it safe for the patient to get a Brazilian butt lift with HA Filler? Can we inject fat after hyaluronic acid fillers?
Buttock augmentation with Stabilized HA is a very safer and effective non-surgical procedure. HA is a natural, biocompatible and biodegradable molecule. Moreover, in case of severe adverse reactions, which are very rare, we can use Hyaluronidase, an enzyme that degrades the product.
Q15. What is the duration difference if we compare fillers with fat transfer?
Durability depends on product characteristics, injection amount and technique, patient metabolism, and lifestyle. In general, GeneFill Contour lasts up to 18 months. Strenuous exercise should be avoided at least for 2 weeks when the product is totally integrated into the tissue. During this period, the product gradually reabsorbs, so based on the patient’s request, the doctor will decide when it’s time for a touch-up. Fat transfer is, in general, a permanent treatment. However, it also depends on the patient’s metabolism and lifestyle as it will reduce by loosing weight
Q16. Is there any bioequivalence of the amount of filler with respect to the volume that we can obtain?
For GeneFill contour we consider three times the volume of the product. (i.e. for 20mL of product, after 2-3 weeks, you will achieve 60mL of volume).
Q17. Does necrosis in the buttocks show as fast as other filler treatments? How to detect it?
Necrosis is a very rare side effect that occurs as a consequence of the vascular injection. In gluteal area, probabilities of vascular injection are very low, considering that a blunt cannula is used for the treatment. Vessels are located below the muscle so as long as the injection of HA is in the subcutaneous you are preventing having necrosis.