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    Surgeon touts benefits of liposuction/fat grafting, implant/mastopexy combinations


    The trend to combine surgical procedures that address either the breast or the buttock areas into one single session is becoming a mainstay in cosmetic surgery, according to Samir Pancholi, D.O., a board-certified cosmetic surgeon in Las Vegas.

    "Two areas where I use combination procedures include the breast and buttocks. I will often perform breast implant surgery with a mastopexy in the same session, and similarly, I will combine liposuction with fat grafting techniques when performing the Brazilian butt lift," Dr. Pancholi says.

    A 36-year-old patient before (left) and three months after simultaneous breast augmentation/mastopexy, which included bilateral subpectoral placement of saline high-profile 550 cc (filled to 570 cc) and bilateral superior pedicle vertical mastopexy. (Photos credit: Samir Pancholi, D.O.)
    BUTTOCK CONTOURING According to Dr. Pancholi, the Brazilian butt lift represents an aesthetic solution for many cosmetic patients who desire more rounded and shapely buttocks. Dr. Pancholi says he typically performs liposuction to remove fat at the lower spine/lumbar region, causing a slight hollowing of this area and resulting in an accentuated curve and aesthetic protrusion of the buttocks. The amount of fat removed from this area will in part help define the curvature and protrusion of the buttocks, but the degree of aesthetic accentuation of the buttocks varies from patient to patient, Dr. Pancholi says.

    For a more exaggerated curving effect and aesthetic protrusion of the buttocks, Dr. Pancholi says he then takes the lipoaspirate and re-injects it at the superior aspect of the buttocks. The injections are placed within the muscle fibers of the gluteus maximus and minimus where the blood supply is greatest, giving the lipoaspirate the highest chance of survival, he says.

    A 32-year-old patient before (left) and three months after Vaser liposuction of the waist, lower back and outer thighs, as well as fat grafting (340 cc right buttock, 360 cc left buttock).
    "We generally try to put quite a bit of volume in the buttocks, and in the average patient, I will usually aim for somewhere between 500 cc to 600 cc of fat per buttock, meaning I will have aspirated approximately 1,000 to 1,200 cc of fat for the transfer. In my experience, that is the level where you really see a difference aesthetically," Dr. Pancholi says.

    "For an even more enhanced protrusion of the buttocks, not only do we perform liposuction at the lumbar spine area to get that curve, but also around the buttock itself to really help give it that nice heart-shaped look," he adds. "We then will re-inject and place the fat at the superior aspect of the buttock to give it that finishing touch and give the patients the volume they want. These combined procedures really make the difference, especially in those patients who started out with a more flat, or less curved, buttock area."

    A 20-year-old patient before (left) and three months after Vaser liposuction of the waist and upper and lower back, as well as fat grafting (525 cc left buttock, 475 cc right buttock).
    IMPLANT POSSIBILITIES One of the limiting factors in achieving a more accentuated buttock region is the amount of fat that can be aspirated from the lower lumbar region, Dr. Pancholi says. Slender patients can be more challenging to treat, as they will typically not have much fat to aspirate from the lumbar area. In such cases, the patient may require buttock implants in order to reach desired cosmetic goals, he says.

    Dr. Pancholi says he often refrains from using buttock implants because of the risks associated with the procedure, including infections, malpositioning of the implants, capsular contraction and other risks consistent with other implant surgeries, such as those performed in the breast.

    "Buttock implant surgery is not a procedure for novice surgeons, but I think that in the right hands, buttock implants can result in excellent cosmetic outcomes," he says. "I personally prefer not using them because in my experience, I have spent more time removing butt implants from surgeries that have gone awry than I have spent putting them in. In my opinion, the combination of liposuction with fat grafting is a safer technique in which I can consistently achieve excellent aesthetic outcomes resulting in happy patients."



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