Gluteoplasty (Buttock Augmentation) in Ukraine

The shape of the buttocks is determined not so much by the muscle as by the layer of fat beneath the skin above it and by the structure of the pelvis. Exercise increases the size of the gluteus maximus muscle but changes neither the distribution of fat nor the proportions between the waist and hips, which is why some patients do not get the shape they want even after years of training.

Gluteoplasty addresses this in two ways: it adds your own fat, moved from other areas of the body, or places a silicone implant beneath the muscle or beneath the fascia. Both options increase volume, but they do it differently, and the choice between them is the main subject of the consultation.

Indications: naturally flat or small buttocks, loss of volume after significant weight loss or with age, noticeable asymmetry, disproportion between the waist and hips, and the after-effects of injury or a previous procedure. Often what bothers the patient is not the volume itself but the transition from the lower back to the buttock, and this is also a task for the surgeon.

Who the operation does not suit: with marked excess skin, what is needed is not added volume but a lift with excision, which is a different procedure; with a body mass index below 20 there is usually not enough donor fat for grafting; with an index above 30 the risks of anaesthesia and thrombosis rise so much that the operation is postponed until you lose weight. Surgeons do not operate on smokers who are not prepared to give up cigarettes, on patients with unstable weight, blood clotting disorders or uncontrolled diabetes, or on those whose expectations do not match what the method can deliver.

MediUkraine is a treatment search and coordination service, not a clinic. We select a medical centre and a plastic surgeon with relevant experience, arrange dates and support patients, including those travelling from abroad. The decision on the method, and on whether the operation is possible at all, is made by the surgeon after an in-person examination.

The same name covers two operations with different logic, different lists of complications and different restrictions afterwards. In the first, volume is added with your own fat; in the second, with a silicone implant. The choice depends on three things: how much donor fat you have, what shape you want and what restrictions you are prepared to accept during recovery.

Buttock fat grafting starts with liposuction of the donor areas, most often the abdomen, flanks, lower back, back and inner thighs. The fat is collected under low vacuum to keep the cells viable, then cleaned of blood, solution and damaged fragments by settling, filtration or gentle centrifugation in a closed system. The purified fat is transferred into syringes and injected with a blunt cannula through several punctures of 3–4 mm.

The amount of donor fat decides whether this technique is possible at all. A noticeable result usually needs 300–400 ml of purified fat on each side, which means harvesting roughly 1.5–2 litres of lipoaspirate. A patient with a body mass index of about 20 most often simply does not have that much, and the surgeon's honest answer here is that there is not enough fat, not an offer to try collecting it from everywhere. Sometimes it is wiser to gain a few kilograms first, and sometimes to choose an implant.

Not all the grafted fat survives. A realistic figure is 50–70%: the rest is absorbed over the first three months, so the surgeon injects extra volume, and the final result is assessed after six months. Some patients have a second stage after 6–12 months if they want more volume or if asymmetry needs to be evened out. Fat that has survived behaves like ordinary fatty tissue: lose ten kilograms and your buttocks will get smaller too.

The main technical detail of this technique is the plane of injection. Fat is injected only beneath the skin, into the layer above the muscle fascia; injection into the gluteus maximus muscle or beneath it is not done at all, because that is where the large gluteal veins run. The cannula must be blunt and at least 4 mm in diameter, and it is held parallel to the surface of the skin or angled upwards, not downwards. More and more clinics are adding real-time ultrasound monitoring of the cannula position. The reason for such firmness is the risk of fat embolism, described in detail below.

Buttock implant augmentation is a different operation. A buttock implant is made of solid silicone elastomer: unlike a breast implant, it contains no gel and does not leak if the shell is damaged. Typical volumes are 200 to 400 ml, and the shape is round or anatomical. Access is through a single 5–7 cm incision in the crease between the buttocks or through two parallel incisions: in the natural groove the scar is usually less noticeable, but the area itself heals less well than others.

There are two placement planes. Intramuscular: the implant is placed within the gluteus maximus muscle so that a layer of muscle at least 2–3 cm thick remains above it. The contour is softer and less visible and the implant is better secured, but the operation is technically more complex, the first days are more painful and the volume is limited by the thickness of the muscle, usually to 350 ml. Subfascial: the implant is placed beneath the gluteal fascia, on top of the muscle. This allows a larger volume, less pain and faster recovery, but the coverage is thinner, so in slim patients the edges of the implant may show, and seroma is more common.

The subcutaneous plane is not used. Only fat and skin would remain above the implant: contours and rippling show through, the capsule hardens more often, the implant shifts under its own weight, and the incision in the crease between the buttocks, an area of high tension and poor conditions for healing, comes apart with a risk of the implant becoming exposed. This approach was abandoned while the method was still being developed, and there is no reason to go back to it.

Which suits whom. Grafting your own fat is chosen by those who have enough reserve in the donor areas and who also want to slim the waist and flanks at the same time: the shape usually feels more natural, and no foreign materials remain in the body. An implant is chosen by slim patients who have no fat to take and by those for whom predictable volume matters: the implant itself is not absorbed, although the fatty tissue around it does respond to changes in weight. Sometimes the methods are combined: the implant provides the basic volume, and grafted fat smooths the transitions to the lower back and thighs.

What neither option does. The operation does not tighten the skin: marked sagging requires the excess to be excised. It does not remove cellulite or replace exercise, does not change the structure of the pelvis and does not create a figure the skeleton does not allow. A separate note on what must not be done: injecting biopolymers, silicone oil or polyacrylamide gels into the buttocks is not an alternative to surgery but a source of granulomas, chronic inflammation and fistulas, which then have to be removed together with the surrounding tissue.

For the first 1–2 days you stay in hospital under observation. Pain relief is prescribed on a schedule, antibiotics where indicated, and thrombosis prevention starts while you are still in theatre. You are asked to get up and walk a little on the day of the operation: movement is the main defence against deep vein thrombosis.

The compression garment is put on straight away and worn around the clock for the first 3–4 weeks, then as the surgeon instructs, for up to 6 weeks in total. It compresses the donor areas after liposuction, reduces swelling and helps the skin contract. After implant augmentation, drains are sometimes left in for a few days.

The main restriction is sitting. After fat grafting you must not sit with your weight on your buttocks for 2–3 weeks: pressure disrupts the blood supply to the newly transferred cells and reduces the proportion of fat that survives. For several weeks after that you sit on a special cushion placed under your thighs. For the first weeks you will need to sleep on your front or your side; short trips to the toilet are allowed from the first day. After implant augmentation the restrictions are different: for roughly the first two weeks you avoid sitting upright with pressure on the incision, deep squatting and straining, and it is advisable to sleep on your front or side, as this lowers the risk of the incision in the crease between the buttocks coming apart.

Swelling and bruising peak on days 3–5, and most of it goes down within 4–6 weeks. Numbness and firmness in the donor areas last up to 2–3 months; this is a normal course, not a complication. Stitches are removed on days 10–14. People return to office work no earlier than three weeks later, since sitting for a full day is not allowed earlier after either fat grafting or implant augmentation, and for several weeks more they work sitting on a cushion placed under the thighs. Sport is allowed no earlier than 6–8 weeks later, starting with walking.

The timeframes for assessing the result differ between the two methods. After fat grafting, the volume decreases over the first three months, so the outcome is assessed after 6 months, and that is when you discuss whether a second stage is needed. After implant placement the volume is stable straight away, but the contour forms as the swelling goes down, which takes 2–3 months.

Scars take longer than anything else to mature: over a year they become lighter and softer, and throughout this time they need to be protected from the sun and treated as the surgeon prescribes. After fat grafting it is worth keeping your weight stable, as the result is directly linked to it. Follow-up appointments are usually scheduled after a week, a month, three months and six months.