From implant enquiries to the treatment of cellulite, requests for procedures that enhance the appearance of the buttock area are on the rise. Aesthetics speaks to practitioners offering these sought-after treatments and investigates the growing trend sweeping the UK
Bigger, smaller, tighter, tauter – aesthetic practitioners are continually challenged with an increasingly wide range of requests for augmenting the buttocks, and improving the appearance of the surrounding area. Body contouring procedures that target stubborn-to-shift areas on the abdomen, flanks, buttocks and thighs are in increasing demand, as well as remedies for what patients often regard as ‘unsightly’ cellulite. In recent years, enquiries into treatment options have soared and, at the end of 2014, the American Society for Aesthetic Plastic Surgeons (ASAPS) recorded an 86% increase in buttock augmentation treatments performed in the US since 2013.1 The president of ASAPS, Dr Michael Edwards, suggests that the technological advancements and improvements in efficacy of non-surgical fat reduction devices are encouraging people to undergo treatment. “The rise in its popularity is indicative of the public’s desire for non-surgical alternatives in lieu of their invasive counterparts,” he says, adding, “It’s not surprising that more people are opting to freeze or melt away stubborn body fat in the comfort of their surgeon’s office, as opposed to undergoing surgery.”
In the UK, it’s no different. Both aesthetic practitioners and plastic surgeons have reported a rise in patient requests for treatments in this area and, while reducing the size of the buttocks has been popular for some time, some doctors have noted an increase in enquiries for buttock enhancements. In June last year, private healthcare search engine WhatClinic.com reported a 115% rise in enquiries for the ‘Brazilian butt lift’ since the previous year,2 and cites the infamous Kim Kardashian ‘belfie’ (bottom selfie) photograph as a prompt for the 136% increase in enquiries that happened within a month of the photograph being shared on social media.2 The website also noted that within the same month, buttock implant procedures rose by 53%.2
Of the surgeons interviewed, none currently offer buttock implant surgery in their practice. Upon release of the Whatclinic.com statistics, cosmetic surgeon Dr Massimiliano Marcellino of CosmeDocs, Harley Street, did, however, highlight the risks associated with performing the surgery. He says, “For a surgeon to perform a buttock implant they need to be incredibly skilled as the procedure comes with a very high risk of infection and displacement of the implants,” adding that non-surgical buttock augmentation treatments are becoming more popular thanks to minimal downtime and no scarring.
One such method increasing in popularity is VASER (Vibration Amplification of Sound Energy at Resonance) Liposuction. The Private Clinic of Harley Street claims that its staff members perform more than 1,000 procedures a year,3with The Private Clinic practitioner and trainer Dr Dennis Wolf explaining that he treats an average of nine to 12 patients each week with VASER. And while flanks are the most common area he treats, thighs amount to approximately 30-40% of the VASER procedures Dr Wolf performs per week. He says, “By treating the areas surrounding the buttocks, you’ll make it stand out more. It’ll have a little more definition thanks to VASER treatment.”
To administer VASER Liposuction, the practitioner inserts a small probe into the area requiring treatment, which is then used to transmit sound energy and liquefy fat cells prior to their removal through a suction process. Dr Wolf claims that only one treatment is needed, and it will improve the overall shape and contours of the body.
He also advocates that patients should undergo Manual Lymphatic Drainage (MLD) following a VASER treatment. The specialised massage technique aims to help stimulate the lymphatic system and encourage the flow of lymph fluid. According to Dr Wolf it, “Makes a big difference to patients’ recovery and results.”
In terms of patient demographics, Dr Wolf says that although 60% of his patients are women, male interest in VASER Lipo is definitely increasing. “In recent years, it’s become ok for men to have treatment. They have become more self-conscious of their appearance and are savvy in terms of what procedures are available,” he says.
Managing patient expectations, however, is always of utmost importance. “Make sure they’ve got realistic expectations and understand that you’re not going to make a model out of them,” advises Dr Wolf. “We’re not striving for perfection, we’re striving for improvement.”
This is reiterated by Kim Way, the managing director of Changes Clinic in Portsmouth, who says, “Don’t overpromise and be honest. Tell patients treatment is not going to replace a surgical procedure or liposuction – but it will help. Let patients be pleasantly surprised when they see the results.”
In her clinic, noninvasive treatments offered to augment the buttocks include ProMax Lipo and Aqualyx. The first uses ultrasonic cavitation to penetrate the fat layer, which aims to cause vibrations and the formulation of microbubbles within the interstitial fluid. As the bubbles collapse, the resulting shock wave leads to a temporary change in the fat cell membrane, allowing lipids to escape the cell and be ejected by the body.4 To compliment this procedure, ProMax Lipo also utilises multi-polar radiofrequency and vacuum massage. Application of the device aims to encourage controlled waves of energy to heat the patient’s fat cells, increase their circulation, reduce the appearance of cellulite and increase fat cell metabolism.4 According to Lynton, the manufacturer of ProMax Lipo, the thermal energy from the device also results in instant collagen contraction, creating long-term improvement to collagen fibres – producing firmer, tighter skin.4 In simpler terms, Way compares it to an opera singer shattering glass. She says, “If you reach a certain pitch, it would shatter – the ProMax works in a similar way by shattering the fat cell and disrupting the membrane around it to allow the lipids inside to disperse. The second stage using the vacuum then helps draw those lipids into the lymph system so that they’re taken away by the body and not re-metabolised. Radiofrequency then aids collagen and elastin stimulation to tone the buttocks.”
According to Way, patients will usually require six to eight treatments with ProMax to notice the best results, but most will see changes after just a couple of treatments. She claims that the procedure comes with little to no downtime and usually takes 30 to 40 minutes to complete. Taking regular before and after photographs significantly helps patients appreciate the gradual results, says Way, commenting that some can be very cynical of claims of good outcomes. “One of the main questions I get asked is, ‘So does it really work?’ – I think people initially assume that you have to have liposuction or surgery to remedy areas of stubborn fat. What we’re trying to do is make patients aware that there are plenty of non-surgical options available.” Another buttock augmentation treatment offered at her clinic is Aqualyx. This fatdissolving injection has gained traction in recent years due to the publication of a range of clinical studies5 and the introduction of UK distribution in 2013. The CE-marked solution is injected into localised fat deposits, aiming to liquefy the fat cells and destroy them permanently. According to the manufacturers, lipids are then eliminated naturally through the lymphatic system.6
Way explains that although she only introduced Aqualyx to patients nine months ago, her staff members have seen a significant interest in the new technology. “We’re finding it very effective for all areas of stubborn fat – patients keep coming back to have other areas treated,” she says.
It is clear from each practitioner’s experience that removing fat from the buttocks continues to be popular amongst aesthetic patients. However, it is imperative to consider the earlier statistics that demonstrate an increase in requests for buttock implants and the ‘Brazilian butt lift’. Brazilian aesthetic practitioner Dr Ariel Haus offers his ‘Brazilian Beach Bottom Lift’ treatment in both his London clinic and his home city of Rio de Janeiro in Brazil. Using the Velashape III, he aims to lift the buttocks, smooth the skin and reduce the appearance of cellulite. The device combines infrared, bi-polar radiofrequency and vacuum to deep heat the fat cells, their surrounding connective fibrous septae and the underlying dermal collagen fibres. Efficient heating aims to promote an increase in circulation, lymphatic drainage, cellular metabolism and collagen depositing.7
Dr Haus notes that there has been more demand for such treatments within the past five years, and cites celebrities such as Kim Kardashian and Jennifer Lopez publically embracing their curvaceous figures as an influence on patients’ interest.
“The bottom is a popular area of concern and many patients may have issues with cellulite and sagging. Other complaints relate to post-pregnancy figures, which can benefit from help toning up and firming,” he says, commenting that, “During the consultation process it’s important to establish what results patients are hoping to achieve – this allows the creation of a uniquely tailored plan with a recommended course of treatments.”
According to Dr Haus, six Velashape III sessions for the buttocks are recommended, and results are visible from the first. “Following the treatment, patients are advised to drink plenty of water in order to flush out toxins from the body and ensure a healthy diet and plenty of exercise.” This notion of maintaining a healthy lifestyle pre and post buttock augmentation procedures is echoed by all of the practitioners interviewed. Dr Wolf says, “Weight management and cutting down on alcohol intake is important – patients need to engrain dietary changes and exercise into their daily routine.” Consultant plastic surgeon Mr Geoff Wilson adds that he reminds patients the work that they put in prior to surgery is very important to their recovery, the healing process and the final appearance of the buttocks following procedure.
Despite the rise in less invasive buttock augmentation procedures, surgical options are still popular. The British Association of Aesthetic Plastic Surgeons (BAAPS) found that, in 2014, liposuction procedures moved from the sixth to the fifth most popular cosmetic procedure in the UK, with 7% more people opting to have the surgery compared to 2013’s statistics.8 Mr Wilson agrees that he has seen an increase in demand, especially in the last four to five years. “I think the media has perpetuated the interest with celebrities endorsing different types of procedures. People are looking to plastic surgery for a more permanent treatment,” he says.
For patients presenting with buttocks they describe as ‘too big’ or ‘too small’, a lack of shape, lots of cellulite or sagging skin, Mr Wilson offers Liposculpture. The surgical process utilises traditional liposuction to remove fat, which can then be redistributed, sculpted and contoured in the body to suit a patient’s preference. He says, “Often, patients come in complaining of a banana-shaped role of fat at the top of their thighs. We can remove this and replace it in another area to make a more apparent gluteal crease.”
During consultation, Mr Wilson says it’s important to try to best capture why a patient wants surgery, and highlights that they must fully understand the consequences and risks associated with the procedure. “They can’t be flippant – it must be taken very seriously,” he says. “If, on the rare occasion, alarm bells do sound, such as a patient showing signs of Body Dysmorphic Disorder (BDD), we will seek a second opinion or suggest they see a psychiatrist who can offer further support and advice to that patient.” Again, Mr Wilson emphasises the need for a healthy lifestyle in order to achieve optimal results. “We work with a dietician who will offer nutritional advice to those who need it most – this could be if they have a large calorific intake or health-related issues such as diabetes,” he explains, commenting that, “Losing a bit of weight or toning the bum beforehand could improve the outcome.”
Following surgery, patients are advised to wear support garments for six weeks and attend two check-up sessions. “All patients are invited to call any other time they need us,” adds Mr Wilson. Of the practitioners interviewed, none reported seeing any major complications following treatment. All did emphasise, however, that while the treatments on offer are aimed at enhancing aesthetic appearance, they should not be undertaken lightly as ‘quick-fix beauty treatments’. “With any minimally-invasive procedure, there are of course the regular risks of infection, bleeding and bruising,” says Dr Wolf, adding, “It’s important to remember with these types of treatments that there can be irregularities, pigmentation changes or a risk of lumpiness. Patients should be made aware that if they don’t want to accept those risks they shouldn’t have treatment.”
It is important to also note the association between the appearance of cellulite with the thighs and buttocks. While each of the practitioners claim their augmentation methods can improve its appearance, there are other cellulite treatments available. Nurse prescriber and vice president of the UK’s Society of Mesotherapy (SOMUK) Pam Cushing offers mesotherapy to patients looking to reduce the appearance of cellulite. She says, “Mesotherapy sits very well in aesthetics for women who can’t afford other methods, and produces high-satisfaction rates.” According to SOMUK, the goal of mesotherapy is to adapt a specific treatment to each form of cellulite. Dr Philippe Hamida-Pisal, president of SOMUK, says, “Cellulite will appear in different forms depending on the appearance it may have when palpating. This will also match a clinicopathological form: flaccid cellulite, fat cellulite, fibrous cellulite, fibro-sclerotic cellulite, and orange skin cellulite – caused by water retention.” He explains that when a mesotherapy treatment is performed, the results will be linked to the knowledge of one of these particular states of cellulite, which often depends on the patient’s age and the age of the cellulite. He adds, “Old cellulite can indeed be found in a 25-year-old woman, which started even before adolescence and, on the other hand, young cellulite can exist in a woman of 35 or 40 years old.” Cushing explains that she pinch-tests the cellulite and uses the Nurnberger-Muller scale to classify its severity.
A combination of specially prepared mixtures, which could include vitamins, homeopathic ingredients, amino acids and medication, is then personalised to the patient’s specific needs and the practitioner begins administering a course of treatment. Cushing explains that, in her clinic, patients usually undergo one treatment per week for eight to 10 weeks.
“For post-care treatment, I encourage the patient to increase their intake of water, wear loose clothing and avoid sunbathing as it could inflame the area,” she says. “I also advise them to massage the area following a shower to improve circulation.”
As with all injectable procedures, there is the usual risk of bleeding, bruising and infection. “Practitioners should also be mindful of the risk of necrosis, which can be caused by poor injection techniques,” warns Cushing. “To reduce the risk of unevenness I grid the injection points 1cm apart and am careful not to scratch the skin with the mesogun.” Similarly to the other practitioners interviewed, Cushing emphasises the need for a healthy lifestyle, comprising a well-balanced diet and regular exercise, for patients to benefit from the most aesthetically pleasing results. Just a few of the plethora of treatments available have been covered in this article. Yet whatever method you adopt for buttock augmentation or body contouring in your clinic, it seems imperative that patients should understand that, though elective, the treatments they are undergoing are still medical procedures, which do come with side-effects and risks. Following Keogh’s recommendations,9 practitioners should explore why a patient is requesting treatment and offer impartial, evidence-based guidance on the most suitable method for managing the patient’s aesthetic concerns.