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AesthPlastSurg

https://doi.org/10.1007/s00266-022-03166-1

GlutealAugmentationwithHyaluronicAcidFiller: ARetrospectiveAnalysisUsingtheBODY-QScale

AdrianoSantorelli1 • FabioCerullo1 • GiovanniSalti2 • StefanoAvvedimento1

Received:28July2022/Accepted:30October2022

SpringerScience+BusinessMedia,LLC,partofSpringerNatureandInternationalSocietyofAestheticPlasticSurgery2022

Abstract Introduction Minimallyinvasivetechniques,suchasﬁller injection,arenowavailableforposteriorbodycontouring. However,limiteddataontheoutcomeofglutealaugmentationwithhyaluronicacid(HA)areavailableinthe literature.

MaterialandMethods Weperformedaretrospective analysisof43patientswithBodyMassIndex B 30,and low-gradeptosisornoptosiswhounderwentglutealaugmentationwithHAatourclinics.Treatmentresponsewas evaluatedwithapatient-reportedassessmentscale(BODYQ)atbaseline,andafter6months.

Results Patientsweresatisﬁedwithtreatmentasobserved byastatisticallysigniﬁcantincreaseinmeanBODY-Q scoresat6months(8.14 ± 2.19vs.14.40 ± 2.38, p \ 0.0001).Suchincreasewasmorepronouncedinpatients whoweretreatedwithahighernumberofvials(8–12vials vs.14–20vials).Noseriouscomplicationswereobserved duringoraftertreatment.

Conclusion Glutealaugmentationwithhyaluronicﬁllersis asafe,minimallyinvasiveprocedurewithgoodaesthetic results.

LevelofEvidenceIV Thisjournalrequiresthatauthors assignalevelofevidencetoeacharticle.Forafull descriptionoftheseEvidence-BasedMedicineratings, pleaserefertotheTableofContentsortheonline InstructionstoAuthors www.springer.com/00266

& StefanoAvvedimento stefavve@hotmail.it

1 AcademyofAestheticSciences,ViaRaffaeleMorghen,88, 80129Naples,Italy

2 MedlightMedicalInstitute,ViaClaudioMonteverdi,2, 50144Florence,Italy

Keywords Hyaluronicacid Glutealaugmentation Glutealcontouring Fillerinjection

Introduction

Bodycontouringisoneofthemainreasonswhypatients visitaestheticsurgeons.Demandforglutealaugmentation andposteriorbodycontouringhasbeenincreasingly growingduringthelastdecadeduetochangesintheperceptionoftheidealbody.Techniquessuchassilicone implantsandautologousfatgraftingarecommonlyused forglutealaugmentation;however,theseareinvasive procedureswithahighcomplicationrate[1].

Thedevelopmentoflargeparticlehyaluronicacid(HA) ﬁllershasallowedtoapplyminimallyinvasivetechniques toposteriorbodycontouring.Thisapproachshowsevident advantagestothepatients,whousuallypreferlessinvasive procedures.Glutealaugmentationwithﬁllerinjectionis alsovaluableforcliniciansbecauseitimpliesminimalrisk forthepatientifperformedwiththenecessaryprecautions. Nevertheless,currently,therearenoguidelinespublished describingtheprocedure,andlimiteddataontheoutcome ofglutealaugmentationwithhyaluronicacid(HA)are availableintheliterature[2].

Therefore,theobjectiveofthisstudywastoassessthe outcomeofthistypeofintervention,anddescribethe techniqueused.

Complications

Patientsweremonitoredforaperiodofsixmonthsinorder topromptlyidentifybothmajorandminorcomplications relatedtotheprocedure.

StatisticalAnalysis

SPSSsoftwareversion17.00(SPSSInc.,Chicago,USA) wasusedforstatisticalanalysis.Datawerepresentedin absolutefrequencyandpercentage,oranalyzedasmeans andstandarddeviations(SD).Comparisonsbetween baselineand6-monthtimepointwereperformedusing unpaired-samplest-test.Avalueof p \ 0.05wasconsideredstatisticallysigniﬁcant.

Results

BetweenSeptember1,2021,andOctober31,2021,43 patientsunderwentglutealaugmentationwithHAﬁller.All patientswerefemale(43,100%).Patient’sagerangedfrom 19to57years,withameanof34.12years[Standard Deviation(SD), ± 8.79].BODY-Qscoreassessedat baselinerangedfromaminimumof5toamaximumof12, withameanof8.14(SD, ± 2.19).Themeannumberof vialsusedforpatientforeachbuttockwas14.74(SD, ± 3.52),rangingfrom8to20.

Sixmonthslater,astatisticallysigniﬁcantincreasein meanBODY-Qscorewasobserved(8.14 ± 2.19versus 14.40 ± 2.38, p \ 0.0001)(Fig. 2).

BODY-Qscorerangedfromaminimumof9toa maximumof19.Suchincreasewasmorepronouncedin

treatments(8–12vialsvs14–20vials)

patientswhoweretreatedwithahighernumberofvials (8–12vialsvs.14–20vials)(Fig. 3).

Nomajorcomplicationsweredescribed.Minorand transientcomplicationsweredescribedin3patients (7.0%).Specifically,excessivefirmnesswasobservedin2 (5.9%)patients,supposedlyduetoaremarkablecellular infiltrationofthecapsulesurroundingtheproductwithits subsequentretraction.Massagetherapywitharnicagelwas suggested.Delayedgranulomaformationwasseeninone (2.3%)patient.Treatmentconsistedofadrainageusinga 21Gneedle,whichledtocompleteresolution.

Fig.2 MeanBODY-Qscoresatbaselineandafter6months

Fig.3 MeanBODY-Qscoresat6months:comparisonbetween

Fig.4 PatientApicturebeforetreatment

Theoverallcostofthecompletetreatmentrangedfrom 1200(8vials)to3000euros(20vials).

Figures 4, 5, 6, 7 showtwodifferentpatient’spictures takenbeforetreatment(Figs. 4, 6),andaftertreatment (Figs 5, 7).

Discussion

Inthisretrospectiveanalysis,43patientsunderwentgluteal augmentationwithHAfillers.Self-assessmentwasprovidedbypatientsatbaselineandafter6monthsinorderto measuretheoutcomeoftheintervention.Astatistically significantincreaseinmeanBODY-Qscoreswasobserved at6monthsaftertheprocedure,whichindicatesthat patientswerehappywiththeresultsofHAfillerinjection.

GlutealaugmentationwithHAisarelativelyrecent technique.HAﬁllersareconsideredsafetouseincosmetic medicine.TheversatilityofHAgelisamajoradvantage comparedtopermanentimplants.HAcanbeusedbothfor augmentationandcontouringpurposes.Furthermore,due toitsbiodegradablenature,HAcanbealsousedasan indicatoroftheeffectthatcanbeachievedwithpermanent implants[6].

TheuseofHAgelinjectionsforglutealaugmentation hasbeenpreviouslyinvestigatedintwoprospectivestudies,oneofwhichwasmulticenter[6, 7].Thesestudies showedthatglutealaugmentationisasafeandeffective treatmentfortemporaryaestheticaugmentationofthe buttocksyetlimitedbythecostoftheinjectableinrelation tothehugevolumerequiredtoachieveoptimalresults.

Long-lastingresultscanbeobtainedupto24months. DeMeyereetal.observedthat,althoughthesubstance degradesovertime,24monthsaftertreatmentagood proportionofpatientsratedtheirbuttocksasimproved (40%),andexpressedsatisfaction(33%)[6].Similarly, Camenischetal observedthetreatmentwaswelltolerated, andinvestigator’sandpatient’sperceptionofaesthetic glutealaugmentationcontinuedhigh,evenifsmallvolumesofHAremained[7].

Cerquaetal.showedthatat8monthspost-injection,a 60–70%correctionpersistedin90%ofthepatients.They assertedthatﬁllerinjectionsareapredictable,safe,and long-lastingnon-surgicalproceduretoﬁllcontourdefects thatariseafterliposuction[8].Moreover,Scaperrottaetal. analyzedpatientsthatunderwentbreastaugmentationwith HAinjectionandshowedthattheresorptionratevaried betweensubjects.However,after24months,ameanof approximately20%oftheinjectedvolumeremainedinthe breast.Evenaftermorethanfouryears,smallamountsof Macrolanewerestillvisibleonmagneticresonanceimagingorultrasoundinsomepatients[9].

Fig.5 PatientApictureafteratreatmentat6monthswith160mlof HAﬁller

Fig.6 PatientBpicturebeforetreatment

Fig.7

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