Each of these locations shows characteristic signs at the physical examination, so that a simple physical assessment is sufficient to identify the site of damage. An analysis of our cases led us to infer that such retractile notches can involve, to different degrees, the subcutaneous, fascial, and muscle levels. This classification encompasses all the different types of retractile notches we found in the 214 surgery cases we treated during a 19-year period. The techniques we developed and have been using to treat the different types of retractions are also presented. The objective of this study, in addition to defining gluteal depression, is to present a classification and an algorithm to guide diagnosis and location of the defect through the physical examination in order to make a treatment decision. 2, 4 Some authors have described the involvement of all layers-skin, subcutaneous layer, fascia, and muscle-at the same time, 3–5 but we have not found any reports of treatment of all the levels together in order to obtain a good aesthetic outcome. Some describe incisions that may be understandable given the severity of the cases, but which are aesthetically unacceptable. 4, 5, 7, 10 None of the treatments described in those reports was performed as an aesthetic procedure. The few reports on pathologic conditions that cause gluteal depression address severe muscular changes associated with functional disorders, 1–11 which some authors have named gluteus maximus contracture. However, they can also be severe, and can be associated with fibrosis and intense atrophy, producing negative aesthetic and psychological effects.Īlthough the number of patients seeking treatment for GRs is increasing, there has been no attempt at systematizing the diagnosis and treatment for every type of problem from an aesthetic standpoint, nor is there any literature available to guide the diagnosis. If small, such hollows are usually not bothersome to most people. ![]() Most GRs are multiple hollows on the lower third of the buttocks. The surgeon must be able to diagnose such conditions preoperatively in order to plan a good approach. There are many different kinds of retractile notches in the gluteal area, depending on the severity of the damage and the anatomic structures affected. ![]() However, because gluteal depressions are often associated with fibrotic components at the subcutaneous or fascial level as well as with muscle defects, the outcome of a treatment that addresses the subcutaneous tissue alone may not be satisfactory. These treatments are efficacious for those hollows that involve only the subcutaneous tissue. Most surgeons have treated gluteal depressions using fat grafting or injectable alloplastic material. Gluteal retractions (GRs) may be defined as depressions on the buttocks surface, caused by pathologic conditions at the level of either the subcutaneous tissue, fascia, or muscular fibers, or the association of these levels, which may have aesthetic and sometimes functional consequences. In 31.2% of patients with subcutaneous defects, more than one fat grafting session was required to correct subcutaneous defects.Ĭonclusions: The classification system and algorithm based on physical examination presented here for the treatment of gluteal retractions have been shown to be useful tools for diagnosis and treatment of specific types of defects. Complications included seroma in 2 cases of fascial fibrosis, 1 of which was followed by infection residual inelastic muscle fibers in 2 cases overcorrection in 8 cases and infection in 1 case of fat grafting. Results: Treatment results in a series of 214 patients were satisfactory. Subcutaneous defects were treated percutaneously by fat grafting and fiber lysis and addressed under local anesthesia or epidural anesthesia when combined with correction of a muscular or fascial retraction. Methods: The affected muscle fibers or fibrous fascial segments were lysed and removed through an incision on the intergluteal crease, under epidural block. ![]() Objective: We present a definition and a classification of gluteal retractions based on the anatomic structures affected, the assessment used to identify each type of defect, and the techniques used to correct different problems. Until now, no attempt has been made to systemize the diagnosis of these defects or to describe a treatment approach from the aesthetic viewpoint. ![]() Background: The buttocks can be affected by many different kinds of retractile notches, all of them caused by histologic alterations of the subcutaneous tissues, gluteal fascia, or muscle at different levels of severity.
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