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An often-neglected part of the lower body lift procedure is the gluteal region. The objective of this study was to classify massive weight loss patients undergoing a body lift procedure and provide a safe, standardized approach for gluteal augmentation.A retrospective review of all body lift procedures performed between January of 2012 and January of 2017 was conducted. Patients undergoing a lower body lift with or without gluteal augmentation were included for analysis. Patients were classified as follows: type I, minimal lower and upper back fat and deflated buttock; type II, substantial lower back fat, minimal upper back fat, and deflated buttock; type III, substantial lower and upper back fat and deflated buttock; and type IV, good buttock projection. Type I patients had gluteal implants, type II patients had autologous flap augmentation, type III patients had gluteal lipofilling, and type IV patients did not have any gluteal augmentation.Two hundred eighty patients were included for analysis. Two hundred thirty-eight underwent concomitant gluteal augmentation (85 percent): 213 had autologous flaps (76 percent), 13 had gluteal implants (5 percent), and 12 had large-volume lipofilling (4 percent). Forty-two patients underwent a body lift with no gluteal augmentation (15 percent). Gluteal augmentation did not increase the rate of complications. In both groups, no skin necrosis, venous thrombosis, or pulmonary embolism was reported. Patients who had a sleeve gastrectomy had significantly lower odds of complications compared with gastric bypass (OR, 0.45; p = 0.017).A standardized algorithmic approach for gluteal augmentation may optimize the result without increasing the complication rate.Therapeutic, III.