Another look at taboo subjects


Jean-Pierre AMSELLEM, MD


Nowadays, having a toned and lifted buttocks is a sign of beauty, youth and sensuality.
In addition, despite a healthy and balanced lifestyle, some patients do not achieve the desired results, often due to genetic factors.
Therefore, one of the solutions is to resort to surgical or non-surgical body procedures in order to obtain the desired buttocks.
If we compare the evolution of the shape of the buttocks between the nineteenth and twentieth centuries, we see a clear preference for generous buttocks.


Just like other parts of the body, the shape of the buttocks varies from one person to another, but also from one ethnic group to another.
There are five types of buttocks:
    -squares Hips: are devoid of curves and a certain harmony on the edges, with very marked and short hips. The pelvis is less generous on long and straight buttocks muscles, which gives a square shape from one end to the other of the buttocks.
    –heart-shaped or pear shape. Considered the most voluptuous shape. The harmonious symmetry ranks it among the wide buttocks, projecting less to the rear but compensating for its assets with wide hips. It is part of the "canon" type of buttocks.
    -in the shape of an A Hips: are rather masculine, with little or no marked hips. Athletic type buttocks, slightly round or small.
     -rounds : They are the famous "bubble butt", are generally in three dimensions: round on the hips, round on the fall of the kidneys, round on the curve. They represent the bouncy buttocks par excellence with a high and marked curvature. This shape is highly sought after by women and is extremely feminine and desirable.
     V-shaped Buttocks: considered the least attractive, causing discomfort and complexes. These are flat and slouchy buttocks giving them an unattractive shape.
We can already specify that the most beautiful and convincing results are obtained with the square buttocks.
The shape of the buttocks must also be taken into account according to ethnicity. (SLIDE 4)
        -Asian buttocks.
        -African buttocks.
        -Caucasian buttocks.
        -European buttocks.


Four important points to define:
         -the lateral depression; probably the most important one to correct. (1)
         -the posterior fossa; also called supra gluteal fossa (2)
         the sacral triangle: V-shaped, at the upper part of the gluteal fork. (3)
         -the infra gluteal fold (4)


Is defined according to several criteria;
           A - the greater trochanter
           B - the maximum projection of the mount of Venus.
           C -the maximum gluteal projection
           D - anterosuperior iliac spine    
The ideal projection is 2-1: ratio between AB and AC such that AC = 2 AB       
The ideal projection is 0.7.


The beauty of the buttocks is also defined by the golden ratio, which is an irrational number:
                     1 + V5
———–    = 1,6180339887498948482
This golden number is also called PHI (PHIDIAS) sculptor and architect 430 BC.   
The ideal shape of the buttocks is the shape of an egg, because the egg contains this golden number.
Let A be the width of an egg and B the length; B/A = 1.618
Thus we can make an analogy between the egg and the hips of a woman, and to obtain perfection, it is necessary to obtain this famous ratio guaranteeing a divine beauty.
Most women have a lateral gluteal depression that can be compared to the shape of a guitar, and correcting this depression will transform the shape of the guitar into the shape of an egg and thus achieve that golden number.




Buttock augmentation is a body contouring procedure that gives the buttocks more volume and contour.
There are several options available to us:
-surgical methods:
  • BBL : Brazilian Butt Lift, liposuction and lipofilling.
  • gluteal implants.
  • gluteal liposuction alone.
  • gluteal lift.
-non-surgical methods:
  • tensor threads.
  • fillers: hyaluronic acid.
Very popular method, giving very good results in expert hands, giving very little pain, few complications, with a very short social eviction.
HA use increased by 15.7% from 2018 to 2019, with more than 4.3 million procedures performed worldwide, making it the second most common noninvasive procedure after botulinum toxin.
Benefits of hyaluronic acid:
  • under local anesthesia.
  • predictable results.
  • easy to add immediately if the patient is not satisfied.
  • possibility of correcting certain errors or complications with hyaluronidase.
  • natural result.
  • possibility of treating several zones in the same session.
  • promotes hydration, resulting in plump, moisturized skin.
Disadvantages of hyaluronic acid
  • non-permanent.
  • high price depending on the number of syringes injected.
  • rare allergic reactions.


Injections do not necessarily have to be performed in the operating room, but in all cases they must be performed under rigorous aseptic conditions, sterile fields, sterile gloves, disinfection with dermal betadine, and shower with betadine scrub the day before and the day before the procedure.
  1. The procedure lasts between 30 and 40 minutes
  2. 7 days before the operation; stop taking blood-thinning drugs, anti-platelet agents (aspirin)
  3. stop anticoagulants the day before and resume them the day after the operation (with the agreement of the cardiologist).
  4. Start by marking the areas to be treated and in an upright position; avoid using felt pens which may cause hyperpigmentation at the penetration points. Use potassium permanganate in saturated solution instead.
  5. Pure local anesthesia combining lidocaine, adrenaline, bicarbonates in NACL at 0.9%. It is better not to inject too much volume of anesthetic so as not to modify the volumes too much and also to avoid diluting the injected hyaluronic acid.
  6. Injections are not expected to be a problem when HA is injected by a trained practitioner and in reasonable amounts.
  7. Do not exceed 10 x 10 cc syringes per side.
  8. 18G cannulas will be used for HA injection.
The injection site is also crucial: the injection must be subcutaneous and not in the muscle.
Postoperative care:
-Ice pack and painkillers.
-no excessive heat for 3 days (sauna, hammam, sun)
-The use of a restraint for a period of 3 days.
-Avoid sitting for more than 3 hours in a row for the first 3 days and avoid violent sports.
-It is advisable to massage the treated area for 3 days following the procedure to help the product integrate properly.


Congenital forms
  • gluteal hypoplasia.
  • disproportionate buttocks.
  • gluteal lipodystrophies.
Acquired forms
  • accidents.
  • post-tumor reactions.
  • animal bites.
  • abscesses or post-injection hematomas.
Degenerative congenital deformities caused by :
  • age, sun damage, massive weight loss.
  • obesity, menopause and skeletal deformities.
  • Prolonged bed rest after chronic diseases.
Iatrogenic abnormalities
  • after surgery of the trochanter or gluteal region.
  • after liposuction.
  • depressions after corticosteroid injections


  • hematomas.
  • Tyndall effect.
  • nodules.
  • granulomas.
  • infections.
  • abscesses.
  • scars.
  • necrosis by vascular occlusion.


  •  severe lipo-atrophy.
  • Insufficient covering tissue.
  • significant ptosis of the lower 1/3 of the buttock.
  • severe skin laxity.
  • obesity.


The gluteal region is composed of 2 muscle layers:
-a superficial layer with the gluteus maximus and the tensor fascia lata.
-a deep layer with the small buttocks covered by the Gluteus Maximus (piriformis, obturator internus, superior and inferior gemelli, and the quadratus femoris).



The results last between 12 and 18 months and very often satisfy our patients.
Training is essential to avoid mistakes.
Asepsis must be draconian, and the number of syringes injected humble.


[1] Lee EI, Roberts TL, Bruner TW. Ethnic considerations in buttock aesthetics. Semin Plast Surg 2009 ; 23(3): 232-243.
[2] Oranges CM, Tremp M, di Summa PG, Haug M, Kalbermatten DF, Harder Y, et al. Gluteal Augmentation Techniques: A Comprehensive Literature Review. Aesthet Surg J 2017; 37(5): 560-569.
[3] Campos L, Humzah D. Buttock augmentation with hyaluronic acid fillers. The PMF A Journal 2021 ; 8(2).
[4] Abulezz T. A Review of Recent Advances in Aesthetic Gluteoplasty and Buttock Contouring. Plast Surg Mod Tech 2019; 6(1): 1-10.
[5] Msarapu V, Wang PS, Gorbachova T. Slow-growing buttock mass after failure of incorporation of autologous fat transfer for gluteal augmentation: ultrasound and MRI features. Skeletal Radiol 2020; 49(10): 1669-1675.
[6] Serdev NP. Serdev Suture for Buttock's Lift - Ambulatory Scarless Procedure. The Open Dermatology Journal 2012 ; 6 : 33-41.
[7] Trignano E, Baccari M, Pili N, Serra PL, Rubino C. Complications after breast augmentation with hyaluronic acid: a case report. Acorn Surg 2020; 9(6): 2193-2197.
[8] Heden P. Update on Body Shaping and Volume Restoration: The Role of Hyaluronic Acid. Aesthetic Plast Surg 2020; 44(4) : 1295-1299.
[9] Ono S, Hyakusoku H. Complications after self-injection of hyaluronic acid and phosphatidylcholine for aesthetic purposes. Aesthet Surg J 2010; 30(3): 442-445.
[10] DeMeyere B, Mir S, Peñas J, Camenisch CC, Heden P. Stabilized hyaluronic acid gel for volume restoration and contouring of the buttocks: 24-month efficacy and safety. Aesthetic Plast Surg 2014; 38(2): 404-412.
[11] Baumann LS, Shamban AT, Lupo MP, Mohit GD, Thomas JA, Murphy DK, et al. Comparison of smooth-gel hyaluronic acid dermal fillers with cross-linked bovine collagen: a multicenter, double-masked, randomized, within-subject study. Dermatol Surg 2007 Dec;33 Suppl 2: S128-35.
doi: 10.1111/j.1524-4725.2007.33352. x.
(12) Marc Henri Bon. La beauté mise en équation". Publisher: Glyphe. Illustrated edition (May 28, 2014) 05/2014.
(13) Jean Pierre Amsellem. "Beauty is in the fat. 02/2010
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Aesthetic health based on scientific evidence

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