BACKGROUND

The pursuit of the "perfect body" is a subjective and often culturally influenced concept that can lead individuals to engage in various procedures and behaviors. The surgical procedure called “Brazilian butt lift” is one of the most popular in recent years and consists of liposuction followed by fat grafting in the gluteal region. However, as an invasive procedure, there are some risks, such as infection, irregularities, fat embolism and adiponecrosis. The treatment of complications following aesthetic surgical procedures can be challenging and may vary depending on the nature and severity of the complication. In cases where the adiponecrosis has resulted in noticeable volume loss or contour irregularities, fat grafting or augmentation may be considered. Calcium hydroxyapatite (CaHa) filler is a well-established, safe, minimally invasive and effective agent for increasing soft tissue and substantially improving the skin of the face and body through endogenous stimulation of type 1 and 3 collagen and type 7 elastin production with minimal inflammatory response.

OBJECTIVE

To report a successful case of repair of adiponecrosis secondary to gluteal fat grafting with CaHa biostimulator.

CASE REPORT

Female patient, 32 years old, who had undergone a liposuction and buttock lift procedure and developed complications. The patient reported that she underwent a 6-day hospitalization after the surgery to resolve a post surgical necrosis and subsequent infection and sepsis, requiring the use of antibiotic therapy and measures for clinical support. Five months after the resolution of the emergency, the patient complained about the irregularities and atrophy in this region. The treatment chosen was with CaHa biostimulator in the gluteal region. The treatment was carried out using a multilayer injection technique with different dilutions (with 75% saline solution and 25% of 2% lidocaine as diluents) for each specific objective. 1:4 dilution with injection plane in subdermis was used in the first session with the aim of assessing an initial response. 1:2 dilution with an injection plan in the deep subcutaneous layer was used to improve the shape, contour and volume. Over the period of two years 12 syringes were used on the more atrophic side and 8 on the other one, divided into 7 sessions.

Figure 1: Beginning of the infection that led to adiponecrosis.

RESULTS

An increase in volume and gluteal contour was observed, in addition to the skin quality and lifting effect improvement. The patient did not experience any adverse effects during the course of treatment.

DISCUSSION

Adiponecrosis can sometimes occur as a complication, particularly in areas where liposuction or fat grafting has been performed. The treatment of the atrophic are can be challenging, and the approach may demand the restoration of volume depending on the severity and location of the condition. In this case, CaHA was demonstrated as a safe alternative to correct surgical complications and restore the body shape, due to its collagen stimulation properties, improving not only the areas of atrophy and irregularities, but also providing a better contour and lifting effect.

Figure 2: A and B - Pre-treatment. Images C and D - Post- treatment. An increase in volume, better gluteal contour and lift effect are observed, in addition to the skin quality improvement.

Figure 3: Volumetric gain of 315.29 cc in left gluteal atrophy.

References:
1 - Mowlavi A, Berri M, Talle A, Talle M. Objectifying High-Definition Brazilian Buttock Lift Results Using the Buttock Assessment Tool. Plast Reconstr Surg. 2021 Nov 1;148(5):727e- 734e.
2 - Teodoro MDS, Di Sessa D, Barros JHDFA, de Vasconcelos RCF, Miot HA. Buttocks Beautification 3D with Calcium Hydroxylapatite (RadiesseTM): An Individualized Approach to Diagnosing and Treating Contour, Sagging, and Cellulite of the Buttocks in Seven Cases. Clin Cosmet Investig Dermatol. 2023 Oct 24;16:3039-3051.
3 - Fakih-Gomez N, Kadouch J. Combining Calcium Hydroxylapatite and Hyaluronic Acid Fillers for Aesthetic Indications: Efficacy of an Innovative Hybrid Filler. Aesthetic Plast Surg. 2022 Feb;46(1):373-381.
4 - de Almeida AT, et al. Consensus Recommendations for the Use of Hyperdiluted Calcium Hydroxyapatite (Radiesse) as a Face and Body Biostimulatory Agent. Plast Reconstr Surg Glob Open. 2019 Mar 14;7(3):e2160.