A Bibliometric Analysis of the Top 100 Papers on Gluteal Augmentation

Background

Gluteoplasty or gluteal augmentation is a popular cosmetic procedure that is used to improve the volume, shape, and contour of the buttocks.

Objectives

This bibliometric analysis aims to characterize emerging research trends and to assess the methodological quality of the highest impact gluteoplasty research.

Methods

The 100 most-cited publications in gluteoplasty were identified on Web of Science, across all available journal years (from Inception to August 2023). Study details, including the citation count, main content focus, and outcome measures, were extracted and tabulated from each publication. Oxford Centre for Evidence Based Medicine level of evidence (LOE) of each study was assessed.

Results

The 100 most-cited publications regarding gluteoplasty were cited by a total of 2375 publications. Citations per publication ranged from 5 to 176 (mean 23.75 ± 25.86), with the highest-cited study being authored by Simonacci, discussing autologous fat grafting (n = 176). Most publications were LOE 5 (n = 55), representative of the large number of case series and reports. The number of publications for LOE 1, 2, 3, and 4 was 1, 9, 13, and 22, respectively. The main content focus was "surgical technique" in 38 publications, followed by "outcomes" (n = 34) and "risk factors/prognosis" (n = 10). Patient-reported outcome measures (PROMs) were used in 20 publications, and 33 publications reported aesthetic outcome measures.

Conclusions

This analysis demonstrates a need for improvement in research methodologies regarding gluteoplasty research. This advancement would be facilitated by robust, high-quality research through randomized control trials and multicenter studies, as well as the further development of validated PROMs for gluteoplasty.

Level of Evidence 2

Morbidity induced by the infiltration of foreign substances into the buttocks: A systematic review

The infiltration of substances into the buttocks for esthetic purposes can cause local or systemic damage. These infiltrated substances, known as adjuvants, foreign substances, and polymers, often lack sufficient and frequently controversial evidence. To identify the systemic complications associated with substances locally infiltrated in the buttocks for treatment, we conducted a systematic review following the PRISMA criteria. Of 275 publications, 29 met the eligibility criteria: 3 systematic reviews, 6 case series, and 20 case reports. The study comprises 463 cases, mainly women (87%), with an average age of 39.94 years. The average time between infiltrations was 7.65 years. Infiltrated substances included silicone, oils, methyl methacrylate, guaiacol, sodium gadolinium, collagen, paraffin, and other unknown substances. The complications fell into three categories: local, systemic with inflammatory-immune response, and renal damage due to hypercalcemia induced by the granulomatosis caused by the substance. Treatment lacked uniformity, mainly focusing on the main effect. Surgical resection of affected tissue resulted in local and systemic improvement (renal, hypercalcemia, or inflammatory-immune) for most patients. Patients who received comprehensive treatment based on inflammatory-immune control, control of renal involvement, and resection of the tissue area that contained large amounts of the infiltrated substance had a better prognosis than those with diffuse infiltration and delayed treatment.

Complications of Silicone Fillers in Gluteal Augmentation: An Unusual Case of Filler Migration and Granuloma Formation

Silicone liquid (polydimethylsiloxane) is an inert material commonly used for cosmetic purposes. A combination of both systematic and local devastating complications can cause end-organ toxicity and multi-organ dysfunction. In this article, we examine the literature and present a case of a patient who presented with lower extremity filler migration and granuloma formation 11 years post gluteal silicone injection. A 31-year-old woman who had received a gluteal silicone injection 11 years ago was experiencing painful erythema, progressive fibrosis, and swelling as the result of the injection. The patient was diagnosed with postfiller autoimmune syndrome. Multiple surgical interventions were conducted to remove the permanent filler from her left knee. As a result of multiple surgical sessions, the patient has been managed successfully with no relapses. This case demonstrated complications of an unusual silicone injection technique for gluteal augmentation. Despite silicone being considered inert, complications can arise years after injection, necessitating extensive medical intervention. This case also raises questions regarding the systemic effects of silicone fillers, warranting further research. Through this report, we aimed to enhance awareness and management of similar future cases.

Safety and Efficiency of Minimally Invasive Buttock Augmentation: A Review

BACKGROUND

Volume restoration and enhancement of the gluteal region appearance has become nowadays a popular concern in particular for many women. Several options are available, none however are without complications and side effects. Volume enhancement with soft tissue fillers of the gluteal region is emerging as a highly attractive minimally invasive modality. It has led unfortunately to more unlicensed, nonmedical practitioners administering illicitly injections for buttock augmentation at relatively low costs.

MATERIALS AND METHODS

To determine safety, efficacy, and cost effectiveness of mostly used soft-tissue fillers for buttock augmentation, a systematic literature search of PubMed, Medline, and Embase was conducted to identify the mostly used fillers for gluteal augmentation. It was complemented by searching for each of the identified filler material separately to retrieve any missed reports. References of clinical studies and trials, reviews, and consensus reports were reviewed as well for the same objective.

RESULTS

In the final analysis 12, mostly strongly biased clinical reports providing a low level of evidence, were identified for inclusion in the review. Two studies involved Polymethylmethacrylate (PMMA), 5 Poly-L-lactic acid, 1 Calcium hydroxyapatite and 4 hyaluronic acid filler injection. No studies were identified involving liquid silicone or Polyacrylamide hydrogel. The little available evidence provided by this review indicates that a specific brand of PMMA in Brazil has a demonstrable relatively good safety, efficiency, and cost-effectiveness record superior to surgical alloplastic gluteal augmentation or to lipofilling only when injected by experts.

CONCLUSION

Gluteal augmentation with soft tissue fillers is not as simple and innocuous as advertised. Serious complications may occur. Moreover, optimal buttock contouring entails not only volume augmentation but also volume removal; thus, volume augmentation with soft tissue fillers may not be ideal. Popularizing this modality must also be approached with great care. Serious complications do occur; they become inevitable when performed illegally by non-specialized, non-authorized, and unscrupulous practitioners in non-accredited facilities. Patients must be warned that adherence to regulations is critical and that only well-trained certified experts practicing legally in accredited facilities can address safely and efficiently their concerns.

LEVEL OF EVIDENCE III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Silicone Granulomas of the Eyelids-A Case Series Illustrating a Distant Migratory Phenomenon

PURPOSE

Exogenous silicone has been reported to migrate to anatomic sights far from an initial injection or implantation site; this phenomenon has been rarely described in the ocular adnexa, especially in the eyelids. We document 3 additional cases of distant migration of silicone implanted elsewhere in the body to the eyelids and review the prior literature on this uncommon event.

METHODS

A retrospective chart review of 3 patients was conducted along with analysis of diagnostic histopathology. A comprehensive review of the literature regarding dissemination or migration of silicone to the eyelids in patients with either silicone breast implants or silicone facial filler use was performed.

RESULTS

Cases of silicone migrating to the eyelids from silicone breast implants and silicone-based facial filler are outlined in Tables 1 and 2, respectively. There are 4 total reports of women with silicone breast implants, including the 2 described here, with evidence of migration of silicone to the eyelid. Similarly, 5 cases of silicone-based facial filler with resultant migration of filler to the eyelids were identified, including 2 of the cases presented in this report (1 patient had both silicone breast implants and silicone facial filler).

CONCLUSION

Silicone is chemically inert, but is known to travel throughout the body, causing a resultant foreign body response in tissue that can adversely affect even the eyelids. Silicone has a relatively characteristic histologic appearance and diagnosis of silicone granuloma highlights the importance of obtaining a thorough clinical history, particularly regarding prior cosmetic injections or breast enhancement surgery. Foreign material/foreign body granuloma is important to consider in patients with deep eyelid nodules of unclear etiology.

Complicated breast augmentation via self-injection of ultrasound gel and shoe glue: A case report

Various types of dermal fillers have been developing for soft tissue augmentation. Even though many fillers have been approved and strictly regulated by authorities, homemade products for body contouring procedures are widely available and easily purchased on websites without prescriptions. It is challenging for radiologists to interpret radiological findings of complicated breast augmentation of unknown origin. While ultrasound is the modality of choice for initial work-up, magnetic resonance imaging (MRI) plays a role as the gold standard in evaluating the integrity of prosthetic implants. Using silicone or water-only MRI sequences may also be able to distinguish them. We report a rare case of breast abscess of a young female patient after self-injection of the mixture of ultrasound gel and shoe glue. The clinical and imaging aspect, especially MRI imaging, will be discussed.

Outcomes and Complications of Surgical Removal of Foreign Body Granulomas Due to Illicit Polymer Injection for Cosmetic Purposes

BACKGROUND

Subcutaneous injection of illicit polymers can result in a number of local complications, including injection-site deformity, granulomas, and skin changes.

OBJECTIVES

The aim of this study was to compare postoperative complications and symptom flare in patients undergoing surgical excision of foreign-body granulomas.

METHODS

We retrospectively examined data of patients who underwent surgical removal of foreign-body granulomas caused by polymer injection for cosmetic purposes. The granulomas were removed by ultrasonic-assisted liposuction or en bloc excision with primary closure, skin grafts, or free flaps during 2014 to 2020. Data collected included demographic and operative parameters. Postoperative complications, symptom flare, and time to flare were reported. The relations between type of surgery and complications, symptom flare, and time to flare were determined through statistical analysis.

RESULTS

The final cohort included 49 surgeries (42 primary and 7 secondary) in 35 patients. The overall complication rate was 28.9%, with no significant intergroup differences (30.8%, 20%, 66.7%, and 40%; P = 0.328). Wound dehiscence and skin burns were the main complications. An overall symptom flare of 35.1% in surgically treated areas over a mean period of 28.49 months was reported. Chi-squared test indicated statistical significance between type of surgery and symptom flare (P = 0.004) and between complications and flare (P = 0.013). Kaplan-Meier test for flare was statistically significant (P = 0.006) after comparison of the 4 groups.

CONCLUSIONS

The rate of postoperative complications was similar for each type of surgery. However, en bloc excision and reconstruction by either primary closure or free flap was associated with a significantly decreased rate of symptom flare and a longer symptom-free period.

LEVEL OF EVIDENCE: 4

Does (mis)use of industrial liquid silicone implants interfere with bone mineral density in transgender women?

The effects of gluteal implants on bone mass remain unclear. Transgender women with ILS presented higher BMD in the hip compared with transgender women without implants, while no difference was observed in other sites. These results may be artifactual and suggest using spine/forearm sites for DXA in individuals with ILS.

PURPOSE

The inappropriate use of industrial liquid silicone (ILS) injections for cosmetic purposes is practiced by some transgender women. The aim of this study was to evaluate the impact of gluteal ILS on femur BMD in transgender women.

METHODS

A total of 46 trans women with and without ILS injection in the gluteal region were selected. All patients underwent clinical and hormonal evaluation, and bone mass was assessed by DXA.

RESULTS

Bone mineral density (BMD) values were significantly higher in trans women with ILS (n = 23) in femoral neck and total femur when compared with trans women without implants (n = 23). Similar BMD was observed in other sites, such as lumbar spine and forearm. Good agreement was found in the evaluation of low BMD using spine/forearm or spine/femur in patients without implants (k = 0.744 and 1.000 for male and female reference database, respectively), but poor to fair index was found in patients with ILS implants (k = 0.330 and 0.646 for male and female reference database, respectively).

CONCLUSIONS

In transgender women with ILS implants, poor to moderate agreement was found on BMD when comparing lumbar spine/femur DXA with an alternative site to the femur, depending on using male or female database. These results may be artifactual and suggest using spine/forearm sites for more accurate DXA assessments in trans women with ILS gluteal implants.

Filler Migration and Granuloma Formation After Gluteal Augmentation with Free-silicone Injections

Gluteal augmentation may be performed using a variety of techniques, including implant-based, autologous fat grafting, local flaps, impermanent filler injection, or, as in this case, by way of permanent filler injection with free-silicone. Of these, free-silicone injections carry one of the highest complication rates, specifically regarding migration of the filler material from the native injection site and induction of painful reactive soft tissue changes at the new filler location. A radiologist providing this diagnosis may assist the clinician, who often cannot obtain a history of illicit silicone injection for gluteal augmentation unless the suspicion is raised. Presented here is a case of painful filler migration to the knee with granuloma formation after free-silicone gluteal injection.

Silicone-Induced Foreign Body Reaction: An Unusual Differential Diagnosis of Posterolateral Hip Pain

Background

Silicone injection is commonly used for soft tissue augmentation for esthetic purposes. It is not without complications.

Case presentation

We present a case of a 31-year-old woman presenting with refractory left lateral hip pain. Magnetic resonance imaging of the patient's pelvis revealed innumerable small low signal foci throughout the gluteus maximus and overlying subcutaneous fat bilaterally consistent with injectable material, possibly silicone.

Conclusions

This case report emphasizes that silicone-induced granulomatosis must be considered in the differential diagnosis of hip pain when evaluating a patient who has had access to plastic surgery or clandestine operators.

Aesthetic journeys: a review of cosmetic surgery tourism

BACKGROUND

Medical tourism has witnessed significant growth in recent years. The emerging trend towards international travel for cosmetic surgical interventions has not previously been reviewed. The current review aims to critically address the scale and impact of cosmetic surgical tourism and to delineate the complication profile of this form of medical tourism.

METHODS

Articles published in the English language on the PubMed database that were relevant to surgical tourism and the complications of elective surgical procedures abroad were examined. Reference lists of articles identified were further scrutinized. The search terms used included combinations of 'surgery abroad', 'cosmetic surgery abroad', 'cosmetic surgery tourism', 'cosmetic surgery complications' and 'aesthetic tourism'.

RESULTS

This article critically reviews the epidemiology of cosmetic surgical tourism and its associated economic factors. Surgical complications of selected procedures, including perioperative complications, are described. The implications for travel medicine practice are considered and recommendations for further research are proposed.

CONCLUSION

This narrative literature review focuses on the issues affecting travellers who obtain cosmetic surgical treatment overseas. There is a lack of focus in the travel medicine literature on the non-surgery-related morbidity of this special group of travellers. Original research exploring the motivation and pre-travel preparation, including the psychological counselling, of cosmetic surgical tourists is indicated.