Outcomes of Intramuscular Gluteal Augmentation With Implants Using Tumescent Local Anesthesia

Abstract

Background: Tumescent local anesthesia (TLA) describes the practice of injecting a very dilute solution of local anesthetic combined with epinephrine and sodium bicarbonate into the tissue until it becomes firm and tense to obtain local anesthesia and vasoconstriction. The use of TLA in augmentation intramuscular gluteoplasty has never been described for implants positioning. Advantages of the TLA technique include a reduction in blood loss through epinephrine-induced vasoconstriction and hydrostatic compression from the tumescent effect. We describe TLA technique for primary intramuscular gluteal augmentation, reporting our experience during the last 5 years.

Methods: From 2017 to 2021, 20 patients underwent bilateral primary gluteal augmentation under TLA and conscious sedation. The tumescent solution was prepared with 25 mL of 2% lidocaine, 8 mEq of sodium bicarbonate, and 1 mL of epinephrine (1 mg/1 mL) in 1000 mL of 0.9% saline solution. The solution was infiltrated with a cannula inside the gluteus maximus muscle intra-operatively.

Results: The mean age of the patients was 39, 15 years. The average amount of tumescent solution infiltrated was 240 mL per gluteus. Operating time was 1 h and 40 min, and recovery room time averaged 240 min. Major surgery-related complications were found in 15% of patients (2 hematomas and 1 seroma) and minor complications were described in a total of 8 patients (4 wound dehiscence and 1 dystrophic scar formation). No signs of adrenaline nor lidocaine toxicity were reported and conversion to general anesthesia was never required.

Conclusions: The tumescent local anesthesia technique represents a safe and efficacious technique for performing gluteal augmentation surgery with an intramuscular implant positioning. The advantages of this technique are safety, reasonable pain control during and after surgery and a low incidence of postoperative side effects due to general anesthesia avoidance.

Level of evidence iv: 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 .

Fig. 1

Preoperative markings. The intergluteal fold is marked. Joining the coccyx to the ischial tubercle and continuing up to the femur, we indicate the full size of the gluteus maximus muscle and, therefore the space where the intramuscular gluteus implant will be placed. Of notice is the area of suprafascial detachment on both sides of the intergluteal fold measuring 6 cm on each side with an inverted heart shape

Fig. 2

Gluteus maximus and its fascia are exposed

Fig. 3

A small lidocaine bolus is performed to incise the muscle for the cannula positioning

Fig. 4

A cannula is inserted within the muscle, connected to a peristaltic infiltration pump, and positioned in this plane for the TLA infusion

Fig. 5

a Preoperative view. b Postoperative view after 6 months

Fig. 6

a Preoperative view. b Postoperative view after 1 year