According to previous reports, the correction of post-liposuction infragluteal fold deformity mainly depends on flap reconstruction, liposhifting and autologous fat transplantation [5–8]. Flap reconstruction is efficient in severe cases of infragluteal fold deformity , but the low patient’s acceptance of sequel scar limits its application. Liposhifting is a technique which free the subcutaneous fat by stab incisions and cannulas and shift the surrounding fat to correct depression deformities without liposuction or fat injection . However, this procedure may be insufficient to correct large deformities with severe adherence. In regard to the case we presented, fat transplantation was considered as the optimal option for refusing flap reconstruction. However, the result was still not quite satisfactory after multiple operations.
As far as we are concerned, the difficulty in correction of the post-liposuction infragluteal deformity may mainly relate to the subcutaneous scar. In anatomically, the infragluteal fold region is described as an adherence zone, in which the superficial fascia tissue fuse and firmly adherent to the deep gluteal fascia at the lack of deep layer fat [9, 10]. This is critically important in formation of the infragluteal fold and caudal gluteal border . While in the case of overaggressive liposuction, the superficial fascia is almost substituted by scar tissue and the dense fibrous attachment to underlying deep fascia is broken . The fat graft is difficult to be filled and survival into scar tissue, thus the volume maintain is hard to predict. This would result in the inefficient of fat transplantation. Moreover, for the loss of attachment between scar and deep fascia, the transplanted fat would hardly contact to the adjacent healthy tissue. Inevitably, the fat graft is prone to translocation, for instance downward and lateral translocation presented in our patient, even if avoid local pressure to the transplantation region as possible after operation. Therefore, the effect of fat transplantation in the correction of severe post-liposuction infragluteal deformity is limited.
Expect for the multiple infragluteal folds, the correction of gluteal ptosis after overaggressive liposuction could be more difficult. The post-liposuction gluteal ptosis may be associated with the destruction of conjunctive fibrous which sustaining the buttocks, and the subsequent skin laxity by soft tissue volume reduction . Generally, the evaluation of gluteal ptosis is determined by the length of infragluteal crease and the amount of sagging tissue passing over the infragluteal fold [4, 12–13]. In the respect of our patient, after the 5th fat transplantation, although the soft tissue volume of infragluteal region was supplemented, without intact sustaining structures, the increased volume and redundant skin sagged and the infragluteal crease were extend. As a result, the gluteal ptosis was aggravated. Therefore, we recognize that fat transplantation is problematic in improving sever post-liposuction gluteal ptosis.
In conclusion, the post-liposuction infragluteal deformity is very difficult to correct. It is important to recognize that the subcutaneous scar formation, conjunctive fibrous destruction and soft tissue volume reduction after liposuction may result in infragluteal deformity; and the effect of fat transplantation is limit while dealing with serve deformity. In our opinion, the infragluteal region should be reserved as possible during liposuction to avoid deformity.