1. The gluteal retraction are gaps or depressions on the bottom. These gaps are caused by abnormal fibrosis and should not be confused with cellulite.

2. How do they form?
The great part of these depressions does not have a specific cause. However, the association to a vast number of injections during childhood is normally frequent. In some cases when the retraction is symmetric, bilateral and deep the cause is congenital.

3. Are you a good candidate for it?
Every young person who is 14 years-old or older and have gaps on the bottom which are caused by fibroid retractions as explained above. There are differences on the treatment between the superficial retractions and the deep ones, that’s the reason why the reports are separated.

4. Types of retraction
The retractions can be superficial or deep. The superficial ones are on the bottom fat tissues and the deep ones are in the fascia – muscle cover – and the musculature. A test was created by Dr. Raul Gonzalez to differentiate the deep retractions from the superficial ones. When you raise your leg, as show on the side picture, the deep retractions show a strong depression, increasing even more the gap. Touching this gap you can feel a certain hardening showing the presence of fibrosis tissue. When the retractions are superficial ones, when you raise your leg, the depression looks better instead of worsening it, once the muscle and its cover are not compromised. When you stretch your leg the fat is distributed, disguising the problem. When the retraction is deep, the skin is practically glued to the muscle and when you fold the leg, the muscle pulls the skin, increasing the hole.

TECHNICAL REPORT – SUPERFICIAL RETRACTIONS THAT DO NOT AFFECT THE MUSCULATURE

1. Anesthesia
Local or local with sedation

2. Hospital admission
It is not necessary once the surgery is done ambulatory.

3. Time of surgery
Around half to an hour depending on the complexity.

4. What happens on the next day
The patient returns to his/her normal activities, with no restriction already on the next day. If a fat transfer was done, on the first 48 hours of operation, the patient should avoid sitting down or lying down on the fat transferred area.

5. Place of incision and scarring
The surgery is done thoroughly using thick needles even fat transfer is done without leaving a scar. To withdraw fat that is about to be transferred, it is necessary a small cut of 2 or 3 mm.

6. Re-operation
Not always you can get a satisfactory result on the first operation. Sometimes it is necessary, therefore, a new liberation and fat transfer between 4 to 6 months after the first surgery.

7. Durability of the fat transferred
After a year of fat transferred, all the fat that was “caught” will endure forever. If the person put on or lose weigh, the fat will accompany this lost or weight gain.

8. Precautions on the long run
The most important caution it is to avoid thigh panties that squeeze the fat transferred areas or the areas where there are gaps. All of this can take to a fat absorption that can be even total and it can result in total lost of the transferred fat.

Technical report to deep retraction – with fascia compromise – muscular cover – and the musculature
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1. Anesthesia
Peridural

2. Hospital admission
One to three days according to the complexity

3. Duration of the operation
Half an hour to two hours.

4. What happens on the next day
According to the complexity the patient must avoid sitting down for 48 hours or eventually 72 hours. On the simply cases it is allowed to sit down on the next day. It is allowed to walk, move and take a shower. Pain killers will help fight the mild pain.

5. Draining
The great majority of the cases need it. This draining should be done for 48 to 72 hours, being the reason of the hospitalization.

6. Place of the incision and scarring
The lower retractions are taken by an incision in the fold between the buttock and the internal part of the thigh and the higher retractions by an incision between the cheeks. Both incisions result in unnoticeable scars and totally hidden when the patient is standing up.

7. Lying down
To sleep the patient should lye down – on the stomach - or side ways for seven to ten days, avoiding directly pressure on the area.

8. Hospital discharge
The discharge is 48 to 72 hours, according to the liquid quantity that is collect on the draining system.

9. The first week after the surgery
After returning home, the patient should maintain a relative resting state, avoiding doing excessive torso flexion. The ideal position is to sit down ‘stretched’, avoiding the torso to flex. It is not necessary to rest. One can walk without a problem. Immersion baths are prohibited during this week.

10. Return to the activities
After the first week, the worked area has already been “glued” and the patient can drive and go back to his/her activities that do not demand physical efforts.

11. Result
The vast majority of the cases that have the muscle cover and musculature compromised has almost 100% solution with this surgery. Many times, the presence of compromised important fat tissue implies some fat transfer around four to five months to complement the procedure.

12. Association with buttocks augmentation
In many cases, the retraction is so intense that in order to obtain a good result it is necessary to associate it with buttocks augmentation in order to substitute the fbrosis tissue taken out and also to shape and round up properly the buttock which was atrophied due to the presence of theses fibroses. In around 30% of the serious retractions buttocks augmentation is advised.

In your appointment with Dr. Raul Gonzalez he will advise you about it.

For more information go to the gluteal implant icon.

14. Cautions on the long run
Once the final result is obtained, it is recommended that the patient does not wear thigh panties around the worked area, because it can result in fat atrophy in this region, compromising the result.