Gluteal Fold: Cadaveric Dissection of the Superficial Fascial System in the Buttock and Anatomy-based Gluteal Liposculpture

Abstract

he gluteal fold (GF) is one of the key factors determining the attractiveness of the buttocks. It is widely accepted that a desirable buttock should consist of a short and indistinct GF and a proper width of the thigh base. 1,2 The superficial fascial system (SFS) of the buttocks consists of superficial and deep layers of fat, which are wrapped in septae by the retinaculum cutis superficialis (RCS) and retinaculum cutis profundus (RCP), respectively, and separated by the superficial fascia. 3,4 To refine the buttock contouring procedures, our team dissected the SFS of the GF region in fresh specimens, aiming to explore the anatomy of the GF, present a theory about the GF formation mechanism, provide anatomical explanations of GF deformities, and thus put forward a set of corresponding methods for contouring improvement. METHODSTen fresh specimens (mean age, 62 years; age range, 47 to 80 years) were dissected. All specimens were intact, without signs of buttock and thigh trauma or surgery. Dissections were made on the upper, middle, and lower levels of the buttock Background: The anatomy and formation mechanism of the gluteal fold (GF) remain unclear. Given that understanding the anatomy of the superficial fascial system (SFS) may facilitate the improvement of liposuction techniques, this study aimed to clarify and define the anatomical components of the GF. Methods: A total of 20 fresh female buttocks and thighs were dissected sagittally to observe the changes of the SFS along the GF and were dissected horizontally to observe the SFS on the upper, middle, and lower levels of the buttock. Results: Through these dissections, 2 patterns of the SFS in the GF region were identified. The retinaculum cutis (RC)-dominant SFS, named the fascial condensation zone, features an extremely dense and tough RC, originating from the bony structures (eg, the ischium) and radially anchored by the dermis. The fat-dominant SFS features a classic double-layered SFS structure. The RC-dominant SFS is mainly distributed at the medial GF, thus forming the depressed fold. It gradually disappears along the GF and the SFS becomes fatdominant, making the fold increasingly less visible. At the lateral buttock, the SFS of the buttock and thigh reach an identical status in terms of morphologic features, showing a smooth curve between the buttock and the thigh instead of a fold. Thus, based on these findings, different liposuction methods were formulated to manage GF contouring. Conclusions: The SFS of the GF region shows a regional variation pattern. Topographic anatomy of the SFS in the GF region helps us understand GF contour deformities and provide an anatomical basis for surgical correction.