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Dynamics of Gluteal Cleft Morphology in Lower Body Lift: Predictors of Unfavorable Outcomes
Paul N. Afrooz, MD, Sameer Shakir, BS, Isaac James, BS, J Peter Rubin, MD, Jeffrey A. Gusenoff, MD.
University of Pittsburgh, Pittsburgh, PA, USA.

Lower body lift procedures routinely involve dermatolipectomy of the superior gluteal area and lower back. Generally, the length of the superior line of excision is positioned closer to the waist and is shorter than the length of the inferior excision line in the gluteal region. These skin edges are frequently incongruent in the horizontal dimension at the time of re-approximation. Following re-approximation, excess tissue redistributes along the length of the repair. As tissue redistributes in a medial direction into the gluteal cleft, lengthening of the gluteal cleft in the superior direction frequently occurs leading to undesirable gluteal cleft morphology. This retrospective review aims to identify lower body lift excision patterns that lead to suboptimal gluteal cleft morphology.
Lower body lift procedures were identified by CPT code. Patient demographics included age, gender, BMI and delta BMI. Preoperative excision patterns were examined and classified based on their relationship to the gluteal cleft. Patterns that were entirely superior to the gluteal cleft were designated as Type I patterns. More inferior patterns that partially incorporated the gluteal cleft were designated as Type II, and those patterns with the gluteal cleft spanning the entire height of the pattern were designated as Type III. Postoperative morphology of the gluteal cleft was then examined and classified:
Grade I: gluteal cleft height that is unchanged.
Grade II: mild to moderate lengthening of the cleft
Grade III: significant lengthening of the gluteal cleft
86 patients had complete information for the purposes of this study. 77 (90%) were female, and 9 (10%) were male. Average age was 47.1 + 8.99 years (range 25 - 63). Average preoperative BMI was 28.0 + 3.86 (range 21 - 37) and average delta BMI was -22.5 + 7.5 (range -9.9 - (-55.9)).
Of 86 total patients, 32 (37%) had type I excision patterns, 30 (35%) had type II patterns, and 24 (28%) had type III patterns.
Sixteen (18.6%) patients had Grade 1 postoperative clefts. Ten (62.5%) had Type I patterns, 4 (25%) had Type II patterns, and 2 (12.5%) had Type III patterns.
Forty-three (50%) patients had Grade 2 postoperative clefts. Nineteen (44%) had Type I patterns, 13 (30%) had Type II patterns, and 11 (26%) had Type III patterns.
Twenty-seven (31%) patients had Grade 3 postoperative clefts. Three (11%) had Type I patterns, 13 (48%) had Type II patterns, and 11 (40%) had Type III patterns.
Age, gender, and delta BMI were not found to be significantly associated with postoperative gluteal cleft grade.
Logistic regression analysis demonstrated that pattern types were predictive of postoperative gluteal cleft grade (p=0.001).
Dermatolipectomy excision patterns used in lower body lift surgery frequently encompass the gluteal cleft. Discrepancy of the horizontal excision lines leads to tissue redistribution following reapproximation. Alteration of gluteal cleft morphology ensues. These data demonstrate that excisional pattern type is predictive of postoperative gluteal cleft morphology. Patterns involving larger portions of the gluteal cleft (Type II, and III) lead to greater and often undesirable lengthening of the gluteal cleft postoperatively (Grade 2 and 3).

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