How much filler is typically required to achieve desired results in buttocks augmentation with hyaluronic acid (HA)?

On average, 200 mL of hyaluronic acid filler is used per session, with 100 mL per buttock. This amount is generally enough to achieve noticeable volume and reshaping, providing a fuller and more contoured look.

The exact amount of filler required may vary depending on the individual’s desired results, starting body shape, and natural fat distribution. Some patients may require additional sessions to further enhance the volume, with a recommended waiting period of 4-6 weeks between each session.

Always consult with your practitioner to determine the specific volume needed for your treatment plan.

They are injectable treatments that enhance the volume and shape of the buttocks and hips.

Hyaluronic acid attracts and retains water, adding volume and smoothness to the treated areas.

Hyaluronic acid provides natural-looking results, has a high safety profile, and offers immediate volume enhancement.

We use Charmost 100% Pure Hyaluronic Acid, which has the following specifications:

• Cross-Linked Agent: Bdde Cross Linked Technology
• Content: 24 mg/ml HA
• Function: Correction of Thin Superficial Lines
• Particle Size: 0.5-1.25
• Shelf Life: 2 to 5 years

The maximum recommended amount per session is 200 ml of HA, with approximately 100 ml of HA injected into each buttock.

This limit helps:

• • • Reduce Risk of Complications: Prevents overfilling, which can lead to complications such as uneven results or vascular issues.
    • Ensure Safety: Allows the body to effectively integrate and accommodate the filler.
    • Achieve Optimal Results: Gradual enhancement helps in achieving better control of aesthetic outcomes and reducing the risk of complications

Typically, the procedure lasts between 45 minutes to up to 1.5 hours, depending on the amount of filler to be injected.

Most patients report minimal discomfort. Local anesthesia or numbing cream can be used to enhance comfort.

After the procedure, individuals can immediately notice changes in the shape or contour of the buttocks and can resume their daily routines instantly. The treated area is dressed with a disinfectant to avoid infection.

                                      Antibiotics:

• Augmentin 1 gm contains 875 mg of amoxicillin and 125 mg of clavulanic acid. It is typically prescribed twice daily (BD) for 5 days to prevent infection.
• Alternative if Allergic to Augmentin: Clarithromycin 500 mg twice daily (BD) for 5 days. Clarithromycin is a macrolide antibiotic used to treat various bacterial infections when penicillin or amoxicillin is contraindicated. 

• Anti-inflammatory:
  • Arcoxia 90 mg is an anti-inflammatory medication containing 90 mg of etoricoxib, a selective COX-2 inhibitor. It is typically prescribed once daily for 5 days to reduce swelling and redness.
  • Alternative if Allergic to Arcoxia: Ibuprofen 400 mg three times daily (TDS) for 5 days. Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that helps manage pain and inflammation.
• Precautions: Avoid heavy workouts, excess alcohol, sun exposure, extreme temperatures, and steam baths for 3 weeks post-treatment.
• Swelling and Firmness: Slight swelling and redness may occur. The area may feel firm initially, but this will gradually soften and take a natural shape.

It is generally recommended to wait 4-6 weeks between each treatment. This interval allows:

• Additional Volume: Provides time for the previous treatment to settle and integrate before additional volume is added.
• Assessment of Results: Allows for evaluation of the outcome and planning for further enhancements if needed.

The follow-up protocol is a plan for monitoring and evaluating the results of the buttocks and hip filler treatment over time. Here’s a breakdown of what it means:

• Follow-Up Schedule: Patients are scheduled for check-ups at:

  • 2 weeks
  • 3 weeks
  • 4 weeks
  • 6 months
  • 12 months
  • 18 months

• Purpose of Follow-Up:

• Assess Satisfaction: During these visits, the practitioner evaluates the patient’s satisfaction with the results, including the size, shape, firmness, and overall physical appearance of the treated areas.
• Monitor Results: Ensures that the filler is settling well and achieving the desired outcomes.
• Identify Issues: Detects any potential side effects or complications early and addresses them promptly.

• Patient Feedback: In general, patients are expected to report high levels of satisfaction with their results and typically experience no significant side effects related to the treatment.

• Post-Treatment Monitoring: Following the administration of the chosen antibiotic, the client should be reviewed by a medic 48 hours later in person (not via electronic methods such as FaceTime or Teams) to monitor for signs of infection.
• Documentation: At every opportunity, photographs of the suspected infection should be taken for monitoring purposes.
• Further Action:
  • If after 48 hours there are no signs of improvement, the client should be referred to their GP for further antibiotics and consultation.
  • If symptoms such as fever (above 37.5°C), dizziness, hallucinations, or fluid leakage from the incision are observed, the client must be sent directly to the nearest accident and emergency department for potential sepsis treatment and incision and drainage of the filler.
• Advisory: Whichever antibiotics are prescribed, there should be a strict limit on smoking and drinking.
• Wound Care: Ensure that wound care and sterile dressings are administered to the site after the procedure. Dressings should only be removed by the practitioner during the 48-hour follow-up, adhering to ACE guidelines.

This protocol helps ensure that the treatment is effective and that any concerns or issues are addressed in a timely manner, contributing to a positive overall experience for the patient.

Common side effects include swelling, bruising, and tenderness. Serious complications are rare but can occur.

Why Antibiotics Are Recommended:

• Prevent Infection: Although the risk of infection is low, antibiotics help minimize this risk, especially in procedures involving injections where bacteria could potentially enter the skin.

• Reduce Inflammation: Some antibiotics, like doxycycline, have anti-inflammatory properties that can help reduce swelling and redness.

• Promote Healing: Keeping the area free from infection supports a smoother and faster healing process.

Monitoring and Follow-Up:

• Review: The client should be reviewed by a medical professional 48 hours after the administration of the chosen antibiotic to monitor the infection. This consultation must be done face-to-face and not via any electronic method of communication (e.g., FaceTime or Teams).

• Photographs: At every opportunity, photographs of the suspected infection should be taken for monitoring purposes.

• If No Improvement: If there are no signs of improvement after 48 hours, the client should be signposted to their GP for further antibiotics and consultation.

• Emergency Symptoms: If at any point the client displays symptoms of:

  • Fever and high temperatures above 37.5°C
  • Dizziness
  • Hallucinations
  • Fluid leaking from the area of incision They MUST be signposted directly to their nearest Accident and Emergency department for treatment of potential sepsis and incision and drainage of the filler.

Additional Guidelines:

• Smoking & Drinking: There is a strict limit to smoking and no drinking advisory.

• Aftercare: Ensure the client is given strict aftercare instructions as per the practitioner administering the treatment to reduce the risk of infection.

• Wound Care: Wound care and sterile dressings should be administered to the site after the procedure and only be removed by the practitioner at the review, which should happen every 48 hours within the first week of treatment in accordance with ACE guidelines.

• Inclusion Criteria:
  • Subjects ≥18 years of age
  • Individuals seeking buttock augmentation
  • Candidates based on body fat percentage:
    • Suitable for fillers: Body fat <20% or in the range of >20-<30%
    • Recommended for weight loss: Body fat >30%
• Exclusion Criteria:
  • Individuals with permanent fillers
  • Autoimmune diseases
  • Known allergies to hyaluronic acid (HA) and its components
  • Susceptibility to keloids
  • Current treatment with steroids
  • Pregnancy and lactation
  • Age <18 years
  • Bleeding disorders
  • Use of anti-platelets, anticoagulants, thrombolytics

Avoid blood thinners (if is possible) and alcohol before the treatment. Follow your provider’s specific pre-procedure instructions.

Follow your provider’s aftercare instructions, including avoiding strenuous activities and excessive heat for the first 2 – 3 weeks. Ensure to maintain proper wound care and adhere to smoking and drinking advisories.

Yes, hyaluronic acid fillers can be dissolved with an enzyme called hyaluronidase if needed.

• • Follow the protocol for monitoring and follow-up as outlined by your provider. Immediate action may be required if symptoms such as fever, dizziness, hallucinations, or fluid leakage are observed, including potential emergency care for sepsis.

Further Action:

• • If after 48 hours there are no signs of improvement, the client should be referred to their GP for further antibiotics and consultation.
  • If symptoms such as fever (above 37.5°C), dizziness, hallucinations, or fluid leakage from the incision are observed, the client must be sent directly to the nearest accident and emergency department for potential sepsis treatment and incision and drainage of the filler.

What are the differences between implant-based augmentation and buttocks filler with hyaluronic acid (HA)?

1. Procedure Type:

   • Implant-Based Augmentation: This surgical procedure involves the insertion of silicone implants to enhance the buttock’s shape and volume. It is a permanent and more invasive approach to augmentation.
   • Buttocks Filler with HA: A non-surgical method where hyaluronic acid (HA) is injected into the buttocks to provide temporary volume and reshaping. The procedure is minimally invasive with lower risks compared to implants.

2. Efficacy and Safety:

   • Implant-Based Augmentation: While providing long-lasting results, implant-based augmentation has a high complication rate, around 30.5% as revealed in a literature review of 7834 participants. The risks include implant rupture, infection, and in some cases, serious complications like fat embolism when fat grafting is involved.
   • HA Fillers: Studies show HA fillers are a safe and effective option for gluteal augmentation. In a retrospective study involving 91 participants across three clinics, two in Italy and one in the UAE, HA injections were shown to provide temporary yet satisfactory results. Moreover, instances of serious complications, such as fat embolism, are rare in the use of HA for buttocks compared to facial treatments, which have reported such occurrences.

3. Recovery Time:

   • Implant-Based Augmentation: Surgical implants require significant downtime, with recovery extending for weeks or even months. Patients often experience swelling, bruising, and discomfort during the recovery process.
   • HA Fillers: The recovery period is much shorter, with most patients resuming normal activities within a few days. There may be some swelling and redness, but these side effects are generally mild and resolve within a few days to weeks.

4. Duration of Results:

   • Implant-Based Augmentation: The results are permanent, though implants may require replacement after several years due to wear or complications.
   • HA Fillers: HA injections offer temporary results, with a portion of the filler degrading over time. Camenisch et al. found that after 6, 12, and 24 months, 56%, 36%, and 24% of the HA gel remained, respectively, suggesting the need for follow-up sessions to maintain the desired volume. Participants can typically expect the results to last up to 18-24 months, depending on individual factors. 

5. Volume and Customization:

   • Implant-Based Augmentation: Implants are available in predefined sizes, limiting how much customization is possible in shaping the buttocks.
   • HA Fillers: HA allows for precise volume control, tailoring the enhancement to each patient’s desired look. Studies have reported that participants received an average of 206.71 mL of HA for gluteal augmentation, with 239.79 mL (approximately 119.89 mL per side) being a commonly used volume in clinical practice.

6. Complication Rate:

   • Implant-Based Augmentation: As previously noted, the complication rate can be high, and serious side effects like fat embolism have been reported.
   • HA Fillers: Studies, including those by Camenisch and De Meyere, report that HA fillers are well-tolerated, with high satisfaction rates and minimal complications. In a study involving 61 patients, most reported improved gluteal appearance, and 40% maintained satisfaction even 2 years post-treatment.

7. Natural Look and Feel:

   • Implant-Based Augmentation: Implants can provide a more dramatic, pronounced look but may feel less natural than fillers.
   • HA Fillers: HA fillers integrate with the body’s tissue, providing a softer, more natural appearance and feel compared to silicone implants.

8. Cost:

   • Implant-Based Augmentation: The cost tends to be higher due to surgical fees, implants, anesthesia, and potential post-op care.
   • HA Fillers: HA filler procedures are generally less expensive upfront, but maintenance treatments every 1-2 years can add to the long-term cost.

Conclusion:

• Implant-Based Augmentation is suitable for patients seeking permanent, dramatic enhancement but carries a higher risk of complications and longer recovery.
• Buttocks Filler with Hyaluronic Acid is a safer, non-surgical option that offers natural-looking results with less downtime. The results are temporary, but HA fillers provide a high degree of customization and patient satisfaction with fewer risks.