Dr. TomCombining mechanical subcision with buttock fat transfer offers superior aesthetic results and is a patient-pleaser, according to Walter W. Tom, M.D., a cosmetic surgeon who practices in California and Hawaii.
Dr. Tom, who presented “Optimal Cellulite Treatment with Concomitant Subcision and Fat Grafting,” earlier this year at the American Academy of Cosmetic Surgery’s annual scientific meeting in Las Vegas, says the issue of cellulite and the need to treat it is hard to ignore. Women have different reticular fibers than men, which predisposes them to the development of cellulite, regardless of whether they’re skinny or overweight.
Although aesthetic physicians address cellulite alone, they should also tackle cellulite around the buttocks to achieve optimal results when gluteal fat grafting (Brazilian butt lift), he says.
“Many times despite the amount of fat that we can place in the buttocks, there will be areas where, instead of a bubble butt, there will be flattening of the contour of the buttocks. And that’s related to those same reticular fibers that cause cellulite in women,” Dr. Tom says. “It may not be noticed initially in women, especially if they’re younger. But, even as we try to expand the envelope of the buttock, these reticular fibers tether the skin and prevent us from getting that nice full bubble butt region.”
Patient shown before and after combination butt lift and reticular fiber subcision. Photo courtesy Walter Tom, M.D.
Dr. Tom uses mechanical subcision with the Cellfina system (Merz) to release the tethering fibers. He uses fat grafting to fill the empty areas left after subcision. That prevents indented scarring and smooths the skin’s contour around the buttocks, according to Dr. Tom.
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A Step-by-Step Approach
The first step in the combination butt lift and subcision approach is to mark the areas of buttock dimpling and folds in order to target subcision treatment.
Patient shown before and after combination butt lift and reticular fiber subcision. Photos courtesy Walter Tom, M.D.
“In the obvious patients, you’re going to be able to mark the areas of buttock dimpling and folds. And in the patients where you suspect it but it’s not clinically evident, you have them flex their gluteus muscle, and it will become more evident. Then, you can mark off those areas before doing the buttock fat transfer,” Dr. Tom says. “… by basically releasing the tethering fibers, it allows us to place fat in those areas and get a rounded, aesthetically pleasing bubble butt end result, versus irregularities or flattening of the buttocks.”
In the combined approach, Dr. Tom first releases the tethering reticular fibers, and follows immediately with fat grafting in the deep subcutaneous plane and then in the superficial subdermal fat grafting plane.
“The deep injections are for structural support and the superficial is for smoothing the contour of the skin,” he says.
Outcomes from the approach are predictable, reproducible and satisfying for patients who want the bubble butt contour post Brazilian Butt Lift, he says.
Patient shown before and after combination butt lift and reticular fiber subcision. Photos courtesy Walter Tom, M.D.
Dr. Tom also uses the FDA-cleared Cellfina for the long-term treatment of cellulite, alone. Results have been shown to last three years, according to Cellfina.com.
Authors of a review of cellulite research, including treatment options, published January 2017 in Clinical, Cosmetic and Investigational Dermatology, suggest subcision is an ideal therapeutic option for the “cosmetically distressing condition.”
