At its origin, the gluteus maximus muscle extends to include parts of the iliac bone, the sacrum, the coccyx, the sacrosciatic ligament, and the tuberosity of the ischium.

Given the nature of the surgical incisions to the gluteus maximus muscles, the therapeutic management of post-surgical pain (at the surgical-wound sites) and normal tissue-healing usually require a four to six-week convalescence, after which the patient resumes their normal-life activities.

[2] The augmentation and contouring of the buttocks with autologous fat transfer (lipoinjection) therapy is realized with the excess adipose-fat tissue harvested from the abdomen, flanks, and thighs of the patient.

Then, the harvested fat is injected to the pertinent body area of the gluteal region, through a fine-gauge cannula inserted through a small surgical incision, which produces a short and narrow scar.

[10] Nonetheless, physiologically, the human body's normal, health-management chemistry does resorb (break down and eliminate) some of the injected adipose-fat tissue, and so might diminish the augmentation.

[12] The augmentation of the buttocks, by rearranging and enhancing the pertinent muscle and fat tissues of the gluteal region, is realized with a combined gluteoplasty procedure of surgery (subcutaneous dermal-fat flaps) and liposculpture (fat-suction, fat-injection).

Therapeutically, such a combined correction-and-enhancement procedure is a realistic and feasible lower-body-lift treatment for the patient who has undergone massive weight loss (MWL) in the course of resolving obesity with bariatric surgery.

[13][14] In the case of the patient who presents under-projected, flat buttocks (gluteal hypoplasia), and a degree of gluteal-muscle ptosis (prolapsation, falling forward), wherein neither gluteal-implant surgery nor lipoinjection would be adequate to restoring the natural anatomic contour of the gluteal region, the application of a combined treatment of autologous dermal-fat flap surgery and lipoinjection can achieve the required functional correction and aesthetic contour.

The usual buttocks-reduction treatment is lipectomy with applied tumescence and anaesthesia, wherein the body fat is harvested by aspiration (suction) through a small-gauge cannula (2–4 mm) that is inserted through a small incision, either to the intergluteal sulcus (the butt-crack), or to the upper area of the gluteus maximus muscle proper.

The quick fat-harvesting allowed by the ultrasonic lipectomy technique has eliminated the larger (long and wide) surgical incisions that once were required for removing a large volume of adipose tissue.

Nonetheless, because of the sensitivity of the gluteal-region tissues, the skin of the pertinent donor-site is cooled in order to prevent ultrasonic heat damage caused by the liquefying and removal of the excess adipose fat.

[2] Reshaping the buttocks with liposculpture is performed with a small cannula (2 mm) specifically for contouring superficial body fat, the configuration of which (number of open ports) is determined by the type and the degree of gluteal correction to be realized.

Moreover, superficial liposuction can be combined with other treatment methods for contouring the gluteal region to achieve the required functional, anatomic correction, and the aesthetic enhancement sought by the patient, such as reshaping the lateral area of the buttocks into an athletic form.

[18] To meet the functional requirements and the aesthetic expectations (body image) of the patient, the plastic surgeon establishes a realistic and feasible surgery plan by which to correct the anatomic contour deficiencies of the gluteal region.

Afterwards, the surgeon sutures the dissection-incision and secures it with adhesive tape to ensure that the augmentation-pocket remains open, as dissected, ready to receive the injections of adipose fat.

For the revision of scars, with surgery and injections of autologous fat, or with allopathic synthetic fillers, the surgeon applies subcuticular closures to the incision wounds, which then are bandaged.

The patient is advised to avoid exercise and strenuous physical activity until three weeks post-operative; how to properly care for surgical-incision wounds; and how to wear a compression garment that will keep in place the surgically corrected tissues, and so ensure their healing as a whole anatomic unit of the gluteal region.

[20] Secondary lymphoedema of the lower extremities has been reported as an unusual side effect of liquid silicone injection on the hips and buttock while thromboembolism, implant displacement and explosion has also been listed as some of the dangers.

Moreover, during anaesthesia, maintaining the patient's stable blood pressure can be difficult, which increases the possibility of bleeding, and the possibility that anaesthetic toxicity can occur if excessive doses are administered by infiltration; the symptoms are manifested as central nervous system (CNS) occurrences of drug-induced anxiety, apprehension, restlessness, nervousness, disorientation, confusion, dizziness, blurred vision, tremors, nausea, vomiting, shivering, and seizures; likewise, as manifestations of drowsiness, unconsciousness, respiratory depression, and respiratory arrest.

Hence, the patient is advised to facilitate the re-sensitizing of the numb area(s) with applications of gentle massage, to prevent the development of a neuroma complication, and to alleviate pain.