Alain Tenenbaum, M.D., PhD, DSc
Via Vergio 37, CH-6932 Breganzona – Switzerland
alaintenenbaum(at)aol.com

 

The immediate chemical and medical Gluteopexy is a new weapon for dermatologists, by using the techniques called Endopeel, which have like mechanism of action a myotension, a myoplasty and a myopexy which duration does not exceed 6 months.

These techniques can be proposed to patients who wish to get a gluteopexy, to patients who are not candidates for a surgical Gluteoplasty, to patients which refuse suspension threads, to surgeons who want to complete their operation of Gluteoplasty with gluteopexy.

The advantages of these techniques are important for the patients, as the immediate effect, the absence of scar, the absence of down time, the absence of social eviction, as the transitory complications which are limited only to short duration edema and ecchymosis.

Patients’ selection

• All patients who desire a surgical or non-surgical gluteopexy can be candidates, as those not being candidate for any kind of filler(the fillers are too often sources of complications like granulomas, necrosis, migration, nodules etc.), and those wanting to complete or to maintain the benefits of suspension threads .Best indication is not fatty gluteal area, sagging down .
• Our critter of exclusion: Alcoholic patients, smokers, pregnant women, subjects under 18 years, patients affected with a cardiopathy, nephropathy and liver problems.

Benefit and Advantages:

• The gluteopexy effect is immediate and is perfectly visible 30 minutes after the end of the treatment with a maximum result 2 to 3 days after the procedure.
• The gluteopexy effect is early and will be relayed by the late peeling effect, specific to the techniques Endopeel.
• The treatment can be ineffective in 8% of the cases (bad technique).
• The effectiveness of this treatment increases with the number or the repetition of the procedures because the basic muscular tone will be thus increasingly high on the scale of the tension of this last
• It is easy to prove objectively the effectiveness of this treatment by treating for example only one side only on the same patient and by making a comparison between the treated side and the controlateral untreated one by pure visual inspection, or by photographic images, or by using points of reference. Results can be not only appreciated by inspection but also by palpation and eventually for very special experts by percussion.
• These same parameters are taken again to evaluate the duration of the results objectively
• The procedure is made comfortable for the pusillanimous patients thanks to the special anesthetic gel applied before the Endopeel procedure and giving satisfaction of painless technique to each patient, because the protocol can be adapted perfectly according to the timetable of the patient and also according to his social requirements
• In the field of safety, so far and since 16 years these techniques started to be used, no legal procedure against a physician using the techniques Endopeel was announced and/or indexed to our knowledge. The only complications met are only transitory, like edema ecchymosis.
• The report/ratio benefit cost of the treatment is accepted in the large majority of the cases.

Techniques

• The selection of the patients has been described above.
• The material to be used is the following:

–                 The medical device like oily acid carbolic ( DocTNB)

–                 Syringes 1 ml luer lock

–                 Flexible needles for the body 25 or 27g

–                 1 needle 18g to aspire the solution of oily carbolic acid

–                 An anesthetic specific gel   containing lidocaine 23%, tetracaine 7%, using an emollient lipophilic lubricating gel like vector

–             A post, Endopeel, cold cream

–                 Finally one not alcoholic disinfecting product, gloves and gauzes.

• The technique known as standard treats: the whole gluteal area on all sides, the banana fold, eventually the areas under the banana fold as the area above the bitrochantericline.
• Areas of, love handles, can be treated as well if there is no fat excess. In case of fat excess a prior lipoplasty should be done and Endopeel technique can follow 1 month after the lipoplasty procedure.
• The basic technique consists in injecting in subcutaneous perpendicular to the plan of the muscles 0.10 ml of oily acid carbolic each 2cm and same in the perpendicular plan to the precedent following the direction and the sense to obtain the wished lifting effect using crisscross-technique.
• Errors: The intra vascular injection of carbolic acid cannot be regarded as an error, considering the sclerosing effect of this substance. The injection into the motor plate or any nerve of carbolic acid may slow down the speed of nervous conduction for short duration.
• Safety: It is recommended for toxicity reasons not to inject more than 25 ml/ day/ patient . In case a patient needs more than 25 ml, this technique can be divided in consecutive days, respecting the maximal dose per day per patient.

Conclusion

Until now, the concept of Gluteoplasty was based only on volume augmentation concept, without taking care of the gluteopexy. With Endopeel techniques one acts not only on the myotension by preserving the muscular mass and without affecting the muscular contraction but also on the myoplasty and the myopexy .With this fact the indications of the fillers become more restricted and will apply only to the depressions which remain after tissue tension of the selected area. Indications of sutures will be too more restricted as they are not only painful but it is rare that a patient submits 2 times to sutures gluteal lift.

Finally chemical gluteopexy with a handing-over in tension of tissues with tightening effect like the Endopeel techniques give a better shape of the gluteal area, project a nice convexity of the new gluteal shape , which is tighten too , with redraping of the oranges skin dued to cellulitis ( which gets the, iron effect, with Endopeel ). Also the eventual stretch marks will only optically disappear, being as well redraped through the, iron effect, of Endopeel.

The technique Endopeel is a new strategic weapon for the Dermatologists and Plastic Surgeons enabling them to complete and/or maintain a Gluteoplasty which is an alternative to the surgery.