Concepts in Hip Implants

Q: Dr. Eppley, I have heard and read that you are pretty innovative with techniques. I am a woman with unfortunately narrow hips. I had previously asked about hip implants. I’ve been doing some reading on these hip implants and they don’t seem to actually make the hip appear much wider. They seem to more smooth the hip out without width being the primary goal. They seem to fill in the hip dip between muscles.

I know many women who would love to have substantially wider hips, or at least the illusion of bring wider. I’ve contacted quite a few doctors about this and the responses are less than favorable with no one really willing to think outside the box to get this done correctly with natural looking results. I’m not a doctor and I have no clue what is possible in the medical field. That’s why Im contacting you. 

It seems hips are not actually the issue the more I look at anatomy, but the angle of the femur toward a wider pelvis and the way muscles form? If this is the case I really don’t want to perform any bone surgery (hip replacement or lengthening). 

Is there a way to get substantially larger hips, 2-3″ at the widest point (slightly below greater trochanter)? I envision it taking 2 implants, firstly from the actual hip bone tapered toward the greater trochanter. Secondly from the greater trochanter (actually slightly lower) tapered toward the knee? Would there be a way to anchor these implants in a submuscular position to prevent shifting? Would there be something flexible enough to stretch and move with the body and not appear unnatural while sitting?

Again, sorry, I don’t take surgery decisions lightly unless I understand them on some level. I am trying to figure the best way to stop having to wear hip pads on a daily basis like I have been for the last 3 years. If you have any insight to other surgeons who have been innovative in this area I would love to hear about them or their techniques as well.

Thank you so much for your time.

A: Since hip implants are not standard body implants that are frequently performed and so few surgeons actually do them, there are no established techniques for this type of body implant surgery. (implant design and shapes, pocket locations etc) Thus there are numerous misconceptions about them which can lead to your perceptions about them…both accurate and inaccurate. From that perspective I provide the following comments based on my experience with them.

1) There are no standard preformed manufactured hip implants. So what surgeons use for hip implants can widely vary. Unless the surgeons makes them custom for each patient based on the area of hip coverage desired, what is being used are implants ill suited injections many patients for the desired effect. I suspect the most common implant used for the hips are round buttock implants..and it is easy to see how that would be used for hip indents to fill it in. What that is a valid type of hip implant if that is what the patient wants, I would not consider that location or type of implant what many patients want for creating a more substantial hip width effect.

2) Non-hip implants are often placed in the subfascial plane on top of the TFL muscle. What it is always a good idea to place any implant in the body below as much vascularized tissue as possible, the TFL subfascial pocket is more limited in terms of the area and amount of hip augmentation that can achieved. Thus subfascial hip implants are by definition much smaller and only modestly effective.

3) Covering a larger area of the the hips requires a custom made implant as its surface area coverage needs to be much bigger. Surface area coverage for a hip implant is far more important for more significant hp augmentation than projection. This is also critically important to avoid the ‘bump on the side of the hips look’. A broad covering hip implant with feathered edges (not rounded) is also necessary to avoid visible edge transitions.

4) Such hip implants as indicated in #3 by their surface areas coverage must be placed above the TFL fascia in the deeper subcutaneous fat layer to allow for such broad hip coverage.

5) I doubt that but would be necessary to hace a hip implant that needs to be 2″ to 3′ inch to achieve a very substantial effect. Such central projections of the implant at that amount may also prevent the important feather edging of the implant given the disproportion between its height and diameter measurements.

6) All body implants today are made of very low durometer solid silicone. This makes the very soft and flexible and, as a result, they do not interfere with normal range of motion.

Dr. Barry Eppley

Indianapolis, Indiana