Hip Implant Questions

Q: Dr. Eppley, Aesthetically, my concerns about hip implants are coming from the perspective of a late transitioning transgender woman. So my pelvic bones developed in typically male fashion, giving me basically no hips,and none of the anterior pelvic tilt that’s typical for a woman. As a result, in profile my butt appears flat with relatively little projection and seen from behind the shape appears long and narrow – no curves. It seems like hip implants might provide a more typically female shape, but would they appear imbalanced without butt implants also? Can one do both? For trans women, do you typically get better results from an under or over fascia placement? Where do you place the incisions, and how extensive is the scarring? 

Realself.com shows many before/after photos of breast and butt implants, and some results look very good, but to my eye, in the majority of cases, the results appear noticeably unnatural and I often feel like the before photos looked better with the larger volume implants being more likely to appear disproportionate or even to present visible contour around the perimeter of the implant. Is it possible to simulate the likely results of various sizes, shapes and placements on my own body? Most of the results I’ve seen were for cis women and due to skeletal differences it’s impossible to infer much from their photos how similar implants might appear on a trans woman’s frame.

I also have questions about function. I enjoy yoga, running, hiking, and cycling. Would hip implants restrict my range of motion in yoga? Would the repetitive impact of running cause them to move? Would the pressure from a backpack’s hip band be a problem? In a bike crash, the soft tissue over the trochanters and iliac crest are often points of impact and abrasion – would hip implants make such injuries worse?

For one reason or another, it seems like many women who get breast implants end up needing follow up surgeries for removal, repositioning or repair. You mentioned that hip implants are relatively new. How many have you done and what’s been your experience with follow up so far? What types of complications have you encountered? Should one expect to need more surgeries over years and decades to maintain or remove hip implants?

A friend who got hip implants said the recovery was fairly arduous. She said the pain was worse than sexual reassignment surgery, liposuction or breast augmentation. That she couldn’t really sit down or lie on her back and that she could only sleep on her tummy. How long is it before one can sit or sleep on one’s back or side?

Finally, I wonder what you think about the iliac crest extensions these guys are experimenting with in Korea? Considering the relatively tall and narrow shape of the male illiac crest in comparison with typical female development, I might guess that making the area appear wider at the top without also doing something down the sides over the trochanters could yield a disproportionately top-heavy shape for trans women, but that doing both together might work really well. As far as I know, they’re not doing these for the general public yet, and apart from their press release claims, there’s very little information available about their technique and outcomes.

This e-mail turned out much longer than I expected – thank you for reading all of it!In closing, I’d like to thank you for the work you do – never before have trans women had the opportunity to make these sorts of changes to our bodies – it’s pretty awesome and amazing what you’re providing with the procedures you offer.

A: Thank you for your detailed description of your body shape concerns. In answer to your questions:

1) Hip and buttock implants can be done together but great care must be taken to ensure that their two implant pockets do not merge into one.

2) Hip implants can be done alone without the use of buttock implants. It all depends on what shape and size hip implants that are placed to keep it in proportion.

3) Whether one places hip implants above or below the fascia depends on implant size and what area of the hip needs augmenting.

4) Hip implants are placed through 3 cm long skin incisions just above or slightly back from the upper hip prominence.

5) It is important in reviewing before and after pictures to realize that those results may have been exactly what the patient wanted and they may think it looks quite good and natural. The fact that many do not look good to you speaks to what your goals are and how the choice of implant style and size are of critical nature in achieving your desired results. The key in buttock and hips implants for the most natural look is implants that have larger diameters with lower central projections and very feathered edges all the way around the implant. That often requires the use of custom made implants.

6) Hip implants do not restrict one’s physical activity. Although I have never placed them in a patient who cycles so I can not speak as what the level of activity means for them.

7) Because all hip implants are ultra soft they are actually protective from traumatic injuries rather than placing one at increased risk of injury.

8) Unlike breast implants which are fluid filled sacs which are designed for eventual failure and the need for replacement, hip implants are a very soft but solid material and will not undergo the need for replacement because of implant failure.

9) Your friend’s description of her implant recovery is far different than in my observed experience. It is not nearly as arduous or difficult as that description or comparison.

1) Iliac crest implants are the newest body contouring implant the I am working on both in design and surgical technique. They also are soft solid silicone implants that are placed just along the iliac crest from a posterior incision. They are a far easier and less arduous recovery than any other body implant that I have ever placed.

Dr. Barry Eppley

Indianapolis, Indiana