Q: Dr. Eppley, I have buttock implants placed into the gluteal muscle right now. 500cc each. It doesn’ t look good. They are to high, it gives my buttock a pointy projection that I don’t like at all. I think I need subfascial placed buttock implants, probably custom made as well. I am looking for a fuller volume in the lower part of my buttocks. I need wider implants with less projection and as far I understand -that is only possible with a subfasial placement of the implants. Hope to hear from you soon. I added some pictures of how it looks now.
A: Generally, it is very difficult if not next to impossible to get a buttock implant greater than 350cc to 400cc in the intramuscular space. Even if they were initially placed there, they likely would herniate back through the muscle and end up in some modified location partially under the fascia but mostly in the subcutaneous space. Your pictures suggest that this is so with a very high and visible outline of the implants. All intramuscular implants, even in the right location, will look higher in the buttocks than subfascial implants. It would also be helpful to know the dimensions of your existing implants which likely are round with a relatively narrow base.
You are correct in assuming that only the subfascial location will allow more of the lower buttocks to be augmented. And it will take a very broad-based implant with less projection to cover the area you have shown. It would be interesting to know what is the diameter in cms that you are showing by the marks in the pictures you have attached. The largest round implant diameter is just over 18 cms and what you are drawing may or may not be wider than that. It is impossible to have any sense of scale in close-up pictures.
In planning any buttock implant replacement surgery, it would first be important to get a non-contrast MRI of your buttocks to have an accurate idea as to exactly what tissue plane the implants are currently located in. That will help with surgical planning and to see how much subcutaneous fat exists between the skin and the fascia. From there it could be seen if any stock sizes will meet the dimensions you need or whether a custom design is really needed.
Dr. Barry Eppley