Your Questions
Your Questions
Q: Dr. Eppley, I’m concerned about my right buttock implant. I had large buttock implants (625ccs) placed above the muscle about one year ago. My right buttock implant seems to be lower than my left and it seems to continue dropping. As shown in the attached pictures the left is the perfect buttock while the right is not so perfect. What are my options to correct this without another surgery or spending thousands of dollars?
A: Like all implant asymmetry issues anywhere on the body or face, there are never any non-surgical solutions to their repositioning or adjustment. But to provide a more wholesome perspective, let’s review why you have what you have and what you would do if the concept of another surgery or economics were not an impediment to the desire for improvement.
Buttocks implants in the subfascial plane (above the muscle) have a known propensity to potentially drop as they heal and settle. This is quite unlike intramuscular buttock implants which stay locked in a high pocket because of their tight muscular confinement. At 625cc implant size, this was never an option for you since the largest implant in the intramuscular pocket at your height would be about 350cc to 400c maximum. In the subfascial plane, all the surgeon can do is place them in what appears to be a high pocket knowing that they will settle. Why one implant eventually settles lower than the other one, like in your case, is unknown and unpredictable. Why it may do so even at a late period after surgery is also unknown. The size of the implants may have something to do with it but then the one buttock implant is fine….so clearly size alone is not the sole driving factor. Whether any further dropping may occur is also not known but there is a limit as to how how low it can go and I suspect you have likely reached it.
Correction of buttock implant asymmetry, unlike that of breast implants, is neither easy or assured. Repositioning of a low breast implant, for example, is comparatively easier since the access point (the incision) is at a convenient position on the underside of the breast and the pocket can be sutured upward. Such is not the case with buttock implants where the access point is from above. The implant would have to be removed and the pocket attempted to be sutured from far away through a small incision and the implant re-inserted. This is a very difficult surgery and the retention of the pocket elevation very unlikely given that one has to sit on it at some point after surgery. While it can be done, success with upward buttock implant respositioning is usually very low.
While buttock implant asymmetry is not a desired aesthetic outcome, the risks of revisional surgery may outweigh any effort in that regard. Besides the low probability of success, entering a healed implant pocket always induces the potential risk of infection. Should infection occur, which is always more likely in subfascial vs. intramuscular pockets, the aesthetic outcome would be disastrous with loss of the implant.
Putting all of this in perspective, living with some buttock implant asymmetry may be the only economic choice, it may also be the best medical decision also.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I just got buttock implants done (425cc), but they are no where near the size I want. I was wondering is there anyway for you to add to my hip/ butt area maybe with more implants? I can’t do a fat transfer as I am too thin.
A: Thank you for sending your pictures of your buttock implants result. While I do not know where you started, you have a very good result. It is not possible nor medially wise to seek that degree of buttock size change by larger buttock implants or adding other implants. Such implants in a thin frame like yours is asking for complications and risks losing what you have now. Surgery with implants anywhere in the body is like a roulette wheel. You have spun the wheel once with fairly large buttock implants for your frame and you have achieved good improvement without complications…at least up to this point early after surgery. Pushing all your chips for another spin at the roulette wheel (further implant surgery) risks losing everything with complications like infection, implant capsular contracture and lifelong buttock deformation. While you may have not achieved your ideal buttock enlargement goal, which was never a realistic goal with your body frame, you have reached what I would consider to be medically safe and the probably limits of what your body can tolerate.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in buttock augmentation. I am a 53 year old athletic woman who had liposuction years ago that left me with misshaped and sagging buttocks. A skin lift four years ago helped just a little, but, as photos show, still a big problem. I am wanting to fill out my buttocks but keep an athletic look, since the rest of my body has good muscle definition. Is there a buttock augmentation procedure that will enable me to continue to do extreme sports?
A: The residual problem with your buttocks is a volume issue not one of a skin sag. The dilemma you have is that of two treatment options, fat grafting and implants, one of the them (fat grafting) is not a viable option due to your very lean body. Buttock implants, while effective, poses both a recovery and potential physical activity limitation (during the long recovery process) for what your physical standards are. (extreme sports) It would probably take three months for a full recovery. Given these issues, I do not see any method of buttock augmentation that will work for your specific physical needs. While full gluteal muscle function will return, the impact of intramuscular buttock implants is suspect in very highly athletic people.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am a male to female transgender patient and I am interested in buttock implants. I have been on hormones for 2 years and have already had facial feminization surgery. I have a flat butt and large rib cage. I also have a little fat around my mid section and flanks. I inquired about a butt lift by fat injections but after an examination they said that I do not have enough body fat. They do not do implants and said that they are extremely painful. Your website said that you do them and that there is not so much pain. Any info would be helpful——Thanks !
A:I have done many buttock implants and the key decisions are implant pocket placement (subfascial vs intramuscular) and the implant size and style. Implant pocket placement has a lot to do with the desired size one is after and the type of recovery what is prepared to got through. I am not sure where you read that buttock implants are not that painful as that would be untrue, particularly the intramuscular location. They do have a modestly long recovery since you do have to sit on the result at some point after surgery. They are uniquely different than breast implants for example because of their anatomic location and their functional significance in the short term. In short, buttock implants can provide a successful buttock enhancement result but it requires a motivated patient who can tolerate the 3 to 4 week total recovery process.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had subfascial buttock implants placed three week ago. My doctor wanted to keep the skin stitches in for a long time so that it would heal without coming apart. I’ve been keeping an eye on my stitches now that I able able to see them better. I am seeing an opening develop that I did not see until now. This opening in the incision worries me. Should I get it restitched to assure that it closes properly when I go in for my one month checkup?
A: What you are observing after your buttock implants is very common and, quite frankly, expected. This is why I keep the the intergluteal incisional sutures in for so long. Every intergluteal incision will develop small openings such as you have and they never occur until 2 to 4 weeks after surgery. I do not close them because the sutures will never hold. They need to be allowed to heal in on their own. There are 3 other layers of tissue suturing under that of the skin closure so such small openings are not a concern. I would recommend topical Silvadene dressings which will help the small open area granulate in faster and is a potent antibacterial as well.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am 21 years old, 5 ‘0” and weigh105 pounds. Am I qualified for butt augmentation with fat. (Brazilian Butt Lift) If not what do I need to do to gain more weight or is there anything I can take to gain weight?
A: At your low weight, you are not a candidate for buttocks augmentation by fat injection. And there is no amount of weight that you could reasonably gain to get you to the point where there would be enough fat to make the procedure worthwhile. Even if you did gain a large amount of weight, the fate of the fat that is harvested and placed into the buttocks would be suspect with subsequent weight loss. Only buttock implants would be effective in someone who is so small with very low body fat.
Buttock implants are more reliable in terms of the volume that they provide (fat survives vary variably) but they have a higher rate of potential complications because they are an implant which is not naturally there. I would not say they are any less safe that fat, just that there is more potential complications and recovery than just using you own natural fat as the ‘implant’.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’m largely familiar with the constellation of procedures that comprise Facial Feminization Surgery and Sexual Reassignment Surgery. Procedures that ‘balance’ the lower-body to ensure it’s proportional to the upper body are much less clear. Would you please take a moment to help me understand your thigh and buttock augmentation procedures?
1. What is the vertical & circumferential extend of implants used for lateral augmentation of the thigh (in the region of the greater trochanter)?
2. What are the vertical & lateral dimensions of the buttock implants? My concern here is to understand how these implants, in conjunction with lateral thigh implants, will create a natural curved profile in the waist-to-thigh area (instead of being “localized” augmentation).
3. I have a ‘flat’ area just below the iliac crest. Since this is above the greater trochanter and will likely not change with lateral thigh augmentation, do you have a method (or implant) to fill-in this area for to create an more uniform curvature from waist-to-thigh?
4. How are implants in this area ‘secured’ in their desired location so there will be no dislocation over time?
5. Where are the incision(s) for lateral thigh augmentation?
A: Thank you for your questions. In answer to them:
- There are no standard off the shelf thigh implants. They almost all have to be custom made so their dimensions can be largely what one chooses based on measurements of the patient. But one should not think of them as circumferential, they are lateral implants and that is the extent that they cover.
- Even when put together at the same time in the same patient, buttock and thigh implants will be localized augmentations. They do not connect nor can they. Their implant pockets are separate.
- The trochanteric drop area is best treated by fat injections if possible since it is a flexion area for which implants are not best used.
- All forms of body implants are secured only by the pocket that is made for them. They stabilize because the body forms a layer of scar around them (the capsule) this locking them into place.
- Lateral thigh implants are placed through a small (4 to 5 cm) incision over the upper thigh.
Dr. Barry Eppley
Indianapolis, Indiana
Q: What is the best buttock implant augmentation technique? I have heard differing viewpoints about inside the muscle and on top of the muscle.
A: Just like breast implants which can be placed under the muscle or on top of it, buttock implants share a similar two pocket location approach. (although intramuscular not under the muscle is where buttock implants are placed) Whenever there are two ways to do any surgery and different surgeons either approach, that indicates that neither method is perfect. You then have to look at the different advantages and disadvantages to either approach and figure out which one matches your needs the best and which risk profile is more tolerable.
The arguments for the subfascial location for buttock implants is the following. This pocket location allows placement of the biggest implants with sizes up to 700ccs. It creates a nice ‘S’ curve by making the pocket up to the posterior iliac spine, where the gluteal muscles actually attach. It also has a faster recovery because the muscle fibers are not disrupted deep into the belly of the muscle. Its disadvantages are that it has a higher incidence of seroma formation, potential implant visibility (if you have little subcutaneous fat between the skin and the muscle) and a greater chance of implant displacement/rotation. (since there is less tissue resistance)
The arguments for the intramuscular location for buttock implants is the following. It provides a thicker more vascularized tissue pocket which lessens the risk of seroma formation, potential implant displacement and has less risk of tissue thinning over time between the implant and the overlying skin. Its disadvantages are that it is somewhat more technically difficult to perform, has a limitation to implant size that can be placed (350cc or less) and has a longer recovery.
When you put all this together you can see that it is not so simple as just one implant location is better than the other. You have to look at each patient and make a decision based on their goals, tolerance for recovery and their tissue qualities. For thin or small women that have little subcutaneous fat tissue, an intramuscular implant location is usually best. For larger women with thicker subcutaneous fat layers that want a larger buttock augmentation result, a subfascial location would be preferable
Regardless of buttock implant location, a very important element that affects the result is the strict adherence to postoperative instructions to avoid too aggressive early activities. This can increase the risk of incisional wound separation, seroma formation and implant displacement.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in intramuscular buttock implants. I don’t really feel comfortable with the subfascial pocket for them. Having said that if I go with intramuscular and 350cc or less in implant size, then which shape you would recommend? Can I get away with a round implant? Oval or anatomic? I would also like to have some liposuction for a better shape. Do you recommend to do them at a different time or together with the buttock implants?
After my first liposuction, I noticed that I have developed some fat around my bra area (bra rolls) that I hate. Here I attached some of my pictures with some assimilation on where I like to have the liposuction done. Can you please kindly let me know if they are relatively doable?
A: The most common intramuscular implant that I place is a 330cc anatomic implant that has a lower profile and more tapered edges than a traditional round or tear drop implant. This creates as more natural contour to the buttocks and will definitely avoid a rounder and more fake look. As most of the patients who undergo buttock implants are about your size (because they are not good candidates for BBL surgery), this implant volume is the right and maximum size that can be placed. Trying to ‘stuff’ a bigger implant than this in an intramuscular space is prone to causing other problems and even more prolonged recovery.
In regards to liposuction, you should definitely do it at the time of buttock implants due to the convenience of intraoperative positioning. You need to be in the prone position for the buttock implant procedure and this is the best way to liposuction the bra rolls and flanks as well. This fat could be used to fill in some of your indentations which would not likely go away with the push out of the implants way below them.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am 5’3” and 115lbs, 48 years old, healthy, and work out regularly. I have tried the Brazilian Butt Lift surgery (BBL) but not only didn’t it work but it also made my buttock shape more square than round. It also gave me some indentations. I am now very interested in buttock implants. I consulted with a plastic surgeon in South America and one in Los Angeles. They are both saying intramuscular for the buttock implant location. One is using highly cohesive gel implant called from Silimed and the one in Los Angeles uses semi solid silicone. They are recommending 400cc round or 480cc oval. As I was researching I came across your site. I noticed that you don’t recommend anything bigger than 350cc. I appreciate if you could share your opinion with me. I like the softness of cohesive but safety of solid ones. I love round looking butt, not too big or too small. Thank you for your time and feedback.
A: Let me provide you with some basic information about buttock implants. All buttock implants used today, regardless of the manufacturer, are made of soft flexible solid silicone elastomer. In essence they are all highly cohesive semisolid silicone gel. There is really no difference in their material composition. There are some minor differences in the durometer of the semisolid gel used (slight differences in stiffness) between the manufacturers but tis is really of no consequence to the patient.
Buttock implants can be placed either inside the gluteus maximus muscle (intramuscular) or on top of it. (subfascial) There are arguments for and against each implant location. If there was one perfect location for buttock implants, that would be what everyone would use. Intramuscular buttock implants are technically harder to perform, have a significant recovery but have the lowest incidence of long-term complications. There is also a limit, no matter what a surgeon says, as to the size of buttock implant that can fit into the intramuscular space. In someone of your size, that is going to be about 350cc or less. I can not see how any buttock implant of 400cc or greater can truly fit into the tight intramuscular pocket…at least with someone of your small size. It is not a recommendation that I make, it is simple function of what the anatomy will accomodate.
Subfascial buttock implants are technically easier to perform, have a shorter recovery and permit implants of larger sizes to be placed. It would be no problem to placed implants of 400cc or greater in the subfascial space. You have one important issue that may make this buttock implant location more favorable than it might be for others…you have had a prior fat injection procedure. While it may not have accomplished your overall buttock augmentation goal, it has provided some increased tissue and vascularity to the buttock tissues. I think given your desire for a very round looking buttock of intermediate size, you are likely better off with subfascial buttock implants.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Can oval shape buttock implants rotate? Is there an amount of time that goes by that rotation is no longer a concern because they are now in their permanent place? If so, how long until that happens? If they rotate can you push them back manually without another surgery?
A: Oval, sometimes called natural, shape buttocks implants can certainly rotate if they are placed in the subfascial location rather than the intramuscular position. That risk is greatest during the first several months after surgery but the risk is lifelong since they are not textured implants but have a smooth surface. You may be able to push them around back into the place but they can just as easily rotate again. But if the buttock implants are placed in an intramuscular pocket, the chances of inadvertent rotation are significantly reduced because of the more constricted pocket space.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’m looking to get buttock implants. I am very small framed (5’0” and 105 lbs) and wanted to know what should I get for my size?
A: When you get buttock implants, they should almost always be placed in the intramuscular space to lower the risk of long term problems. While above the muscle (subfascial) is also popular, there are higher risks of seroma formation, implant show and mobility, and infection. The recovery may be quicker but that short term benefit may not be worth the long term consequences.
In the intramuscular space there is a size limitation as to how big the implant can be. You do not have the choice of just any size, the anatomy of the space limits the size anyone can get. Everyone gets the biggest implant size that the space can take because there is no risk of being too big in this buttock implant location.. Generally that is going to be anywhere from 270cc to 330cc. With a small person, it is probably going to be closer to 300cc or less. Fat injections can be added around them to help with some additional size increase if you have some fat available to be used.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, what are the pros and cons of buttock augmentation by fat grafting? I can’t decide between getting an implant or having fat injections done. Fat injections seem better but I read about some bad experiences with them.
A: The pros and cons of buttock augmentation by fat injection grafting are well known and are relatively classic between the effects of one’s own tissues vs. a synthetic implant. The pluses of fat injections in the buttocks are the body contouring benefits of the liposuction harvest, a much easier recovery, few if any complications such as infection or seromas, and a natural augmentation effect. Its negatives are the incredible variability and unpredictability of fat graft retention (may have partial or complete resorption of the fat), a small to moderate buttock augmentation result for most patients, and the potential need for more than one fat grafting session for the best result.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’m interested in getting buttock implants and fat grafting to my hips and butt. I know I don’t have much fat but I really want a much bigger butt. I have attached some pictures of me and a picture of my dream butt. How possible is this result?
A: Thank you for sending your pictures. You clearly have little fat to contribute to your buttock or hip augmentation. Your buttock augmentation result will come largely (95%) from the effect of the buttock implants. The ideal picture you have shown is not a realistic result. That is not going to be achievable no matter what implant size is placed. With an intramuscular implant approach with a maximal volume of 300 to 350cc, that result will be about 33% to 40% of your ideal buttock size result. If the implant is placed above the muscle (subfascial) with a maximal volume of 500 to 550ccs, you will get about 60% to 65% of your ideal result. Any addition of a small amount of fat will add little to the implant-created result.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in getting a combined tummy tuck and buttock implants operation. I won’t have the money for my surgery until April 2014. Is it a good option to have a consultation a couple months ahead or within a certain time frame prior to the surgery. Also how much approximately would it be to have both procedures at the same time? Is there a discount for that or some type of deal for booking both at the same time?
A: I think it is always good to get accurate surgery and cost information way in advance of when any patient wants to do their surgery so they can plan accordingly. Doing it two or three months in advance is a good idea. I will have my assistant pass along some general cost information for a tummy tuck and buttock implants to you by tomorrow, although be aware that these are general numbers since I have no idea as to your exact tummy tuck needs.
Like all cosmetic surgery, bundling procedures together can result in a cost savings due to saving operating room and anesthesia charges. However, the combination of a tummy tuck and buttock implants done together would make for a really difficult recovery and this is not a recommended combination procedure. A tummy tuck and fat injections to the buttocks can be done at the same time but two muscular operations on opposing sides of the torso is not a good combination.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, which has the most effect on your buttock size, implants or fat injections?Which has the better results because I do have some fat from having a baby.
A: The choice between fat injections or implants for buttock augmentation depends on numerous factors. The most significant are how much fat you have to donate and how much buttock size increase you desire. Whether ‘some fat’ is enough to achieve a visible change depends on what your body looks like now. The largest donor source of fat is the stomach area although it can be taken from many other places as well such as the flanks and thighs. The minimum amount of fat one should have should be at least 1.5 liters to be able to put reduce it down to 400cc to 500cc per buttock. I wold consider this to be the minimum to justify the surgical effort. For some women, much more may be needed. If fat is inadequate then the only option is going to be implants.
If you could send a picture of your body and your height and weight that would be helpful in providing a more specific answer.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I currently have butt implants and I love the look of them, but I hate how they feel because I can feel the hard edges of the implants. I want to have them replaced using the softer silicone implants that are approved in other countries. If I purchase the soft implants online would you be able to perform the replacement surgery? Thanks.
A: Do you know the manufacturer of the implants that you now have? I use Implantech very soft gel buttock implants that virtually feel like gummy bear candies (without any hard edges) so it is hard to imagine anything that would be any softer. But they can also be made in a very low durometer that can feel just like jello. Thus I am not sure any implant used elsewhere in the world would be any softer.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I really want a bigger butt but realize that I don’t have any fat in which to inject. I am too thin to get much of a anything. That leaves my only option as buttock implants but I have heard only bad things about them. Are they really that bad? What is the real truth about them?
A: Buttock implants have gotten a historic bad reputation that to some degree is undeserved. When placed by an experienced surgeon into the intramuscular location, they can produce some very good results that fat grafting can not. Intramuscular buttock implant placement will be limited to usually under 400cc for most patients although this can make for a very impressive change despite the seemingly small volume. Buttock implants can also be placed above the muscle in the subfascial location, where much larger implants can be used, but the risks of complications such as infection, fluid collections and implant shifting are higher. Buttock implants can be a very effective and safe buttock augmentation option but what is bad about them is that the recovery is going to be longer and more difficult than that of fat grafting.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am a 28 years old transgender female. I would like to do a hip augmentation with implants and at the same time a liposuction and fat transfer to the butt or maybe butt implants and hip implants together. I would like to know what is the best solution to create more feminine curves in the butt and hips areas.
A: I would need to see some pictures of your body to see the dimensions of your hips and buttocks and see what the best solutions are. But I will assume for now that you do not have enough fat to successfully do any amount of fat injection transfer for augmentation. This usually requires at least 2500 to 3000cc of liposuction aspirate to get 300cc to 400cc of concentrated fat per buttock to inject…which will create a very modest buttock enlargement. This leaves the only options for either buttock and hip augmentation using implants. The decision for buttock implants is whether to go above or into the muscle. I usually prefer the intramuscular approach since this implant location has a lower risk of complications and better long-term results. Hip implants are always placed in the subfascial location and the size of implant that can be placed depends on the tightness of the pocket right below the level of the trochanteric prominence.
Dr. Barry Eppley
Indianapolis,Indiana
Q: Dr. Eppley, I am 46 years of age and a runner in great health–I use to love my breasts, but now not so much. Looking at either breast lift or augmentation and brazilian butt lift. I have always had a flat butt, especially flat since I run…and sit all day–have great legs want the rest of my body to match. Seeking cost of both surgeriess (I realize average is best you can estimate, not having seen me), all scenarios. Would like to save an pay up front if possible, will not finance. PS – I do have that baby belly fat still in there, so I’m sure it can be used to help my buttocks out! 🙂 Thank you!
A: One of your problems will be easy to solve and that is the breasts. Breast implants will provide an immediate and permanent solution to a larger breast mound, of a size of your choosing. Whether you would really need a breast lift I am not sure but as long as your nipple is above the lower breast fold you would not. I will assume that since you are a runner that you have breast deflation not breast sagging. The more difficult problem to solve is that of your buttocks for three specific reasons, none of them surgical per se. First, would a runner in great shape really have enough fat to harvest for an effective brazilian butt lift…in most cases usually not. Second, even if enough fat were transplanted the odds are high that being a runner will result in the fat being absorbed quickly…burning it off. Those who have less fat do so for a reason. Thirdly, like breast implants real buttock implants are the definitive permanent answer but in a runner the recovery might be longer than you want.
Expect silicone breast implants to be around $ 5,700, a brazilian butt lift to be around $ 4,500 since yours is small and buttock implants to be around $ 5,900.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had buttock implants that were removed in December 2011 due to a shifting of the left implant. It left me with a indentation defect. I would like to see what options I have to revise this area. Thank you.
A: If removal of a buttock implant left an indentation defect and had to be removed due to shifting, that would indicate that the original implants were likely placed in a subcutaneous pocket…which is notorious for implant displacement in the buttock region. That would also explain why the indentation defect appeared, probably from pressure atrophy being too buy propecia online without prescription
close to the skin. Such problems do not usually arise from intramuscular buttock implants if they are placed properly.
Depending on the size of the buttock indentation, fat injection grafting would be the best treatment. The indentation likely represents a fat defect so replacing similar tissue with what has been lost seems most logical. Fat injection grafting does require that one has some fat to harvest but for a buttock indentation the volume needed should not be too great.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in buttock augmentation. However, looking at the before and after pictures, it doesn’t look like much of a difference. I would like a really big butt.
A: While the definition of a really big butt is open to various opinions, let me give you the overview of buttock augmentation options and the reality of their outcomes and the process.
SYNTHETIC INJECTIONS Known as black market injections of silicone oils and even caulking compounds, this is an illegal procedure that has a high rate of conplications. While a much larger buttock size can be immediately obtained at the cheapest price, this is not a good trade-off when one risks severe buttock lumpiness, skin pigment changes, infection, chronic pain and even death from necrotizing fasciitis and pulmonary emboli. But when you injected in a hotel room or house by someone of absolutely no training with non-medical and non-FDA approved materials, these results should not be surprising.
FAT INJECTIONS This is the most common method of buttock augmentation today and the most popular. The name Brazilian Butt Lift is what it is most known by. While it is the most popular, that does not mean it is the most effective because it isn’t. Improvements in buttock size can be expected to be modest as best. It is popular because it is a natural material and there is the concomitant body contouring benefit of the liposuction procedure that is needed for the fat harvest. The survival of fat, no matter what you may read, is far from assured and even at its best a 50% survival of what was be injected I would consider a spectacular success.
IMPLANTS The most assured method of sustainable buttock augmentation is with the use of FDA-approved soft buttock implants made from silicone gel elastomers. Implants will produce the biggest size that will last but is a more invasive surgical procedure with a significant recovery and costs. There are two ways to place buttock implants, above and inside the gluteal muscle, and this will also influence the result and the recovery. The best place to put implants is inside the muscle. (intramuscular) This is the best for implants long-term and is associated with the least potential complications but the size increase will be moderate (350cc or less) and the recovery is the hardest. In a small person the buttock size change can be very significant. In larger patients, it will be more moderate. If the implants is placed above the muscle, the largest available implants can be placed in most people (up to 600cc) and the recovery is less than when placed inside the muscle. But there are higher risks of infection, fluid collections and implant shifting than when the implant is placed inside the gluteal muscle.
In short, you can now see that different methods of buttock augmentation have different outcomes, risks and recovery associated with them. So when your goal is a ‘really big butt’, your only good options is a buttock implant placed above the muscle. Whether someone is willing to expend that effort is why so many patient opt for fat injections…but should only do when they are understanding of what the final result will likely be.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I would like to know the sizes of butt implants? how big is the largest one and how many inches thick? and if it has liquid inside or if it has hard gel? Also can I dive to MO after couple days after surgery? Thank you.
A: Buttock implants come in a wide variety of sizes based on volume and base diameter. While buttock implants can range up in size to 550cc with 5 cms projection, there is little reason to put more than 300cc to 350cc in any patient. This produces a surprising amount of buttock enlargement for most patients. This is about the maximal size that can be placed through a 7cm intergluteal crease incision and fit into the intramusular pocket. Trying to place anything bigger is an invitation to complications. While larger buttock implants can be placed above the muscle, this is not a technique that I use as it has a high complication rate such as implant displacement and fluid collections.
Buttocks implants are composed of a very soft silicone gel (not liquid) which feels like a compressible sponge.
Realistically, you would not be comfortable to sit on your buttocks and drive two days after surgery, even if you were just driving around the block. All patients will need someone to drive them home no matter where they live.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I want a fuller butt to compliment the rest of my body. I don’t have any pictures at this time but I’m a black female with what they call a flat butt that doesn’t go with the rest of my body. What are my options for getting a bigger butt?
A: Buttock augmentation can be done by two techniques; implants and fat injections. Each as their own advantages and disadvantages. By far the most common buttock enlargement method today is fat injections also known as the Brazilian Butt Lift. Fat injections offer the advantages of simultaneous body contouring from the liposuction fat harvest and a natural method of enlargement that has a fairly quick recovery. It’s one disadvantage is that there is no predicting how much of the fat will survive. As a general rule, fat injections can produce only a modest enlargement in buttock size. Synthetic implants have the advantage of a permanent method of buttock enlargement that can produce a larger result that is maintained. Its disadvantage is that it requires a small intergluteal scar and has a longer and more difficult recovery.
While many patients can choose between implant or fat injections, some will have no choice but to have implants. If one has little or inadequate donor fat to harvest, then fat injections can not be performed.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am 36 yrs old and have been wearing padded underwear since I can remember. I am ready to have a bottom of my own that I can feel good about.This is my only insecurity and I am ready to do something about it. I want to be able to for the first time fill my jeans out and not have a belly that hangs over them.
A: There are two types of patients that seek buttock augmentation. The first and by far the most common is the patient who simply wants to make larger what they already have. They do not really have buttock hypoplasia or underdevelopment but want to enhance what they already have. This is very common in certain ethnic groups, particularly African-Americans and Hispanic women. The second group and the least common is the patient who really has not buttocks at all. They are completely flat and may even have resorted to padding as you have described.
This second group is the most challenging to treat because they have little to no subcutaneous fat in the buttocks and small gluteal muscles. This makes the recipient site for the most common method of treatment, fat injections (aka Brazilian Butt Lift), very limited. Often they may be quite thin as well without adequate fat donor sites. This leaves them the only option of an actual silicone buttock implant. Such implants can be very effective but they are associated with a longer recovery and other implant-related risks.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’m interested in buttock implants but I want to know what implant (oval or round) will give me the most volume. Also does round implants pull up enough muscle to give you a round booty or do you have to get fat grafting added? My butt isn’t flat at all but needs volume. Will the round implant give me upper buttock volume or all over volume (upper, middle, lower buttock). I was told only the oval can give you upper, mid, lower buttock fullness but not as much volume as a round. Thank you.
A: The answer to your question starts with what you have now and where you ideally want it to be. Buttock implants differ in the amounts of volume projection and generally a rounder buttock implant will have more projection. When patients use the word ’round booty’ that almost always means to me that they want a lot of volume projection. That may not be possible for some patients no matter what technique is used and, for others, may require that they ultimately need a implant and then fat grafting. (although this combinatio is very rare)
The effects of buttock implants is also influenced by whether they are placed subfascial or submuscular. Only subfascial placement can give the entire buttock fullness. Submuscular buttock implants mainly add mid- and upper volume enhancement. The location of the implant is often just as important as the style of implant used.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Have you ever done rigid hip implants to make the iliac crest appear wider/bigger?
A: Let me offer you my opinion and experience on this currently rare plastic surgery procedure. The placement of an implant over the iliac crests, known as hip implants, is both possible and I have done one case previously. It is done through a small incision placed over the anterior superior iliac spine. The implant is placed in a soft tissue pocket directly on top of the ridge of the iliac crest. It does not go back as far as the posterior iliac spine. While the placement of the implant is not difficult, there are several potential problems with the procedure. First, there is no preformed or off-the-shelf hip implant that is available. To make a hip implant, a buttock implant is used and carved to shape during surgery. The implant material should not be rigid like the iliac crest but needs to be soft. Therefore, flexible silicone elastomer implant material is used. Secondly, it is not possible to rigidly secure the implant to the iliac crest without making numerous incisions along its course which would be aesthetically undesireable. Lastly, the concept of having a soft moveable implant over a rigid underlying rim of bone may pose issues of feeling the implant or discomfort when wearing clothes that ride up against them. This last issue is more theoretical than proven given that so few hip implants have ever been performed.
Dr. Barry Eppley
Indianapolis, Indiana
Q: I am very interested in buttock implants. I was initially treated with fat grafting and spent a lot of money but the results did not last. This is why I don’t trust fat grafting and won’t do it again. I was greatly disappointed when I looked the same 3 months after the procedure. Any suggestions would be greatly appreciated.
A: The choice between using your own tissues (fat grafting) versus an implant for augmentation of any body area can be a difficult one. The advantages and disadvantages of either approach are classic and predictable. A synthetic implant will produce a stable amount of augmentation but at the price of more invasive surgery and the risks of infection, seroma, implant migration and extrusion. Conversely, fat injection grafting has none of these risks but its volume retention and predictability of a long-term augmentation result is variable. In some cases, the results of fat grafting can be completely resorbed within a few months. For others, a second fat injection surgery is needed to get the desired augmentation volume.
Whether fat injections or an implant is best for anyone’s buttock augmentation starts first with the size and shape of one’s buttocks and what one’s end goal is. For some, the size of the buttocks one wants is very big and they have little to start with so an implant would be best. For others, their buttock size goal is more modest and they have something to work with from the beginning. For them, fat injections would be a good choice. If one has no significant fat to harvest on the abdomen, flanks or thighs, then implants will need to be used.
If you have had one unsuccessful fat injection surgery, then buttock implants become more appealing. You might feel differently if some of the fat from the first surgery survived.
Dr. Barry Eppley
Indianapolis, Indiana
Q: I was interested in the buttock augmentation with fat injections. I was wondering what parts of the body the fat is taken from, whether I would be a good candidate for the procedure, and the time it will take to heal.
A: The use of injectable fat grafting for buttock augmentation, also known as the Brazilian Butt Lift, has become popular as an alternative to the use of buttock implants. The success of the procedure is based on three factors; having enough fat on the body from which to harvest from, having enough buttock subcutaneous tissue to inject into and how well does the inject fat survive.
Patient selection is the key element in the first two factors and can be determined before surgery is ever performed. The best donor site to get then most fat is usually the abdomen, flanks, and thighs. In general, a harvest volume of at least 1,500 ccs is needed to end up with a processed and concentrated volume of around 800ccs. This allows 350cc to 400cc to be injected into each buttock. Less volumes than this will usually not make the procedure worthwhile. The patient also gets the benefit of contouring from the harvest site as well. Whether one has enough fat to harvest is very easy to determine. Whether one has enough buttock subcutaneous tissue into which to inject is a bit more subjective. Buttock far augmentations work better in those that already have ‘some butt’ present. Completely flat and non-existant buttocks will have a much better result with an implant.
Recovery from buttock augmentation with fat injection is related to the donor site and not the buttocks. Overall recovery is just a few short weeks whicih is far less than when buttock implants are used.
Dr. Barry Eppley
Indianapolis Indiana
Q: I would like to know few things about butt implants Dr. Eppley did my breast implants few years ago and now i would love for him to do my butt. I want to go big. What sizes and shapes can I pick from?
A: Buttock augmentation is similar to breast augmentation in some ways but different in others. Buttocks implants, unlike breast implants, are made from a very soft and flexible solid silicone rubber material. They are not fluid-filled. Like breast implants, they can be placed above (subfascial) or under (actually into) the gluteal muscle. Those two different locations carry greater significance in buttock implants than in breast implants,, particularly in terms of recovery. Intramuscular implant placement is preferred but that also limits the size of the implant that can be used and makes the recovery much more prolonged and uncomfortable. One’s anatomy also can also drive this choice because if there is little subcutaneous fat present over the buttocks, the intramuscular location will produce a smaller but more aesthetic looking result. (concealing the implant edges better)
Buttock implants come in either round or oval shapes and have volumes ranging from about 150cc to 400ccs. Unlike breast implants, in which the size range that can be used is much more variable, the size and shape of buttock implants must be more closely matched to the surface anatomy and measurements of one’s buttocks. In the buttocks you don’t have the luxury of just putting in whatever size implant you want. The risks of postoperative problems and complications is higher when you do so.
Dr. Barry Eppley
Indianapolis, Indiana