Your Questions

Q: Dr. Eppley, I am a 35 year old male-to-female transsexual. I feel that although I have a substantial amount of buttocks, when looking straight ahead my waist to hip ratio is like a square/box shape. And it doesn’t help that I have broad shoulders. I’ve used temporary solutions like Styrofoams to enhance my hips. I’ve thought about liquid silicone injections but I know that is illegal in the US and very risky/dangerous. I want something that is legal and a better approach to hip augmentation as much as possible. Is this something that you can help me with? Do you do fat transfer to hips only or do you do hip implants? Where are the scars made? Any and all information will help and would be greatly appreciated. Thank you in advance for your time.

A: Hip augmentation can be done by either fat injections or, occasionally, using actual implants. When possible, it is always best to perform hip augmentation with fat injections if one has adequate fat donor sites to harvest by liposuction. It usually takes about 150cc to 200cc of injected fat in each hip to make a visible difference. For both sides that would make a need for about 400cc of concentrated fat to inject. Given that the ratio of obtained concentrated fat to liposuction aspirate is 25% to 33% one has to have about 1500cc of fat to harvest to make the procedure worthwhile. These are average numbers which will vary up and down based on the body type and preoperative hip size.

Hip implants are made by modifying other types silicone body implants since no true hip implants are available as an off-the-shelf preformed implant. They are made of low durometer solid silicone so they are very soft and flexible. (actually feels squishy) They are placed over the desired hip augmentation area through a horizontal incision below the prominence of the iliac crest under the thigh fascia if possible. Because the hip area is a flexion region (e.g., sitting, bending) it is important to not get the implant too high and anterior in the hip region.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have seen several doctors say they can use soft silicone implants to enhance the hips. I am also thinking the newer traditional butt implants can be shaped to be placed in the soft tissue “grove” of the hip found on most men, sometimes called “the boy dent”. Why would it not be possible to do? In my experience those who have gotten injectable silicone, most have never had a problem and they inject it below the facia on top of the muscle and a scar capsule is formed around the silicone. So why not place the implants either there or inside the muscle which are where some butt implants are placed now as seen on The Doctors.

A: I would not disagree with your contention for how hip implants can be used and placed. While there is no standard hip implants, ultrasoft buttock implants can be used as hip implants. You can not place them inside the muscle and the fascia overlying the hip musculature is very tight so the implant has to be placed on top of the fascia. But there is no reason why hip augmentation implant surgery can not be done

The problem with large volume silicone injections for body augmentation is that the material tends to migrate away from where you would want it to be. This would very likely happen in the hip area due to gravity. I would feel more confortable with actual implants rather than silicone injections for hip augmentation.

Dr. Barry Eppley

Indianapolis, Indiana