Your Questions
Your Questions
Q: Dr. Eppley, I am interested in getting hip implants. When coming in for hip implants, can you determine how big you want your hip implant of is there just one size?
A: The size of hip implants one can have is dependent on multiple factors including hip location implantation site, how thick/thin the overlying tissue are and what type of hip augmentation results one expect. There is no such thing as a preformed hip implant as the patient demand is too low for any manufacturer to make true hip implants in standard sizes. Hip implants are done using either standard buttock implants or buttock implants that have been custom carved at the time of surgery to fit the patient. Before surgery the location of the desired hip augmentation is measured and those dimensions are used in picking or making the hip implants to be used.
I would need to see some pictures of your hips and your location of your desired hip augmentation site to determine if this is a procedure that might be beneficial for you. One key factor in qualifying the patient for hip implants is whether they can tolerate the location and length of the incision needed to place them.
Dr. Barry Eppley
Indianapolis, Indiana
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’m interested in getting hip implants to achieve an hourglass figure. I hate the indent I have in my hips and would like implants to be inserted up over the iliac crests if I’m not mistaken. The indent has gotten bigger and worse as I tried to gain weight in the hips, but of course I can only do so much with the bone structure I have. My questions are, how wide can the hip implants be? I’m typically trying to achieve at least around an inch. And also I’m interested in getting a labiaplasty to reduce my labia, so could this procedure be done at the same time? Thanks
A: Hip implants are an option for your hip indents but placing them that high up over the iliac crests may be problematic in terms of the waistline effects of wearing clothes. Given your body type I would first consider a fat transfer as you have good volume to be harvested from the knees, inner thighs and some from the abdomen. This is the way to put fat there as opposed to trying to gain weight by your diet. While fat is unpredictable in terms of its survival, it is perfectly safe, natural and would prepare the tissues better if you ever considered placing implants in that area. (although the goal would be to never have to exercise that option) Labiaplasty could be performed with either fat grafting or implants.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I would be very interested in getting hip implants. My hips are tiny. I would like to add an inch to both sides of my iliac crest closer to the front part. Too bad there isn’t a good way to secure them to the iliac crest- I would gladly take scars over my little boy hips for that implant to be rigid!
A: Hip implants are so of a vague term as it could imply areas from along the iliac crests to do over the hip joint. (upper thigh) I would call true hip implants as you have defined your hip concerns…up over the iliac crests. Augmentation could be done by fat injections or actual implants and each as their own distinct advantages and disadvantages. For certain volume retention, an implant is the most assured approach. There are no true commercially produced hip implants but the shape of a calf implant would be ideal for placing on top of or along the edge of the iliac crest. As a long cigar-shaped implant that would be almost an inch thick, a one inch increase on each side of the hips could be obtained. This does require a 1 to 2 inch incision at the front end of the iliac crest to create the tunnel and place them. A single screw could be used to secure the implant to the iliac crest if desired. The only question is whether that is absolutely necessary or not. The long-term stability of the implant over the iliac crest has not been established given the rarity of this type of body implant procedure.
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 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
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: Hi, I am interested in information about hip implants. I have struggled throughout my adolescent and adult life with severe insecurities and embarrassment concerning my boyish figure. I have taken to fashioning shorts with layers of thick fabrics sewn into them to make myself feel better and more properly fit into clothing however, this method is flawed in many ways and the results are still less than desirable. I would very much like to have access to a permanent solution that allows for activities like swimming. I did see on your site that you have performed the procedure at least once and was wondering if I could get some information on it and if possible, before/after photos? Thank you very much!
A: Hip Implants are the rarest of all the body implants performed. They are so infrequently done that few plastic surgeons have ever done them, no specific style of hip implants is currently available, and there is no FDA-approved implant for this procedure. Any hip implants that have ever been done use implant styles for other body parts. It is not clear as to the best surgical technique for the procedure since so few have ever been done.
All of that being said, the placement of an implant into the hip area can be done. But this would involve a significant scar over the hip area and the placement of an implant in a very palpable area. While I have done one such procedure for the purposes of traumatic reconstruction, doing it bilaterally for purely cosmetic reasons must be very carefully considered. This is not like a breast or a buttock implant in that it ends up being placed in a subcutaneous rather than a submuscular position. This makes the risks of palpability, infection and migration much higher.
Before I would consider an actual hip implant, I would give more serious thought to injectable fat grafting. This would be far safer and has none of the potential complications of a synthetic implant in this more risky area. While the biggest problems with fat injections are survival of the injectate, that would be a better risk to take.
Indianapolis, Indiana
Q: Hello. Does Dr. Eppley do cosmetic hip implant surgery? I saw this on the website, but I couldn’t find the surgery listed on the drop down menu.
A:I have performed implant procedures all over the body including the rarely done hip implant. It is very infrequently requested (you are only the second inquiry that I have ever had) and I have only performed the procedure one time, on one side, for a traumatic injury problem to get better hip symmetry and provide a ‘ledge’ to hold up their pants better on that side.
Hip implants are almost exclusively done for cosmetic augmentation and, in rare cases as described above, for reconstructive purposes. For those women who feel that their hips are too narrow and want more of an hourglass figure, hip implants can give them more curvature.
Hip augmentation can be done through either an implant placement or fat injections. each has their advantages and disadvantages. Hip implants require an incision to be placed and are a foreign material in a very palpable and prominent area. They are placed down on top of the fascia or aponeurosis covering the iliac crest. They are not placed directly on the bone surface as this requires stripping of attachments off of the crest which is painful. (like an iliac bone graft harvest) Fat injections use your own tissue (which gets a cosmetic benefit also from the harvest site) and are soft with little risk of infection. But their reliability in terms of volume retention is not always assured.
Indianapolis Indiana
