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
Q: I want butt implants to give me a much larger butt. I was told that’s 400cc implant would give me the size I want but I think that’s too small. Can I send a picture of my butt and a picture of the size I want? Can you tell me what size implant would give me the results I want?
A: Buttock augmentation using implants involves two considerations; size of the implants and implant location. (above or below the muscle) Size of the implant affects whether it can be placed above (subfascial) or below the muscle. Buttock implants are made of a soft flexible silicone material and come in either round or shaped configurations. Like breast implants, buttock implants are commercially available in different sizes (volumes) and dimensions. The most commonly used buttock implants are round shapes with sizes up to around 400cc with a projection of 5 cms. Larger buttock implants are available in shaped sizes up to about 550ccs but with less projection. The larger a buttock implant becomes the more difficult it is to place it under the gluteal muscle. When possible it is always best to place a buttock implant under the muscle.
When considering buttock implant size, the desired area of enhancement and its dimensions are important considerations in implant selection. These are drawn and measured during a consultation and are important in buttock implant selection. Whether one can achieve the the buttock size one sees in a picture may or may not be possible.
Dr. Barry Eppley
Q: Hello Dr. Eppley, is it possible since you’ve had experience with silicone injections running out before during your surgeries for you to do a surgery and just let as much of the oil as possible run out?? I had the same injections but I don’t know if they were done in my tissue of my gluteus muscle. What happens to the gluteus muscle if it is injected?? Does the muscle absorb the silicone oil??
A: The injection of silicone oil for buttock augmentation is almost always done in the subcutaneous fat and not the gluteal muscle. It is taught to be placed as a ‘microdroplet’ approach, meaning to try and disperse the silicone oil into many small pockets and not just one big one. In the buttock, it is not really a microdroplet approach but more like smaller island or pockets of silicone oil placewd through the buttock. Silicone oil is not absorbed no matter whether it is injected into fat or muscle. It is an inert material thaty can not be metabolized by the human body.
Because it is dispersed out through the fat, it is nit really possible to perform a surgery to ‘drain it out’. This would only be possible if there was one large pocket of silicone oil confirmed by an MRI or if there were some problematic areas or pockets that would bebnefit by some drainage. But because multiple incisions would be needed to drain small pockets, this would end up causing significant buttock deformation. Unless certains areas are causing problems such as swelling and pain, it is best to leave them alone.
I have run across silicone oil pockets inadvertently during buttock lifts and any drainage that was achieved was coincidental not intentional.
Dr. Barry Eppley
Can Fat Injections To My Buttocks Be Done If There Is Silicone Oil In My Buttocks From Prior Injections?
Q: I would like to know if Dr. Eppley has any experience in removing free silicone oil from the butt? I had silicone injections in my butt and would like it removed and replaced with my own fat.
A: Once silicone oil is injected into any tissue it can not be removed, from a practical standpoint, from the recipient site. The oil is dispersed throughout the tissues in many islands or droplets (really pools of oil) so it is not just one large collection which can be evacuated. It is not like an implant where it is in just one location as a congealed or formed mass. During buttock lifts I have run across injected silicone oil several times and it just runs out as you hit every subcutaneous pocket that it is in. The only way the silicone oil can be removed would be to completely cut off one’s entire buttocks. Therefore, it is best left alone.
The good news is that the silicone oil is not in the deep muscle but in the fat or subcutaneous tissues under the skin. Buttock fat injections can still be placed with the silicone oil in place as they are placed deeper into the gluteal muscle and deeper fat. I am not aware that the presence of silicone oil causes any problems with doing fat injections to the buttocks or necessarily causes greater problems because it is there.
Dr. Barry Eppley