Plastic Surgery
Dr. Barry Eppley

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Double Board-Certified Plastic
Surgeon Dr. Barry Eppley

Case Study – Intramuscular Placement of Buttock Implants


Background: Buttock implants are the alternative to the more popular BBL (Brazilian Butt Lift) procedure which uses fat injections to create the augmentation effect. The use of fat for buttock augmentation is preferred and should always be the first consideration as it is a natural material and has a very low risk of complications.

But when one has inadequate fat to harvest, implants become the only other buttock augmentation option. The use of buttock implants poses very different technical and outcome options than that of fat. While the placement of an implant into the buttocka assures volume retention, there are tissue constraints as to how big the augmentation can become.

The biggest decision in buttock implants is pocket placement. The options are either subfascial (on top of the muscle) or intramuscular. (inside the muscle) Subfascial placement allows for much larger implants but is also associated with a higher rate of complications. Intramuscular placement allows for only smaller size implants but have a much lower rate of potential complications.

intramuscular-buttock-implants-incision-dr-barry-eppley-indianapolisCase Study: This 26 year-old female wanted buttock augmentation but did not have enough fat to harvest. She preferred implants but wanted them placed in an intramuscular location. Under general anesthesia and in the prone position, 330cc intramuscular soft solid silicone gel implants were placed through a double intergluteal incision. The buttock implants were of an anatomic style. (wider base with lower projection0

tb-buttock-implants-oblique-view-dr-barry-eppley-indianapolistb-buttock-implants-side-view-dr-barry-eppley-indianapolisHer four month result showed a moderate buttock augmentation result. The implants created greater roundness and a natural looking result.

Intramuscular buttock implants are far more technically challenging to place and it is very difficult (and not advised) to try and place implants much bigger than the mid-300cc range. Recovery from implants in the intramuscular pocket also carries with it a significant recovery. These features make the intramuscular pocket less appealing than that of above the muscle but the long-term benefits of better vascularized tissue cover are worth it for many patients.


1) Buttock implants in the intramuscular location are smaller in size than some patients may want.

2) Manipulation of the gluteus maximus muscle creates a longer recovery than one may anticipate.

3) The intramuscular location works best with anatomic shaped buttock implants.

Dr. Barry Eppley

Indianapolis, Indiana

Dr. Barry EppleyDr. Barry Eppley

Dr. Barry Eppley is an extensively trained plastic and cosmetic surgeon with more than 20 years of surgical experience. He is both a licensed physician and dentist as well as double board-certified in both Plastic and Reconstructive Surgery and Oral and Maxillofacial Surgery. This training allows him to perform the most complex surgical procedures from cosmetic changes to the face and body to craniofacial surgery. Dr. Eppley has made extensive contributions to plastic surgery starting with the development of several advanced surgical techniques. He is a revered author, lecturer and educator in the field of plastic and cosmetic surgery.

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