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Dr. Barry Eppley

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Archive for the ‘hip implants’ Category

Pocket Location for Hip Implants

Friday, September 22nd, 2017


The newest member of the body implant family is that of hip implants. Augmentation of the lower torso has been done by various styles of buttock implants for decades. While the majority of buttock augmentation today is done by fat injections (aka Brazilian butt lift), there has been a relative neglect of the hips to the side of the buttocks due to either a lack of adequate fat to inject them or poor fat graft take over the often concave and tighter tissues of the  trochanteric hip region.

From an anatomic standpoint, the hip augmentation zone extends from below the superior iliac crest  down over the trochanteric tuberosity of the femur bone. Underneath the skin and fat layers lies the tensor fascia late muscle/fascia (TFL) which attaches to the iliac crest and runs continuous with the iliotibial band (ITB) down to the side of the knee where it attaches to the lateral epicondyle. At its superior extent the TFL combines with the posterior ITB to create the upper half of the hip fascia. Posteriorly this thick fascia connects to the gluteus maximus muscle creating an overall continuous sheet. Underneath the ITB inferiorly is the vastus laterals muscle. The function of the TFL is for hip movement specifically abduction, flexion and internal rotation.

When considering alloplastic hip augmentation one has to decide whether it is to be placed above or below the TFL. This is primarily determined by the size of the implant and the desired dimensions of hip augmentation. Subfascial placement of the implant is more restrictive in size and will have some short term functional issues. (short term side of the knee discomfort due to the ITB attachment It is somewhat analogous to intramuscular buttock implants where the size of the implant is also restricted and it will induce temporary limited range of motion. When the hip augmentation needs are not excessive a subfascial pocket location can be effective and falls into the general implant philosophy that the tissue coverage an implant has the better.

On top of the  fascia or a deep subcutaneous pocket location in hip augmentation offers the opportunity for larger implants both in perimeter surface area of coverage but also in thickness. Having placed numerous such hip implants I have observed that the thickness of the implant is less important than how much surface area it covers. Greater surface area coverage also allows for a smoother transition into the surrounding buttock and thigh contours. Broader hip implants also requires that their softness (durometer) be the lowest possible so they do not feel restrictive in any way.

Hip augmentation can be successfully done using implants. Currently there are no standard sizes or styles of these body implants. Currently I make all such implants are a custom basis based on patient measurements of surface area coverage.

Dr. Barry Eppley

Indianapolis, Indiana

Custom Hip Implants

Sunday, May 28th, 2017


Hip augmentation is most commonly done using fat injections. Even for patients that do not have a lot of fat to harvest, enough can almost always be obtained to fill in indentations or divots on both sides of the hips. But when combined buttock and hip augmentations are needed or in a thin body type, fat harvest sites may be inadequate. In addition, not all fat injections to the hips are successful.

When fat injections is not option or has failed for hip augmentation, the only other option is the use of an implant. There is no standard or preformed hip implants. While some surgeons may try and use implants made for other parts of the body, the hip area requires a unique implant shape. This shape is more like that of a shaped buttock implant but with a lower profile at its peak projection.

Because the length of the hip and its indentation is different for each patient, custom hip implants are most ideally used. Using measurements taken from the patient, the length and width of the implant can be created. The higher projection of the implant is on its superior end and usually does not need to be greater than 3 to 3.5 cms. The implant tapers down to a fine edge on its inferior extent.

Hip implants are placed through a posterior incision placed at the upper-posterior margin of the implant pocket. It is usually no more than 4.5 cms in length. The pocket is dissected down on top of the TFL (tensor fascia lata, outer thigh muscle) along the outer implant markings. The iplants are inserted using a no-touch funnel technique. Their low durometer makes passing through the funnel possible. Drains are often used and stay in place for 3 to 5 days. An above the needle girdle or cross-buttock taping with Mefix serves as postoperative compression.

Custom hip implants provide a permanent augmentation to narrow or indented hips. They are an option when there is inadequate donor sites for fat injections or fat injections that have not persisted. When one has enough fat to do injections this should always be tried first as such injections improve the quality of the hip tissues even if its augmentation effect may turn out inadequate.

Dr. Barry Eppley

Indianapolis, Indiana

Custom Hip Implants

Thursday, April 27th, 2017


Shaping of the waistline and buttocks has taken on great popularity in the past decade. With the widespread use of various buttock augmentation procedures as well as liposuction, changing the outer  shape of the pelvic region can be done. While most commonly done by fat injections (aka the BBL procedure) and the less frequently by implants, the posterior portion of the pelvic region can be satisfactorily increased in volume.

Often buttock enlargement is desired to be accompanied by hip augmentation for a more complete overall and proportionate body reshaping effect. While the area referred as the hips is open to interpretation, it is anywhere from the iliac crest down to the trochanteric indentation. Provided one has enough fat the hips can be enlarged by fat injections either alone or in conjunction with buttock augmentation.

But if one does not have enough fat to harvest for injection or previously injected fat has failed to survive or persist, the options for hip augmentation are very limited. Using implants is the only other augmentation option but there are no standard or preformed hip implants unlike that of buttock implants.

Custom hip implants can be fabricated based on height and width measurements based on the patient’s desired area of hip augmentation. The thickness of the implant and its shape is open to individual patient preference although most designs will have greater fullness on its superior pole and is thinner at its inferior end. Maximum height projections can also be done in the central region or even at the lower pole but these are less common aesthetic hip shapes.

The custom hip implants are made of an ultrasoft (very low durometer) solid silicone material. With implanted underneath soft tissues they will always feel more firm when in place then when squeezed in one’s hand outside of the body. Their feel will be equivalent to that of buttock implants placed in the subfascial location.

Hip implants are inserted from a 4.5 cm curved incision placed at the superolateral location of the marked hip augmentation perimeter. The implant pocket is made underneath the superficial fascia layer and on top of the muscle fascia.  The pocket is made within a limited dissection that goes just to the edge of the overlying marked implant pocket. The implants are inserted with the proper orientation and a three layer closure is done. No drains are used.

Custom hip implants have an aesthetic role to play as a stand alone procedure or in conjunction with buttock augmentation. For the make to female transgender patient they offer a possibility to achieve a more feminizing body shape.

Dr. Barry Eppley

Indianapolis, Indiana

Buttock And Hip Augmentation: Fat vs. Implants

Wednesday, August 6th, 2014


There are two effective and well established techniques for either buttock or hip augmentation. They are either fat injections using your own liposuction harvest  (Brazilian Butt Lift) or soft silicone elastomer implants that can neither rupture or leak. Each has their own advantages and disadvantages, as does every surgical technique, but both may not be appropriate considerations for every patient. For some only fat injections will work and for others implants may be the only option. Each patient must be considered individually based on their anatomy and the desired buttock or hip augmentation size they want to achieve.

Fat injection augmentation is, by far, the most commonly performed buttock/hip augmentation method because of its natural appeal, the side benefit of the body contouring from the liposuction harvest, and a quicker recovery. It has few real complications other than how well it works. The key qualifier is how much fat does one have to harvest. For those that try to gain weight for the surgery, be aware that the fat that you will lose first will be that which was gained as you return to your baseline weight…and it will be from your buttocks. Thus gaining weight for a Brazilian Butt Lift is a flawed approach. You either have enough fat to do it or you don’t.

In addition, at least 50% of the injected fat will be absorbed within months after surgery regardless from what part of the body from which it is harvested. This can even occur despite the best harvest and concentration methods. As a general rule, for every 1000cc (or liter) of fat that is harvested only about 30% to 40% will distill down to what should be injected. Better fat concentration equates to improved survival but a lower total volume of fat available to be injected.

When you simply don’t have enough fat, an implant approach is the only option. And that is how the decision for an implant should be primarily made. Buttock and hip implants have been around for a while now and the quality and size options of implants are so much better today. The implants are very safe but where they are placed and the surgeon’s skill and experience in placing them can significantly impact the rate of potential complications. Because they are implants, by definition, they will have a higher rate of complications (infection, hematoma, capsular contracture) than that of fat injections.

Implants will also have a longer recovery because placing them is more ‘invasive’ and involve areas that impact functions such as sitting and walking. Specifically for buttock implants, they should be placed within the gluteus maximus muscle. In this location, the implant will not be able to be felt nor sag or migrate later. Buttock implants on top of the muscle have an easier recovery but carry with it a higher incidence of problems later.

If you are a borderline candidate for fat injections or are uncertain if you have enough fat, make sure you have a consultation with a plastic surgeon that provides both fat and implant methods of buttock and hip augmentation. In this way your surgeon has no bias either way and will have enough experience to choose which method is best for you… rather than just the method or surgical procedure that they can do. There is no doubt that just about every buttock augmentation patient wants to use their own fat and it is easy to fall into the trap of hoping it will work out when it may never have had a chance to be as successful as you wanted.

There is also a combined approach with implants placed in the muscle and fat injections added above the muscle in the subcutaneous fat layer.  This may be considered when one only has a modest amount of fat to harvest but a very flat buttocks and wants to maximize volume. This makes anatomic sense and can be successfully done. There is the question of whether it should be done together or as a staged technique. This must be considered on an individual basis as there are some increased risks of implant infection.

Dr. Barry Eppley

Indianapolis, Indiana

Contemporary Body Implant Augmentation Surgery

Sunday, May 26th, 2013


Muscular enhancement of certain body parts can be done through the use of synthetic implants. Everyone knows about breast implant augmentation although this is not a true muscular enhancement but a breast tissue enlargement. Historically the most recognized body implants were for the chest, buttocks and calfs. The number of such implants combined pale in comparison to the number of breast implants that are placed but that makes them no less useful.

The number of body implant surgeries that are performed have continued to increase over the past decade. Greater awareness and acceptance of body augmentations has fueled demand as well as improvement in  implant materials and surgical techniques. Body implants, unlike breast implants, are made of a solid but very soft and compressible silicone elastomer material. This makes them capable of being inserted through small incisions and to have a feel that is similar to what they intended to enhance…muscle. Because they are a completely polymerized non-liquid material they will never rupture, degrade or need to be replaced.With these better materials has come an expansion of body implants to new and innovative areas of augmentation. These have included such areas as the arms, shoulders and even the hips to create muscle prominences and increased curves.

Muscle implants are used to surgically build-out an underdeveloped area of muscle in the body. These muscle deficiences can be caused by a birth defect, a traumatic injury, or an aesthetic desire for body shape improvement. Aesthetic desires for body implants (pectoral, calf, arm implants) comes from an inability to build up the muscle adequately from exercise. There are also recent fashion and body image trends for an increased gluteal size. (buttock implants) Birth defects can also drive the need for implants and include club foot and Spina Bifida for calf implants, chest wall deformities from Pectus and Poland’s syndrome for pectoral implants and Sprengel’s deformity for deltoid implants.

An overview of old and new body implants includes the following.

PECTORAL IMPLANTS Male chest enhancement is done by transaxillary implant placement under the pectoralis major muscle but staying within the outline of the muscle. (unlike breast implants) They are available in different oval and more square shape forms.

BUTTOCK IMPLANTS Intramuscular or subfascial pocket placement in regards to the gluteus maximus muscle is used for implant location. I prefer the intramuscular location to reduce the risk of potential complications even if it poses size limitations (< 400ccs implant volume) and a longer recovery.

CALF IMPLANTS Being the smallest of all body implants, they have a cigar-type shape that are available in different lengths, widths and thickness. They may be used to build up the inside of the leg (medial head gastrocnemius muscle) or combined with outside of the calf augmentation as well. (lateral head gastrocnemius muscle)

ARM IMPLANTS The top (biceps) and bottom (triceps) of the arm can be build up for those men that either can’t get enough muscle bulk by exercise alone or want to maintain a more muscular arm shape with less long-term exercise maintenance.

DELTOID IMPLANTS While there are no true shoulder implants, they can be made by either modifying existing body implants used for other areas or hand making the implants from performed silicone blocks.

HIP IMPLANTS Placing implants placed below the muscular fascia below the prominence of the greater trochanter of the hip can build out an otherwise straight leg line.

Body implant surgery is both safe and effective when done by a surgeon who has good experience with these  materials and has anatomical knowledge of the different and varied parts of the body where these implants go. While fat injection augmentation has a valuable role in the enhancement of certain body areas also, synthetic implants offer a permanent and assured solution to body augmentation that has the trade-off of an implanted material and a longer recovery.

Dr. Barry Eppley

Indianapolis, Indiana

Aesthetic Augmentation to the Hips/Upper Outer Thighs

Thursday, May 16th, 2013


The use of implants for body augmentation has been around for over fifty years. Breast implants are the most well known and account for the majority of all body contouring implants placed. But there are a variety of other body site implants that are recognized by most even if they occupy a small number of all body implantations performed. Implants exist for the chest, buttocks, arms and calfs. The numbers of these implant sites is increasing along with the array of implant options that are available for them.

One would think that just about every body site that could be augmented or implanted has been…but this is not true. One new area for body augmentation is that of the hips or thighs. Depending upon how you define this location, the goal is to have more curvature to the upper outer thigh. This seems ironic since most plastic surgery efforts are spent trying to reduce fullness in this area by liposuction. But there are women (and transgender females) that want a more curvaceous look to their outer thighs which is naturally very straight.

Upper thigh or hip augmentation can be done with a very soft silicone implant placed beneath the fascia overlying the outer thigh muscles. The surgical approach for the implant’s insertion is a 3 to 3.5cm horizontally oriented incision over the trochanteric region. The underlying fascia identified over the vastus lateralius muscle and opened where a blunt instrument is used to make the pocket. The implant itself is unique as no standard hip implant exists due to the newness of the application and the rarity of its request. I modify other existing body implants, most commonly contoured silicone carving blocks of sizes about 16 cms. long, 9 cms wide and 2 cms thick to fit into the pocket. Since they lie under the fascia and on top of the muscle, their contours are not seen on the overlying skin.

Other than some tightness of the outer thighs and the potential for infection or seroma (fluid collection), the risk of complications is fairly lower. The anatomy in this area has no major blood vessels or nerves. The muscle is not entered or violated so this hastens recovery. The only nerve of consequence is the lateral femoral cutaous nerve which supplies feeling to the lateral thigh, but its course is above and in from of the location of the incision. Recovery is fairly short in terms of returning to normal activities but strenuous activity and exercise requires waiting a full month after surgery.

The hip or upper thigh implant provides a curve or fullness to the upper outer thigh. These relatively thin slightly convex silicone implants are placed subfascially on top of the muscle to augment an otherwise straight leg line. For those women who have little fat to give for fat injection hip augmentation, an actual preformed implant is an alternative body contouring option.


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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