Background: The bony part of the hip is the well known iliac crest. This is the superior border of the wing of the ilium and represents the most superior and lateral margin of the pelvic bone. Its front to back distance can be seen in front at the outer lower abdomen as the anterior superior iliac spine. (ASIS) It extends back along its bony rim to the back part of the pelvis at the posterior superior iliac spine (PSIS) which is not usually visible and lies much deeper in the subcutaneous tissues.
But the shape of the iliac crest is not exactly convex as its goes from front to back. It is convex in its anterior half where it has its greatest width at the center of the crest. But as it goes posteriorly its shape changes to an inward curve back to the PSIS. The relevance of its shape appreciation is that the contribution to bony hip width is at its anterior half from the ASIS to the midportion of the curve. The iliac crest is also thinner at its center than at its ends.
While the iliac crest has a substantial amount of bone marrow inside its outer cortical bone covering it can be safely reduced without excessive bleeding. Most reduction amounts are in the range of 1cm width. It is necessary to strip off some of its soft tissue attachments at the outer lip (e.g., TFL fascia) to do the bone reduction and this will result in some temporary walking stiffness.
Case Study: This young tall thin male was bothered by his prominent anterior iliac crest and the width that it gave to his hips.
In the standing position the outline of the visible/palpable iliac crests was done with an incision paralleling the crest line marked below it.
Under general anesthesia and in the prone position the iliac crests needed to be remarked as the original skin marks slide upward. The incisions were made in each side and dissection carried up onto the anterior iliac crests.
Using a reciprocating saw the anterior iliac crest, including the ASIS, was reduced by 1 cm. The exposed marrow tissue was covered with warmed bone wax. Using a channel retractors the reduction with bone wax coverage was carried posteriorly to where the crest curved inward.
Closure was done by fascial and dermal closures. No drains were used.
Comparing the initial right iliac crest reduction to the untreated left side the elimination of the crestal prominence could be appreciated.
Frontal before and afters on the operative table showed the effective removal of the iliac crest prominences on both sides.
When seen the next day after surgery in the upright position the results from the iliac crest reduction could be seen in the frontal view.
The results could equally be seen in the oblique views as well.
Iliac crest reductions are another structural body contouring surgery that lacks familiarity and hence awareness that it can be successfully done.
Key Points:
1) The iliac crest contributes to upper bony hip width which is most prominent in thinner patients.
2) The anterior superior iliac spine (ASIS) is the most visible of anterior part of the iliac crest.
3) The width of the bony iliac crest can be safely reduced through an incision below it without any long term functional limitations.
Dr. Barry Eppley
World-Renowned Plastic Surgeon