The use of breast and buttock implants are well established for aesthetic body augmentations and have a high degree of clinical success. Their success rate is largely dependent on the depth of the tissue pocket in which the implant is placed and the shape of the implant. An under the muscle (thick well vascularized tissue cover) location and a round or hemi-spherical implant shape (looks the same no matter how it is positioned) provides both an effective augmentation result and good long-term tissue tolerance . This explains why they are both frequently performed and have an acceptable rate of complications.
While hip implant augmentation is a frequently requested procedure it is very different than breast or buttock implants. Besides the more superficial and less thick soft tissue pocket location hip implants are not round. The hip area is not a spherical mound like the breasts or buttocks. This makes the implant design needed to augment it is different.
In the December 2023 issue of the American Journal of Cosmetic Surgery an article was published on this topic entitled ‘ Concepts in Hip Implant Body Contouring: Patient Evaluation & Implant Fabrication’. In this paper the authors discuss proper patient selection for hip implants, hip implant design and fabrication, surgical placement of hip implants and associated enhancing body contouring procedures. In 3 different cosmetic surgery practices, methods of patient analysis and the process of creating a custom hip implant is presented. Techniques and protocols in the use of fat grafting in association with hip implants is also discussed.
This paper defines the process of planning, designing, and fabricating a custom hip implant with significant patient input. By definition, patient-specific or custom implants can be any shape, size, and projection. The patient and surgeon provide the implant fabrication company a paper tracing of the surface area of the proposed implant along with the maximum projection. Engineering creates a 2-dimensional drawing using a computational software for intelligent system design or CAD. The implants are fabricated with input from the surgeon on silicone material softness (durometer), implant alterations to lower weight and enhance ease of folding for placement, and shape.
When hip augmentation is requested, fat transfer (injections) is the preferred initial procedure. If there is an insufficient volume of fat to augment both the buttocks and hip area, hip fat grafting is prioritized to avoid the use of hip implants. The reason for this treatment recommendation is to avoid the hip implant which has a higher risk of complications than any other body implant. When hip implants are the only viable option for the hip augmentation choosing a smaller size is always better than a larger size (less implant load) to lower the potential risk of postoperative complications. In short it never pays to be ‘greedy’ when it comes to hip implant size. Limiting the surface area of implant coverage and its maximum projection lowers the risk of postoperative complications.
Dr. Barry Eppley
World-Renowned Plastic Surgeon