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The pelvis is large collection of conjoined bones that provides soft tissue support between the abdomen and the thighs. It extends from the lower back by the sacrum and coccyx and extends forward on both sides by a pair of hip bones. These hip bones have three sections to them which include the top (ilium), the sides (ischium) and the bottom. (pubis)

The top part of the ilium is the most palpable and is known as the iliac crest. The iliac crest is a curved or S shaped epiphysis which extends along the top margin of the ilium posteriorly from the anterior superior iliac spine to the posterior superior iliac spine. It creates a visible curved prominence that is most easily seen in thin women. While it is often called a hip prominence,  technically the hips are located below the iliac crest and are largely that of a soft tissue composition.

The prominence of the iliac crest has been suggested to play a role in gender identification. Studies have looked at the shape of the ilium and the iliac crest specifically for the purpose of skeletal sex estimation. Such osteologic studies have produced variable findings that remain equivocal about being a clear cut feminine feature. But despite these findings there are some women that desire a greater prominence to their iliac crestal bone.

While not commonly recognized the iliac crest can be aesthetically augmented. Unlike traditional pelvic implants, which consists of plates and screws for orthopedic repairs or the use of mesh slings for bladder and pelvic floor surgery, the iliac crest can be implanted for the purpose of adding some hip width as the level of the iliac crests. Specific solid high durometer silicone implants have been designed that fit over/cup the curved shape of the iliac crest. They have an internal groove into which the crestal bone fits along its length. Such implants have to be custom made for each patient but typical lengths are in the 15cm range with widths up to 6.5cms at his widest middle part. The depth of the internal groove is 1 cm with 2.5cm maximal height projection at its middle portion.

The iliac crest implant is placed through small incisions at the posterior superior iliac spine. A pocket is created along the iliac crest keeping the TFL fascia attached over the length of the crest. Prior to implant insertion multiple 5mm perfusion holes re placed along its entire perimeter.The curvilinear design allows the implant to conform to the natural convexity of the iliac crest. But tissue ingrowth into the perfusion holes is ultimately what maintains implant positioning long-term.

Iliac crest implants are available to provide an increased lateral prominence to the bony hip area.

Dr. Barry Eppley

Indianapolis, Indiana

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