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Buttock augmentation continues to grow in popularity and is done most frequently by fat injections. (Brazilian butt lift) But not everyone has enough fat to harvest for a successful autologous buttock augmentation and not every fat-injected buttock ends up with the patient’s desired volume. As a result, the use of buttock implants has also grown in numbers by the so called ‘draft effect.’

Unlike fat injections, the use of implants for buttock augmentation offers an assured volume result…but it comes at a price. It is an operation that is associated with all the potential complications that any implant placed in the body can develop. Because of its location and the placement of the incision needed for the surgery (intergluteal incision), it is associated with more potential complications than any other type of body implant in my experience. This is also affected by the choice of the two potential implant locations (subfascial vs intramuscular) which also influences the occurrence of these complications.

As a result, the need for secondary or revisional buttock implant surgery is not rare and is often more challenging than the initial placement operation.

In the June 2018 issue of the journal Plastic and Reconstructive Surgery an article was published entitled ‘Secondary Gluteal Augmentation: Surgical Technique and Outcomes’. In this paper the authors review their experience eighteen (18) secondary buttock implant cases. Their approach was to place the implants deeper in the intramuscular pocket, a capsulotomy/capsulectomy done to the previous pocket, new implants were inserted using a no-touch funnel device and fat grafting was done into the overlying subcutaneous fat layer in some cases. (hybrid gluteal augmentation)

Having performed an even greater number of buttock implant revisions than the number in this paper, the basic concept that this paper indicates which is very true is that a secondary buttock implant procedure is not easy. It is almost always harder than the initial placement procedure. Since this paper is from South Korea there appear to be major differences between the type of buttock implant cases they see vs. what is seen in the U.S. First and foremost, many buttock implant cases with problems seen in the U.S. have the implants in the subfascial pocket and the size of the implant is far greater than the average 200ccs of implant volume reported in this paper. I have never seen a 200cc buttock implant placed in the U.S. yet. Secondly they use silicone gel breast implants as their buttock implants as opposed to solid implants that are used here in the U.S. While it is true that a breast implant will be a softer implant to sit on and is much easier to introduce into the pocket (with or without a funnel), this off-label use of a breast implant in the buttocks in the U.S. may have some associated medicolegal issues.

But despite these differences in secondary buttock implant case presentations, the author’s conclusions are sound. The four main principles of 1) management of the capsules, 2) accurate dissection of the gluteus maximus muscle pocket (new or old), 3) application of infection prevention techniques and 4) the use of fat injections around the perimeter of the implants for camouflage are a useful algorithm for the best chance of a successful buttock implant revision surgery.

Dr. Barry Eppley

Indianapolis, Indiana

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