While iliac plates provide an effective pelvic bone width augmentation the iliac crest does not comprise the entire hip region. It is a very specific form of hip augmentation that is skeletally based. Two-thirds of the total hip region lies below the bony crest. The middle third of the hips is known as the hip dip region which is created by the protrusion of the greater trochanter of the femur beneath it. It is a normal hip feature for many people particularly if they are thin. The iliac plate can exaggerate the prominence of the hip dip and as a result may need to be augmented at the same time.
As the anatomic location of the iliac plate is on the crest and above the fascia any form of hip dip implant must be similarly placed. Like almost any form of silicone hip implants their effectiveness is being on top of the fascia. The incision used for the iliac plate provides good exposure for the implant placement.
The type of hip dip implant that would be the most compatible with the iliac plate is in an evolutionary state. The traditional thought is that a typical hip implant could be used. While this is not wrong it doesn’t produce a smooth transition between the metal plate and the silicone implant due to the feathered edges of such an implant.
One method to overcome this contour problem is to take a standard hip implant and cut off the top part so that it has a blunt superior end. Then it can theoretically abut up against the underside of the metal plate. This is certainly an improvement over an implant that has a tapered superior end and will result in less of a transition in the metal-silicone interface. But being a metal plate there is no good way to secure the implant to the plate. Sutures could be used but the plate has nit holes to do so and placing such sutures would not be very easy.
While modifying an existing silicone implant is one strategy it would be more ideal if a hip dip implant existed that was better made to do so. Improvements in the implant design would be if it has a feature built into it that locked it into the plate without sutures and had a more smooth plate-implant interface. In that regard the hooked hip implant design seems promising. This implant concept comes from a very unique feature of the iliac plate that can go unrecognized because it is not visible. Since the plate sits on the side of the iliac crest and it is hollow inside a space exists under the width projection that leads right up inside the implant. Thus in the hooked design the upper part of the hip implant has the ability to fit inside the hollow of the plate hollow locking it into place.
The special designed hip dip implant appears very promising as a good implant companion to the iliac plate. It will be needed in many patients if they had pre-existing hip dip indentations.
Pelvic width augmentation is optimally achieved using a two implant approach. The iliac plate is the only aesthetic implant that is metallic in composition. When combined with a hip implant it also becomes the first ever ‘system’ for aesthetic augmentation using two different materials. As a newer sketelal body contouring concept the device designs remain in evolution but the experience to date have been very promising.
Dr. Barry Eppley
World-Renowned Plastic Surgeon