The desire for a pleasing appearing buttocks is an historic one. The ancient Greeks had a name for it…callipygeny…meaning beautiful buttocks. A well-developed buttock is uniquely human and developed as a result of standing erect on two feet. The buttock shape is primarily a result of the underlying muscle (gluteus maximus) and the amount of fat between the skin and the muscle. Among different ethnic groups and cultures, there are significant variations in the size and shape of the buttocks. Today, buttock augmentation is more popular than ever as a result of improved implant materials and the popularity of fat grafting. Improved surgical technique has also led to fewer complications, making implant enhancement in particular, more successful and more commonly done than in the past.
Buttock augmentation with implants is a very effective procedure but has not risen to the popularity of other body implants such as breast augmentation. There are many reasons for this but historically, buttock implants, had a significant rate of complications. Some of these were related to the implant material and shape but more were the result of the location of implant in the buttocks itself. Placing the buttock implant right under the skin (subcutaneous approach) and under the gluteus muscle (submuscular approach) cause significant medical and cosmetic problems and have largely been abandoned by most plastic surgeons. Accepted approaches today include implant placement in the gluteus muscle (intramuscular) and between the muscle and its covering. (subfascial)
If you are considering buttock implant enhancement, the question of whether your implants should be placed in the intramuscular or subfascial location is an important one. As a general rule, intramuscular implant placement is reserved for those with a flat buttocks and with little fat between the muscle and the overlying skin. It is important to have a good pad of tissue to cover the implant so deeper in the muscle is a good choice with this type of anatomy. More often than not, thin Caucasian patients need intramuscular placement. For patients who have more buttock substance in both shape and fat content, subfascial placement is acceptable. Enough fat exists already to provide good implant coverage. Usually this approach is used in African-Americans and Hispanics who may already have more than just a flat buttocks to begin with and desire enhancement of their existing buttock size.
Dr. Barry Eppley
Indianapolis, Indiana