Technical Strategies: Iliac Crest Suture Anchors in Hip Implahts

Aesthetic hip implants are solid silicone body-contouring implants used to widen or smooth the lateral hip/“hip dip” area. They are a specialized aesthetic surgery option for patients seeking lateral hip width or hip-dip correction when fat grafting is inadequate or unavailable

Hip Implant Concepts::

• Best use: thin patients or patients without enough fat for hip fat grafting.
• Alternative: fat transfer is usually preferred when enough donor fat exists.
• Placement: typically in a soft-tissue pocket over/around the lateral hip fascia..
• Benefits: more predictable, permanent volume than fat grafting.
• Limitations/Complications: visible/palpable edges, implant show, asymmetry, displacement, infection, seroma, and revision risk.

There are some unique features of hip implants that make them prone to some of the aesthetic issues:

• Vertical orientation:
• Shape: thinner at bottom half than upper half, taller than wide
• Pocket location:  deep subcutaneous location
• Lack of  tissue integration:  As with any silicone implant encapsulation occurs around the implant but without tissue adherence to it

As a result they are prone to bending  or folding at the bottom of the implant pocket creating edge show.

While numerous implant techniques had been used to prevent implant edging, such as application of ePTFE patches to the underside of the implant and perforations through the implant top encourage tissue ingrowth, they are not always successful.

In search of other techniques to prevent the weight of the implant from causing it to bend on its bottom end,  and borrowing from how hip implants are used in the Pelvic Plasty procedure, the concept of anchoring the implant to the iliac crest was conceived.

Technique:

1. A thin titanium mesh piece is fashioned to be applied at the upper edge of the implant.
2. A 2.9mm suture anchor (Juggerknot)is secure into the iliac crest
3. The suture from the anchor is passed through the implant on its underside through the mesh on its outer surface and then passed back through the mesh and implant to its underside. The suture is then tied down to the other suture on the anchor.

Dr Barry Eppley

Plastic Surgeon