Buttock implants have evolved considerably over the past decade or two due to the rise in demand. The overall rise is a reflection of the public’s desire for buttock augmentation in general and implants in particular for those that patients that are not candidates for or have failed BBL surgery. Of the two specific areas of buttock implant evolution the location of the pocket may be the most important factor in long term success. Following a basic implant principle, the deeper in the tissues an implant is placed the better, the subfascial pocket has given way to muscular locations.
The most commonly used muscular pocket location for buttock implants today is intramuscular or inside the gluteus maximus muscle. While effective this is not a natural tissue plane which makes dissection difficult and highly variable (overlying muscle thickness) not to mention traumatic and associated with a significant recovery. The submuscular plane, like the one used in breast implants, has largely been avoided duet its deep location and the presence of the sciatic nerve. But the submuscular pocket is becoming realized as a safe technique that offers a less traumatic dissection and a quicker recovery.
In the June 2024 issue of the journal Plastic and Reconstructive Surgery an article on this topic was published entitled ‘Minimally Invasive Video-Assisted Submuscular Gluteal Augmentation with Implants: An Innovative Technique’. In this paper the authors describe their experience with a submuscular techique using paramedian incisions in fourteen (14) females. Once the gluteus fascia was identified a 1 cm incision was made through it which allowed for finger dissection down into the submuscular space. Balloon dilatation was performed to complete the pocket dissection. Once the pocket was created a laparoscope was inserted to inspect the pocket for hemostasis. High profile gel breast implants were then inserted into the submuscular space. (Implant volumes ranged from 285 to 345) The incisions were closed over a drain.
Total opérative time averaged 45 minutes. No significant complications occurred and the only one was a self-resolving seroma. Of greatest importance is that no sciatic nerve -related symptoms occurred or any hematomas.
While this patient series used an epidural (which I don’t use), necessitating a urinary catheter and an overnite recovery until it wears off, that is really irrelevant to the true benefits of the submuscular pocket location. The low complication rates speaks to its benefits for buttock implantation. The shorter operative time is a ‘benefit’ but what counts most is the very low complications.
The paper does not address what is the one limitation of this technique, implant size, but that is the same issue with an intramuscular pocket location. So patients need to be aware that any size implant can not just be placed. Also this technique requires a gel-based implant to get through the limited tunnel size down to the submuscular pocket location. That will be more challenging with solid buttock implants that are used in the U.S but this is where the funnel introduction device is helpful.
Dr. Barry Eppley
World-Renowned Plastic Surgeon