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The major change in buttock implants over the past two decades is improvements in the implant’s durometer and better soft tissue coverage of the implants. Buttock implants used to be made of a more stiffer silicone durometer which gave them a hard and unnatural feel. That has been improved by softer more gel-like durometers which have both a better feel and also enables them to be more easily placed through a midline intergluteal or paired paraintergluteal incisions. 

The other major change has  been deeper implant pocket locations. As opposed to the historic subfascial implant location, deeper intramuscular pockets have become more the norm today. This provides better implant soft tissue coverage which lowers the risks of infection, seroma formation, excessive inferior migration and implants show. But it is a non-anatomic pocket dissection meaning there is not a natural tissue plane which is entered. It is artificially created within the gluteus maximus muscle which creates wide variability within the muscle where it can be located. As a result if the intramuscular pocket is created too superficial the overlying muscle atrophies and the implant eventually ends up, partially or completely, above the muscle.

In the January 2023 issue of the journal Plastic and Reconstructive Surgery an article was published on this topic entitled ‘The Dual Plane Gluteal Augmentation: An Anatomical Demonstration of a New Pocket Design’. In this well illustrated paper the authors proposed a dual plane approach where the upper half of the implant pocket is under the gluteus medius muscle while the lower half is intramuscular in the gluteus maximus muscle…hence the dual plane designation. They reviewed their experience with a blunt direction technique for these pocket creations in 82 buttock implant patients over a 1 1/2 year period. Implant sizes ranged from 270cc to 360ccs. Technically they performed composite buttock augmentation since every case had fat injection grafting to the buttocks as well. But this doesn’t change the main focus of he paper…the dual superior submuscular gluteus medius and the inferior gluteus maximus intramuscular pocket.

Their patient complication rates were 7 wound dehiscences, delayed seromas in 5 patients and temporary sciatic nerve pain in 4 patients. No reopeations were necessary. 

They evaluated this technique in ten cadavers to determine the anatomic layers of the dual pocket implant dissection which confirmed  the dual muscular coverage of the implant.

The gluteus muscle is a group of 3 muscles of which the maximus is the largest and most superficial muscle of the group. The gluteus medius is the middle muscle located deep to the maximus and superficial to the minimus. But only the posterior third of the gluteus medius muscle is covered by the gluteus maximus…which servers as the anatomic basis for the dual plane technique.

By placing the implant under the gluteus medics muscle there is better coverage over the super-lateral people of the implant which is where in the completely intramuscular technique the mussel often atrophies and the implant edge can become visible.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

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