Hip implants remain an evolving aesthetic procedure as evidenced by the lack of any standard implant to do so. Part of this is due to the historic lack of demand for the procedure as well as cultural norms in the Western world where larger hips was not seen as desirable. But that has all changed today through the greater cultural emphasis on more prominent hip shapes, the widespread use of BBL surgery (and its failure to consistently create a sustained hip augmentation effect) as well as the emergence of the transgender surgery and related body contouring procedures.
In considering hip augmentation it is important to recognize the anatomy of the hip area as it is composed of both bony and soft tissue components. The bony components are the superior iliac crest and the more inferior greater trochanter of the femur. The soft tissue components are the subilia fossa and the lateral thigh tissues. Identifying the patient’ desired areas of hip augmentation will determine the implant’s needed dimensions and the incision location needed to place it.
In thinner patients that lack hip curves the first question is do they have adequate bony hip width. If the iliac crest is deficient then bony augmentation is needed with the Pelvic Plasty procedure using a special designed titanium plate to do so. But if the iliac crest width is adequate subiliac fossa augmentation may suffice.
The subiliac fossa hip implant fills the concavity between the iliac crest and the greater trochanter of the femur. This is not a particularly large implant typically measuring in length 12 to 14cms with width around 8 mms and thickness of 1.2 to 1.5cms in thickness. It is surgically place in the side position intraoperatively through a 3.5cm incision centered just below the mid portion of the iliac crest. The dissection proceeds right down to identify thee iliac crest and its superior fascial attachments. Sweeping down on the gluteal medius fascia the pocket is created down to the greater trochanter.
The hip implant is inserted and closed over a drain which its placed under it. Even at thickness in the 1 to 1.5cm range the creation of a visible hip curve is very evident.
Of the different types and sizes of hip implants that I have used over the years the thin patient in particular poses increased risks of complications in regards to implant show and bending due to their thin subcutaneous fat layer. But if you hang tight to the fascia and don’t cross the greater trochanter with a medium durometer implant these potential complications are lowered significantly. When combined before or during synergetic procedures like rib removal to narrow the waistline san even greater hip curve is created.
Dr. Barry Eppley
World-Renowned Plastic Surgeon