Buttock augmentation is one of the fastest growing procedures in the U.S. over the past few years. Buttock augmentation is sought when a male or female perceives that their buttock shape, size, or proportions are not adequate for their body. Common causes may be genetics, fluctuations in weight (especially weight loss), pregnancy changes, and aging. It is common to hear that patients are tired of trying to achieve the buttock they want with good old-fashioned diet and exercise. Currently, there are two surgical options for buttock augmentation. The first is autologous fat grafting (The Brazilian Butt Lift “BBL”) in which “your own fat” is harvested with liposuction and transferred to the buttocks. The second is augmentation with a semi-solid silicone implant.
Candidates for the Procedure
Those patients who want very full projection and more dramatic proportions, or do not have enough fat for a BBL such as patients with a BMI less than 22. It is not uncommon to have patients who have had a BBL and are dissatisfied with the volume and/or shape augmentation. These “fails” are usually due to the fact that only a limited amount of fat can be grafted in one session, and about half of the original graft does not “take”. Many patients after a BBL, may not have enough fat for another session of grafting. An implant is an option to give them a fuller shape.
These implants have been around for decades. They were originally designed as solid silicone, and they continue to be to this day. Solid silicone is more durable, and able to take the daily stress of sitting, moving of the buttocks. In the US, there are only a handful of companies manufacturing these implants. Until recently, these implants have been very firm, and may feel unnatural to some people. New advances in semi-solid silicone implant technology now have resulted in softer, and more natural feeling implant that is still safe and durable. These implants come in different volume, shapes and profiles similar to breast implants. An examination and discussion of the desired look is critical for the proper implant selection.
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"Couldn't Have Chosen A Better Surgeon! - With all the health issues I have, I’ve seen many doctors throughout my life span… But none like Dr. Morales! Words cannot begin to express my thanks and gratitude to Dr. Morales, for helping me rebuild the confidence I once lost. From Day 1 – Consultation, to this day - 2 month post op, Dr. Morales has been so kind and empathetic to my needs and wants. If I had to do this all over again..."- F. / RealSelf / Apr 17, 2019
"Great Experience - Dr. Morales and his staff were amazing. He answered all of my questions that I had regarding the procedure I was interested in. After Consulting with Doctor Morales and Linda I felt very confident in choosing Dr Morales to be my surgeon. I had my surgery and he did an amazing job."- P. / RealSelf / Apr 12, 2019
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Technique: "Dual Plane"
There are three implant pocket techniques for buttock augmentation. The first is a submuscular approach which places the implant under the gluteus maximus muscle. The advantage to this is that the implant is “protected” with more soft tissue, reducing the visibility and palpability of the implant. A common disadvantage is that it has a longer recovery, and may have long-term pain sequela. The most feared is injuring the deep vessels and nerves of the leg. The second approach is intramuscular and places the implant within the gluteus maximus muscle. However, this is not a true plane, and may impair the function of the muscle. "Animation" of the implant is very common in this plane, and the implant tends to sit high, and there is less lower pole fullness. This plane also has more risk of injuring the deep nerves and vessels of the leg, as well as bleeding. The third option, and less common, is placed under the soft fatty tissue fascia. Historically, this implant pocket technique had high complications rates of infection and implant malposition. Dr. Morales has developed a hybrid novel technique called a "dual plane" augmentation for the implant pocket. The lower third of the pocket is within the gluteus maximus muscle, and the rest of the upper pocket is under the strong muscle fascia. This plane is created under the gluteus maximus fascia, giving the benefit of decreased visibility and palpability, decreases malposition, and decreased risk of long-term pain syndromes. On the lower pole of the buttock, the implant sits within the muscle, thus decreasing the visibility, and gives the pocket long term support.
The preferred implant incision is two concealed incisions within the gluteus crease at the level of the tail bone. Two incisions vs one incision reduces the risk of infection, and buttock crease tenting.
Dr. Morales also uses fat grafting as an adjunctive technique to enhance the final shape of the augmentation. Liposuction is used to harvest fat from the waistline and then transferred to “soften the edges” of the implant just under the skin to ensure a more natural appearing result.
Dr. Morales has had <1% complications and revisions with his technique. Dr. Morales will be presenting his novel technique at the Aesthetic Meeting on May 20, 2019 in New Orleans. His technique description, outcomes, and complications will be presented to his peers at this prestigious meeting. His article on the technique is also in review for the Aesthetic Surgery Journal.
The surgery is performed under general anesthesia in an out-patient accredited surgicenter. The procedure usually takes 2-3 hours to complete.
Dr. Morales first performs the liposuction for the fat harvesting. The patient is then carefully positioned in the prone (face down) position for the augmentation. The implant pocket is created on both sides through the two crease incisions. The implants are then prepared, rinsed with triple antibiotics, and placed into the pocket using a Keller Funnel (decreases contamination and damage to implant). Drains are usually not required. The incisions are closed in multiple tissue layers and the sealed with a skin glue. Fat grafting is then performed on the periphery of the implant to improve the shape and contour. Garments are placed to support the areas of the liposuction.
The patient goes home the same day, with a strict restriction of a prone position only to reduce the risk of complications with the augmentation. No sitting is allowed for 2 weeks, other than for using the restroom to decrease risk of bleeding and malposition complications. A sitting protocol begins two weeks after surgery. Follow up appointments are usually within a week, 2 weeks, month, and 2 months from surgery. Full resumption of normal and exercise activity is allowed at two months after surgery.
The price for buttock augmentation will vary depending on the technique used, the patient’s condition and aesthetic goals, as well as other factors relating to the surgical case. However, on average, most patients can expect to pay between $9,000-$14,000 for their procedure (liposuction, fat grafting, with buttock implants).
Plan Your Procedure
- Average Cost
- $9,000 - $14,000
- Recovery Time
- 2 Weeks
- Average Procedure Time
- 2-3 Hours
- Procedure Recovery Location
Buttock Implant FAQ's
What Size Should I get?
The biggest consideration in buttock augmentation is finding the right size AND shape. Every patient is “designed differently” in that there are different shaped buttocks. These different shapes are due to the anatomical variances in pelvis, and spine curvature.
Dr. Morales will examine you and determine what shape you have and which implants will meet your expectations.
Biggest Implant that will fit?
It is important to understand that one cannot compare fat transfer and butt implants in terms of volume. Buttock implants will give more projection and volume per cc than fat will do for augmentation. The largest implant currently available is a 712cc round implant. Custom implants can be ordered larger, but a premium price. Unlike breast implants that are half under the muscle, the buttock implant is placed under the muscle fascia, which is not as expandable as the breast. Thus, most patients may not have large enough gluteus muscle to accommodate a large implant. However, Dr. Morales routinely augments with additional fat grafting to improve the shape and appearance.
Will I need drains?
Dr. Morales usually does not use drains.
Where are the incisions?
The preferred buttock implant incision is two incisions within the gluteus crease at the level of the tail bone. Two incisions vs one incision reduces the risk of infection, and buttock crease tenting.
How long do implants last?
Unlike breast implants, buttock implants are semi-solid silicone and will not leak gel silicone if the implant fractures. These implants are therefore very durable and can withstand the normal activity of life for years. There is currently no recommendation to change out your butt implants. As long as you love them you just keep.
Risk of complications?
Historically, there were relatively high complications associated with infection and malposition. These were partially attributed to sterile techniques issues and pocket plane. Dr. Morales takes every precaution to reduce these risks. To reduce the risk of infection, the incision is placed away from the anus, and multiple skin prep solutions are performed before placing the implant into the pocket. Antibiotics are used intravenous, with irrigation during surgery, and oral regimen postoperatively to further reduce the risk. Strict bowel regimen protocol is required to reduce postoperative contamination of the incision site. Malposition of the implant was attributed to placing the implant under the fatty tissue fascia. Dr. Morales prefers a true sub-muscle fascial pocket technique. This plane is created under the gluteus maximus fascia, giving the benefit of decreased visibility and palpability, decreases malposition, and long-term pain syndromes.
Are buttock implants painful?
Dr. Morales prefers a true sub-muscle fascial pocket technique. This plane is created under the gluteus maximus fascia, giving the benefit of decreased visibility and palpability, decreases malposition, and long-term pain syndromes.
Will the implant be visible?
Dr. Morales prefers a true sub-muscle fascial pocket technique. This plane is created under the gluteus maximus fascia, giving the benefit of decreased visibility and palpability. Dr. Morales routinely augments with additional fat grafting to improve the shape and appearance to appear more natural.
Will I be able to workout?
Yes! The sub-fascial pocket technique does not impair the function of the gluteus maximus. This technique also has decreased risk of malposition as it is a very strong layer to support and protect the implant.
Implants alone will not give the hourglass figure. That is also true for the BBL. This figure is a result of liposculpting the waist down, and augmenting the buttock and hips with implant and/or fat grafting. Every patient has a different skeletal frame that may limit the extent to which an hourglass figure can be realistically attained. Dr. Morales will examine you and give you a realistic expectation of what can be done.