Butt implant; Subfascial vs. Intramuscular & shape? (photos)

May need to switch doctors :( My questions, dr.2. told me muscle is like cutting thin paper, how do doctors open up the butt cheek enough to dissect a butt muscle place an implant then cover the implant and stitch up the muscle without hurting your sciatica or muscle is this really possible? 2nd. Is it true the implant will slide down my leg if placed subfascial? 3 is there truth to oval or round flipping worse than the other? I think round wld be bigger.Thank you greatly!

Doctor Answers 8

Buttock implant details

To answer your questions and concerns, please read below: 

Buttock/hip implants are a very good, safe, and long term reliable option for most patients seeking buttock/hip augmentation (at least in my practice). I prefer to insert the buttock implants through a 1 1/2 inch long incision along the inner curve of each upper buttock cheek at the level of the tailbone, similar to two opposing parentheses ")(" (concealed within the crevice between the buttock cheeks) and the hip implants through a ~ 1 inch incision just below the beltline above the hip region. The buttock implant should always be placed under or within the gluteus maximus muscle (NOT "subfascial" as this is no different than subcutaneous or "on top of the muscle"). In this position, the implant is less palpable, less visible, and does not sag or shift/migrate over time unlike implants placed on top of the muscle. On the other hand, hip implants are placed under just the fascia because no significant muscle exists in this region. However, because they are much smaller and lighter, their likelihood of migration is relatively low. Because all of this, it is extremely important to seek consultation with a board certified plastic surgeon who specializes in this procedure so that the implant placement is precise for both locations. And in this case too, at least in my surgical practice, the infection rate is minimized to <2% (much lower than and contrary to popular belief by many other surgeons not experienced in buttock implants).

Traditionally, teardrop oval implants have a 20+% risk of rotation and thus change in buttock shape/appearance.  However i have recently created and patented a new oval shaped implant that avoids this issue. The benefit of this is the fact that ~80% of women patients have more of an oval shaped buttock cheek than round. Glad to help. 

Beverly Hills Plastic Surgeon
4.8 out of 5 stars 102 reviews


A lot depends on how much soft tissue coverage (how much buttock fat you have) over the buttock implants. If sufficient the subfascial plane is less painful and has a quicker recovery time. The concerns you mentioned are uncommon complications. I agree with you about perhaps finding another plastic surgeon to help clarify your questions.  Most important is selecting your plastic surgeon wisely. See the below link for helpful hints.

Butt implant; Subfascial vs. Intramuscular & shape?

Hello skinnygirl123.

Thank you for your question.  You are correct that surgeons place the implants either underneath the fibrous tissue (fascia) covering the surface of the gluteus muscle or underneath the muscle itself.  These locations are chosen to help secure the implants in place and "hide" the edges.  I have performed both depending on the patient and I haven't seen a difference in outcomes - especially not sliding down your leg.  Your surgeon has to make a small opening between muscle fibers when placing the implants below the muscle, but this should not injure the muscle in any way.  You are correct that there is a slightly higher incidence of sciatic nerve pain after sub muscular implants, but this is still a rare problem.  Finally, I believe that the risk of rotation or "flipping" is more dependent upon surgical technique than the implant, and I always choose an implant that fits the patient's body (over a risk of rotation).  Good luck!

Hunter Moyer, MD
Atlanta Plastic Surgeon
5.0 out of 5 stars 15 reviews

Buttock implant alternatives and risks.

I use round implants when only an increase in lordotic curvature (side view projection) is desired by the patient. I use oval implants in order to increase buttock width in addition to lordotic curvature. I do not place "sub facial" implants because I believe that the implants' positional stability is less well controlled. Sciatic nerve injuries are a rare but, in that area, the surgeon must be aware of the detailed anatomy in order to minimize the risk of complications. Good luck!

Steven M. Gitt, MD, FACS (in memoriam)
Phoenix Plastic Surgeon
4.8 out of 5 stars 36 reviews

Buttock Augmentation

The placement of the implant depends on the patients body type.  I use but Submuscular and sub facial placement for my buttock augmentations.  I can assure you theat implants placed in the sub facial placement will not slide down your leg.  Sometimes submuscular placement prevents the implant from dropping causing a high riding implant with an artificial look.  Again, this depends on the patient body type.  Be sure you are chosing a board certified plastic surgeon with extensive experience with buttock implants. 

Subfascial vs. Intramuscular Buttock Implants

Buttock implants can be placed as you know in both the subfascial and intramuscular locations. There are advantages and disadvantages of each approach. Smaller low profile round buttocks implants are used in the intramuscular plane which does not go deep enough to injure the sciatic nerve nor can they flip or rotate from this tight pocket. The muscle is not paper thin and is actually quite thin. The surgeon makes the intramuscular plane, since it is not a natural space between the tissues, and the goal is not to make it too thin in the process. Larger buttocks implants of either round or oval shape can be placed in the subfascial plane which is a more natural plane of dissection. The fascial lining is very thin and the implants do have a higher propensity for dropping over time and developing malposition.

Buttock implants

Soem surgeons place them subfascial, intramuscular or subcutaneously. It all depends. They are all reasonable options.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 24 reviews

Butt Implants, Subfascial vs. Intramuscular & Shape vs Round?

Butt augmentation has become very popular over the past several years. It has been the fastest growing aesthetic procedure in the U.S. the past few years. There are two methods for butt augmentation. The first is the Brazilian Butt Lift (fat transfer) the second is Butt implants, both are good options and just dependent on the individual patient.

Butt Implants are great for thin patients that do not have enough fat for a Brazilian Butt Lift or for patients that are looking for a lot of projection. The implants can be done alone or in combination with fat transfer.

There are several ways to place the butt implants and the methods vary from surgeon to surgeon. I commonly place the implants in a subfascial position for several reasons. One, the subfacial plane is very clean and avoids damaging the muscle or nerves. However it still holds the implant in the proper position and decreases the chance of scar tissue forming around the implant. The fascia is the strong covering that wraps the muscle, that is why it can hold the implant in place. The submuscular plane can also be used but in my experience, patients tend to have more pain and over time has little benefit over the subfacial system.

In terms of the implant both the round and shape are good implants. I personally use the round implant for several reasons. It gives good projection, which patients that receive the implant are typically looking for from there procedure. Also the butt take abuse in our daily life from falls and so forth, with the round implant you are less likely to have problems if the implant shifts at all. With a shaped implant if it moves at all it will need to be revised, this is not necessarily true with a round implant.

I recommend that you see a board certified plastic surgeon about your butt augmentation that performs a high volume of these procedures.

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.