Buttock Implant Placement: Under the Muscle Vs. Intramuscular?

Intramuscular implants can improve volume by 400 cc or so, depending
upon the size of the individual. A significant amount above this
volume compromises healing by creating more tension on the healing
incision.  The deeper the placement the greater the risk of sciatic nerve compromise.Kenneth Hughes, MDLos Angeles, CA

The reality is there is no definitive plane between the gluteus maximus and the deeper underlying muscles.  They are all kind of intertwined.  Thus creating a pocket under the first several layers of the gluteus maximus is sufficient to provide good coverage and minimize palpability and visibility and prevent migration of the implant.  Going too deep can lead to impingement &/or injury to the sciatic nerve.  On the other hand, subfascial placement usually tears the fascia and allows more palpability, visibility, and downward migration of the implant over time.  Glad to help... @drryanstanton  

Dear inquirer, You did the right thing, which is due diligence and seeing few doctors. You have to consult with one more doctor who places the implants under the fascia. This is a natural plane and as long as the pocket is well above the crease, the implant is not palpable or visible. In this plane you have less complication, like bleeding and it is much less painful. Most importantly, you can have a much larger implant placed because of a larger pocket and no risk of damaging important anatomocal elements like nerves etc.  Another important issue is the type of implant. The material is mostly solid silicone, but it has to be very soft. The most natural shape is the oval round , which resemble the anatomical shape of the butt. Consult with an experienced board certified plastic surgeon who performed hundreds of surgeries with that technique.

Dear Inquire,

There are three choices for depth of buttock implant placement, each of which has its advantages and disadvantages.  Below the muscle provides more coverage for the implant and therefore makes it less visible.  It is also a much more painful recovery, and runs a greater risk of impinging on the sciatic nerve.  Intramuscular placement provides more of a cushion for the sciatic nerve, may be a little less painful, but is a less definable plane.  There is not enough long term information to confirm whether one is better than the other over time. Good luck!

In placing the buttock implants one needs to understand the anatomy of the muscles of the buttocks.The gluteous maximus  is the most superficial muscle under it is the gluteous medius. muscle. There is no good plane that seperates these muscles to dissect. under that is the major vessels and sciatic nerve. If you try to go under the muscle, there is no plane of dissection and will run the risk of major structure injury. Buttock implants are put intra muscular, some people prefer the subfascial plane. Choosing the right doctor and the right size and shape implant is the most important aspect of the surgery