Subfascial or intramuscular for butt implants?

Regardless of patient anatomy, buttock implants are best placed within (ie intramuscular) the gluteus maximus muscle.  Indeed a subfascial placed buttock implant may look good for the first 6, even 12 months tops but unlikely. However as the final swelling resolves and the size/weight of the implant succumbs to gravity over time, it will become visibly and papably obvious. The reason for this is twofold: 1) the investing fascia of the gluteus maximus muscle is extremely adherent and interwoven with the deeper muscle fibers. Because of this, it is impossible to place a 300+ cc buttock implant under this fascia layer without shredding it to pieces, thus rendering it subcutaneous (under and suported by the skin only), and 2) buttock implants are 5+ times as large as other implants which are typically placed subfascial (eg. calf and hip implants).  These smaller lighter implants are readily supported long term by the fascia layer which is actually much tougher in these areas. However the much larger buttock implants eventually thin out and erode through this layer making them obviously visible, artificially palpable, and yeild a "dirty diaper effect". 
Thus, the only way to place buttock implants for a reliable, long term, and natural outcome is intramuscular within the gluteus maximus muscle.  Glad to help.

Different patients require different solutions, and different surgeons have different preferences. Make sure you find a surgeon who performs a few hundred buttocks surgeries every year, which might not be that easy.I prefer intramuscular placement by all means.Hope that helps

My recommendation is to schedule in office consultations with the three board certified plastic surgeons so that you two can discuss the size of butt implants that would help you achieve the desired outcome. Only by seeing a potential patient in person can the board certified plastic surgeon make a realistic determination of how closely the outcome will reflect your goals.  I place both types in an intramuscular position with a preference for round implants if possible. I prefer round implants to improve projection, improve roundness and fullness laterally, and prevent rotational deformities associated with oval implants. 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.
Kenneth Hughes, MD, Board Certified Plastic SurgeonLos Angeles, CA