What are the pros & cons to the different butt implant placement methods? Which is the best choice if you've had a BBL? (photo)

Had a BBL in 2012, loved the results but after reabsorbtion, it's not enough. I desire a more dramatic derrière & was considering butt implants as well as fat grafting to the hips for balance & aesthetic harmony. What implant shape is best for me & how should I get the implants placed!? What are the pros & cons to subfacial vs intramuscular!? I want to turn heads but also look like my ample bum is a result of genetics and my undying efforts at the gym, not surgery! Please advise, Good Day Drs!

Doctor Answers 3

Buttock implant positioning and sizing

Regarding buttock augmentation, let me start off by saying that I currently see at least 2 - 3 patients per week that failed "brazilian buttock lift" (i.e. the fat melted away after 10 - 12 months) and are now seeking a more reliable and permanent option (i.e. buttock implants).

One of the most important factors in creating the perfect derriere with implants is indeed selecting the right size AND shape. I have found the best way to assure this is to simply measure the actual dimensions of the patient’s buttock cheeks. With these anatomical measurements, I can select an implant that not only significantly augments the buttock but also supplies the correct 3-dimensional enhancement to look as real as possible. Traditionally, teardrop oval implants have a 30+% risk of rotation and thus unnaturally change the buttock shape/appearance when doing so. However i have recently created and patented a new "Stanton Anatomic" 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, thus creating a much more natural and harmonious buttock contour. Thus, the only way for you to know what implant works best is to consult with a board certified plastic surgeon specializing in this procedure and have him/her take your measurements before selecting an implant and proceeding with surgery.
The largest stock buttock implant currently available in the USA is a 690cc round implant. Indeed custom implants can be ordered larger, not only at a premium price but at a premium risk for most patients'. Unlike breast implants which are placed under the very expandable tissue of the breast and half of the pectoral major muscle, buttock implants should only be placed under or at least within the largest strongest muscle of the body, the gluteus maximus muscle, which is not nearly as expandable or forgiving. However, the so called "subfascial" pocket is not a real space in the gluteus and therefore is no different than subcutaneous placement of the implant (aka - on top of the muscle) which should be avoided at all costs. Thus most patients simply do not have a large enough native buttock muscle to fit an implant much over 500 ccs', without leading to significant complication such as wound breakdown/opening &/or implant exposure...necessitating removal.
Some of those sought after video-vixen and celeb-types (without mentioning names) with cartoonish bottoms could have either gotten extremely lucky with a huge oversized implant (very unlikely if properly placed under the muscle), had a very large volume of filler injected such as silicone, PMMA, or hydrogel - all NOT recommended because of high risk of severe infections, migration and/or hardening over time, and even deadly consequences in rare but significant instances (if mistakenly injected into the blood stream); and/or have been genetically "blessed" - although quite unlikely.
I generally do not recommend fat grafting at the same time as placing buttock implants because of a significantly increased risk of infection. For fat to survive it must be grafted into muscle, however that is also where the implant sits. Thus, if fat it injected into the implant or implant pocket then it will die and almost assuredly get infected - necessitating removal of the implant as well. Fat transfer later on must be done very carefully and cautiously, preferably by the original surgeon, for the very same reasons as above. In both instances, the risk/reward ratio is very high (meaning high risk to very low potential reward) because over 80% of the fat is likely to melt away yielding very small gains in augmentation.
Nonetheless, buttock implants are a proven safe and effective method of buttock augmentation as long as the recommendations of a board certified plastic surgeon specialist are adhered to.
Glad to help.

Beverly Hills Plastic Surgeon
4.8 out of 5 stars 102 reviews

Intramuscular butt implants

Let me start with one simple suggestion, subfacial butt implant, NEVER. This is a really old technique and the reason why everyone is scared of butt implants. Huge rate of complications, the implant gets visible and palpable,the implant dislocate to other positions, etc, so NEVER SUBFACIAL BUTT IMPLANTS.

The other 2 options are submuscular and intramuscular, both techniques are really good, the only difference is that in the submuscular placement the implant has to be placed really high to prevent nerve damage. So that leaves the intramuscular placement as the prefered placement nowadays. the only Surgeons that dont use this technique are the ones that doesnt have the training to do it yet. 

For you I would use an oval intramuscular implant. 

Best of luck, 

Luis Eduardo Redondo, MD
Dominican Republic Plastic Surgeon
5.0 out of 5 stars 17 reviews

What Butt Implant is Best for Me?

Deciding on the proper implant size and shape can be difficult for patients just as it is when women are deciding on the proper breast implant size.

First of all there is no one perfect implant for every person. The ideal implant depends on the aesthetic goals that each person is trying to achieve from their augmentation. Typically I will take measurements of the buttock and determine what implants will fit your buttock. There are a range of butt implants and profiles (just like breast implants, though not as many).

The implants are a solid silicone implant that comes in round and shaped styles. The round implants are the most common in the U.S. and in my practice. The implants will help shape your butt and hips to give it the projection and round figure that patient hope to achieve. Butt Implants are typically larger then breast implants, as peoples butts are typically larger than their breasts. In my practice the average butt implant range from 400 to 600cc. Please keep in mind that you cannot compare fat transfer and butt implants in terms of volume. Butt implants will give you much more projection and volume per cc than fat will do for your augmentation.

A couple things patients can do is one; have an open discussion with your surgeon about your aesthetic goals. Second is bringing in pictures that have the look that you are trying to achieve, as this will help your surgeon.

Once I know what you are looking for in terms of appearance and what you body can accommodate then we I will give you some implants to choose from and help guide you as to what is best for your aesthetic goals.

Discuss your butt augmentation procedure with a board certified plastic surgeon that performs a high volume of butt augmentations.

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.