Butt implants with existing PMMA injections in glutes?

Allow me to answer your question as best i can without any photos. However, please keep in mind that an in-person, or at least a virtual, consultation with physical exam is first necessary before any legitimate evaluation or final surgical recommendations can be made.

Make no mistake, and regardless of a history of fillers injections, it is indisputable that the best position (aka “placement”) for buttock implants is in the total intramuscular tissue plane, not half and half within and on top of the muscle (aka “biplanar” or “dual plane”), not completely on top of the muscle and not “sub-fascial" which is exactly the same as on top of the muscle - so please do not be fooled by this terminology. Also, supercharging with adding fat over the implant is also likely to not make any difference other that costing you more and setting you up for more potential complications. The implant life and longevity of aesthetic, tasteful, and realistic results are all best with the “intramuscular” technique, period.

Other than placing buttock implants within the gluteus maximus and medius muscles (aka “intramuscular”) NOT on top of the muscle, “subfascial” or “dual plane”, the most important factors in creating the perfect derriere and/or hourglass figure 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 gluteus muscles (not butt cheek fat pad, which may appear “round”) and quantity and quality/density of these muscles. 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...with positional changes (eg. bending over and squatting down) and even in the most petite patients that have small/lean muscles and minimal overlying fat. The fact is, nearly 100% of the human population has a more oval shaped gluteus muscles not round. Therefore an oval shaped implant such as the Stanton Anatomic®️ buttock implant conforms best and produces a more realistic contoured outcome better than round implants. Contrary to what many think, a round implant placed correctly within the muscle actually sits up at the top of the butt cheek, creating an unnatural pointy or “gum-drop effect”, not at the lower part of the butt cheek and thus does not contribute to filling or rounding out of any of the lower buttock pole. Height and weight are considered but not nearly as relevant as the above measurements. Final note, because an extremely few number of board certified plastic surgeons specialize in buttock implants, you may have to travel away from your local area to seek consultation with this particular type of surgeon. Glad to help.