Should butt implants be done over the muscle or under the muscle?

The short and quick answer is, buttock implants should always be placed under (or within) the gluteus muscle. For more details please read on:Allow me to share with you some information that you may not hear elsewhere. There are only two proven safe and relatively effective methods for Buttock Augmentation and Hip Augmentation: 1) Autologous Fat Transfer (using your own fat, transferring from one area of the body to the other) and 2) Buttock/Hip Implants (semi-solid silicone rubber implants that cannot rupture &/or leak). Both are very good options so what it comes down to, like any surgery, is proper patient selection.Indeed because at least 50+ % of the fat transferred will melt away within a year, most patients are not good candidates because they lack an adequate amount of fat to harvest. Another tip is that if you purposely gain weight (i.e. fat) for the procedure, the fat you lose first as you get back to your baseline weight is that very same fat that was transferred into your buttock...so don't fall victim to this recommendation. Although using your own fat is relatively safe, the one serious complication that can rarely (< 1%) happen is "fat embolism" in which some of the fat gets into the blood stream and travels up into the lungs, heart, and/or brain causing serious problems. This complication is more likely to happen with the larger amount of fat being transferred. This is even more likely to happen when using fillers like PMMA and hyaluronic acids. Also fillers, when injected in large quantities, have a relatively high tendency to migrate away from the original area they were placed and tend to stimulate a lot of inflammation and a subsequent disastrous amount of scar tissue/hardening.Thus buttock/hip implants become a very good, safe, and long term reliable option for most patients seeking buttock augmentation (at least in my practice). I prefer to insert the buttock implants through a 2 inch long incision over the tailbone (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. 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. Therefore it is extremely important to seek consultation with a board certified plastic surgeon who specializes in this procedure (in fact both implants and fat transfer so that s/he is not bias). And in this case too, at least in my surgical practice, the infection rate is minimized to ~5%. Glad to help.Depending upon the amount of your current fat reserves and their distribution, you may or may not be a reasonable candidate for fat transfer. If you are wanting to utilize the fat to further augment your buttock in addition to implants, then I caution you against this. The reason being that the fat needs to be placed into the buttock muscles for optimal survival, however, this is exactly where the implant needs to reside and thus risks infection and/or death of the fat. Because of this risk, I frequently avoid fat grafting into a buttock that has an implant. Bottom line, I recommend consulting with a board certified plastic surgeon specialist in buttock augmentation (BOTH implants and fat transfer) to determine what option is best for you. Glad to help.

Thank you for your question.I have 13 years of Plastic Surgery experience in Toronto Canada and there is not doubt that the Buttock Implants should always be place under the fascia - and if possible, within the first muscle.Here are the layers the surgeon encounters:1. skin2. fat3. fascia (thick and strong lining of all muscles)4. 3 gluteal muscles, the most superficial and largest one being the Gluteus Maximum.Any implantation above the fascia, i.e. under the fat, is a no-no for Buttock Augmentation as your implants WILL move and get malpositioned.The fascia is a thick structure that will secure the implant in place and prevent its shifting and malpositioning.Going a few millimetres into the Gluteus Maximus will also help camouflaging the implant edges.I prefer 2 small incision, 3-5 mm apart, to minimize wound openings (both appear as one and are camouflaged within the buttock crease).If FatGrafting is to be done at the same time, fat grafting should be done first as the ft survives better in the muscle layers.Do get an experienced board-certified plastic surgeon.Hope this helps!

Best,

Dr Marc DuPere

The answer to your question is neither.  in breast buttocks andf body the safest most natural appearing and most enduring position is subfascial.  The subfascial approach is more elegant and requires more technical skill and attention to detail but it avoids most of the downsides of both submuiscular and "above the muscle" approaches.  I hope this helps!All the best,Rian A. Maercks M.D.