Buttock implants under the muscle or at least within this anatomical layer has been known to provide softer, more natural results compared to a placement technique in which the prostheses lie above the muscle.
Placing the buttock implants above the muscle, with only the skin and fat “supporting” their weight, is known to increase the risk of sagging (inadvertent displacement) and palpability.
Leading Inland Empire plastic surgeon Dr. Tarick Smiley warns that the skin’s elasticity means it may stretch over time and lead to implant displacement and other surgical stigmata; hence, he always places buttock implants under the muscle or at least within this layer.
Furthermore, the under the muscle is known to minimize risk of infection especially in the event of poor healing since the muscle itself can serve as a protective barrier.
From the aesthetic point of view, buttock implants under the muscle technique can provide a more natural appearance—i.e., an S-shaped “behind” when viewed from the side.
Nonetheless, achieving natural and proportionate results also entails careful examination of the patient’s buttock dimension. The goal is to use implants that are within the anatomical boundaries, which in turn can also prevent skin thinning, implant malposition, and poor wound healing.
(Note: Patients of average frame are generally advised to stick to buttock implants whose size range is not more than 400 cc to prevent excessive tension on skin. It is important to note that too much tension is closely linked to poor healing and increased palpability.)
All buttock implants are positioned above the “sitting” area and so only the upper half of the butt is actually augmented, while its side (hips) and lower aspect receive no or very little improvement. For this reason, some patients may need a simultaneous fat transfer or fat grafting.
Incorporating fat transfer (which always starts with liposuction to collect fats) also allows the surgeon to “carve out” a more feminine contour by removing the excess fats along the flanks and lower back, says Dr. Smiley.
Liposuction uses a small hollowed tube inserted into tiny round incisions to remove the excess fat adjacent to the buttocks, further improving the contour and profile of the butt cheeks, he adds.
The collected fats from liposuction could be used to reshape the hips and lower aspect of the buttocks for a more proportionate, curvier silhouette, says Dr. Smiley.