Butt Implant

A fellow of the American College of Surgeons and a Diplomate of the American Board of Plastic Surgery, Constantino Mendieta, M.D. has performed the buttock augmentation procedure for many years and in several nations. Consequently, he has appeared many times over in the media and often conducts seminars that teach other plastic surgeons how to do the operation using butt implants.

He often explains that implants are often used in plastic surgery to reshape and augment body parts like the female breast and the calf. Likewise, gluteal implants can improve the shape of patients’ buttocks.

The procedure is fairly straightforward and involves placing a single scar under the butt that, after healing, becomes so well hidden, not even your closest intimate will be able to find it.

Many patients ask if an implant can leak. Breast implants which are filled with saline or silicone can leak but the implants used to augment and shape the buttocks are made of solid silicon which can not break and leak any fluid into your body.

Patients are also quick to ask what the implant feels like after healing. The augmented rear end has a firm but natural feel, about like the feel of a person has who been working out with weights or exercising hard for many years. Moreover, you actually do not sit on the implant because it is placed somewhat higher than the bones on which you actually sit.

Dr. Mendieta has made an in-depth academic study of buttock augmentation in cooperation with another plastic surgeon in Brazil where the female derriere has long been appreciated. Before that, he trained under the surgeons who first developed the technique.

The actual surgical procedure can be done under a general anesthetic, a spinal, IV sedation or an epidural block.

Evaluate the Buttock's shape

There are other variables – like size, shape, and skin quality that need to be considered before making any determinations about which butt augmentation procedure is best for you.

When evaluating the shape of the buttock, we divide its anatomy into three sections; the upper buttock, the mid buttock and the lower buttock. Each area needs to be evaluated and addressed separately to provide the best gluteal harmony.

When a gluteal enhancement is done, the implant is mainly augmenting the upper buttock and the upper portion of the mid buttock. It will not fill out the other areas. In the majority of patients, a careful analysis of the middle and lower buttock needs to be made since complimentary procedures may be required in order to improve the overall shape.

Surgery Options

Although the buttock augmentation implant operation is fairly straightforward, there are many technical aspects to the procedure that may be done differently depending on the surgeons training, experience, and philosophy. The operation involves placing an implant that is made of silicone (either cohesive silicone gel or solid silicone) in the buttock to improve size, shape and contour.

To understand your options and the operation, let us go through the five decisions that must be made. They are:

Implant selection: The implant is either round or oval, the so-called “anatomic” implant. Like breast implants, the implant comes with either a smooth or a textured surface. In my opinion, neither the shape nor the surface texture of the implant makes much of a difference in the outcome. The content inside the implant can be either solid silicone or cohesive silicone gel, with the solid silicone the most commonly used. The solid implant is excellent since it cannot rupture, spill, or deflate while the cohesive gel is not available in the United States. In my practice, I usually use the smooth, round implant. The decision which type of implant will be used is heavily influenced by your surgeon’s preference and philosophy. The augmented buttock has a natural feel and can be somewhat firm to the touch. It basically just feels like you have been working out for a long time.

Incision Location: Once we’ve decided on the implant, the next task is to decide the type of incision. The buttock implant incision can be placed in several locations:

Toward the top on both sides of the upper buttock. Although the scars can be hidden in your undergarment or bikini, it is not recommended since the scar can be quite visible when you are nude. Moreover, two incisions are required. Or,
Toward the bottom in both of the gluteal creases, the areas where your "cheeks" meets the top of the thighs. That choice will leave you with two scars that also can be quite visible. Or finally,
One incision, which is, placed down the center of the sacrum. That’s a small 4-6 cm (about ¼ inch) vertical incision down the buttocks crease. In my opinion, that is the best location because it is extremely well hidden and not even your closest friend can find it. (He or she won't want to be looking in that area). Moreover, the sacrum approach only involves one scar. The only drawback is it may have a higher infection rate than the other incisions due to its location close to the anus. However, an infection is usually cured with antibiotics and wound care.

Above or below the muscle: Once we know the type of incision, the next step is to decide on the placement of the buttock implant.

This again will heavily depend on your surgeon's preference; many nice results have been attained with either position. What it really depends on is the person’s anatomy. I have seen many implants that were placed above the muscle and later looked like a sack of potatoes. That may take place in patients who have a very droopy buttock or poor skin tone. In my practice, I have preferred to place the implant within the muscle. That accomplishes several things:

First, it gives the implant more support, and I believe, prevents it from moving too far down the buttock.
Secondly, it gives an extra layer of coverage so the implant feels more natural to the touch and has a nicer shape.
Finally, the added tissue coverage protects the implant from infection. If the implant were placed above the muscle and the wound became infected, more than likely so will the implant. In this scenario, the implant would have to be removed and left out for three months before inserting it again. Of course, every surgeon has his or her own philosophy and preference.

To liposuction or not to liposuction: The final decision will be if liposuction well be combined with the implant procedure to add further contour to the buttocks.

When I first learned the technique, my mentors were not performing liposuction with the implant procedure. Most of the patients who were having the operation had flat buttocks, but they also had a role of excess fat in the upper-outer part of the buttock. They looked flat from the side but wide and flat from the back. After the augmentation, the patients had nice looking results and a large wide look from all angles. I began to combine the implant procedure with liposuction of the upper outer part of the buttock to improve the wide appearance. I then noticed a tremendous change in the contour and shape of the buttock.

In some patients, liposuction of the lower buttock and outer thigh is also needed to improve the droopy look. I will therefore combine most of my buttock augmentations with liposuction. Please remember that every plastic surgeon has his or her own philosophy; therefore the decision to combine liposuction will depend on what you want and your surgeon’s philosophy.

The Operation Itself

Buttock augmentation is an outpatient procedure that takes about an hour to perform. If liposuction is being done, then it may take an additional half hour.

You must be placed face down for the operation. A 5-6 cm (about ¼ inch) vertical incision is made in the well-hidden buttock center crease, the sacrum. The dissection continues on either side of the sacrum until the buttock muscle is reached. At this point, the muscle is incised and with careful dissection, a pocket is created for the implant within the muscle. Surprisingly, there is very little bleeding. The implants are inserted into the newly created pockets and the muscle closed over the implants. The midline incision is then closed in layers. If liposuction is going to be done, it is performed through separate incisions.

Your New Look

You will need to wear a surgical garment for about two to three weeks. The garment will provide support and help with skin re-draping especially if liposuction was performed. At first, you will notice a definite difference in the gluteus contour, but because you are swollen, the buttock will appear very full, and will have a boxy appearance. You may also notice the implants sit quite high on the buttock. That is all normal, too; kindly remember that you are swollen. It will take at least three months for all the swelling to go down and for the implants to settle into their normal position. You may experience occasional temperature changes and numbness over the buttocks. But that will also improve over the next three months. You may feel a little timid and scared when sitting down, but remember the implant is much higher on the buttock than where you normally sit, so don’t worry.

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