There are three anatomical locations where the implant can be inserted during surgery. There is the location above the muscle, there is the location inside the muscle, and there is a location under the muscle. Of all the different anatomical locations, the one that makes the most sense and the only one that I recommend is performing an insertion of the implant inside the muscle. When the procedure is performed, I like to do a dissection under direct vision, and essentially the gluteal muscle is split in half inserting the implant inside the muscle is the best option because of the following:
It provides support of the implant avoiding bottoming out of the implant.
Covers the implant which prevents the edge of the implant to be seen on the sides.
It decreases the chances of capsular contracture.
In the event that your incision opens, it provides coverage and avoids infection of the implant.
It helps avoid displacement of the buttock implants in the wrong anatomical place or flipping of the implant upside down.
It is essential also particularly with the implant that we have in the United States, to put the implant inside the muscle. This buttock implants is a little bit more firm than other implants in other countries, meaning that soft tissue coverage is of crucial importance to avoid the complication that I mentioned before. In essence, if somebody is going to perform a gluteal augmentation with implants, the other locations including the sub fascia does not provide enough soft tissue coverage, and the under submuscular plane is very risky because major structures like the nerves of the leg will cross under the muscle, particularly on the lower part of the buttock creating problems with compression and pain, etc. Intramuscular placement of the implant is the best location for a successful surgery than any other, which has major limitations that will limit the shape of the buttock that we can accomplish with an implant and at the same time, increase the complication rate.
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