Hybrid Buttock Augmentation:
How Is a Natural Pelvis and Hip Line Created?

What kind of surgery is hybrid buttock augmentation?

Buttock augmentation is not surgery that only enlarges the buttock but body contouring that addresses projection, upper volume and the line from waist to pelvis to thigh together. Hybrid does not layer the implant and fat in the same place; it applies each to the areas that need it.

Related readingBeyond hybrid, the differences among four methods — implant, fat grafting and BiVOL — are compared in "Buttock augmentation methods: implant, fat grafting, hybrid or BiVOL — which is right for you?".

Why use an implant and fat together?

The shape of the buttock is not determined by central volume alone. How slim the waist looks, the curve beside the pelvis, hip dips (the outer hollow between pelvis and thigh) and the curve running top to bottom all play a part.

• Implant: provides projection in bodies with little body fat, where fat alone can hardly create central volume
• Fat grafting: harvested from the abdomen and thighs to finely refine the side line and boundaries, while also contouring the harvest site

In a study reporting 147 patients who had implants and fat together, an average of 300 cc implants and 380 cc of fat were used, and the implant was placed intramuscularly so that fat would not enter the deep muscle layer.^[1]

Related readingCriteria for considering hybrid in bodies with a flat pelvis are covered in "When the pelvis and buttocks are flat, can hybrid buttock augmentation help?" (Korean).

How is hybrid buttock augmentation performed?

First, the body is analyzed to divide the central volume the implant will handle and the surrounding contour fat will handle. The items checked are as follows.

1. Current buttock size and left–right shape
2. Degree of projection from the side
3. Upper and outer buttock volume
4. Location and depth of hip dips
5. Waist-to-pelvis ratio
6. Skin elasticity and soft-tissue condition
7. Amount of fat that can be harvested from the abdomen and thighs

Once the analysis is done, the implant size and position are decided, and the areas and amounts that need fat are planned separately.

Why does the placement plane matter?

In buttock augmentation, both the plane where the implant is placed and the plane where fat is injected affect safety and results. Fat settles better when placed in small amounts across several layers rather than concentrated in one spot, and the principle is to avoid placing large amounts in the deep muscle layer.

In a meta-analysis of 32 studies (2,682 patients) on implant buttock augmentation, placement in the subfascial plane had the most seroma (22.3%) and wound dehiscence (27.1%), while intramuscular or submuscular placement had fewer complications.^[2]

Common myths and facts — hybrid buttock augmentation

In a meta-analysis of 13 studies on combined implant-and-fat buttock augmentation, the implant removal rate was 1.70%, and complication rates differed by the plane in which the implant was placed.^[3]

What matters most in the design?

For example, if hip dips stand out from behind and projection is lacking from the side, rather than adding volume to the center and outside the same way, central volume and the side contour are approached separately. The desired buttock shape also differs from person to person, so rather than size, waist and pelvis width, existing buttock shape and the line into the thigh must be looked at together.