Flat Buttock and Hip Dip Without an Implant: What ADM Can Do

Are a flat buttock and a hip dip the same problem?

Both can look like a lack of volume, but the area needing support differs. A flat buttock usually lacks posterior projection or upper volume; a hip dip is the lateral hollow between pelvis and thigh. Pelvic and femoral structure, fat distribution and muscle form all contribute, so enlarging only the centre does not resolve it.

Buttock augmentation should therefore start by distinguishing what looks deficient — designing upper volume where the top is lacking, or the hip dip where the side is hollow.

Where can BiVol add volume?

BiVol uses ADM instead of a silicone implant to design volume and form where needed. ADM is a biological material made from dermis with the cellular components removed, leaving the extracellular matrix; it acts as a scaffold into which surrounding tissue can grow. ADM itself has long been used in soft-tissue reconstruction, including breast reconstruction.

In BiVol hip-up, rather than enlarging the whole buttock, the plan can address:

• Deficient upper buttock volume
• Posterior projection in profile
• The lateral hip dip
• Left–right volume difference
• The line from waist to buttock

How far ADM can change a hip dip or buttock size depends on individual tissue and the surgical design. Aesthetic gluteal augmentation with ADM has less published long-term clinical data than implants or fat grafting, so the achievable range of change and long-term course should be discussed carefully.

ADM is a material used in reconstruction and in treating capsular contracture, where a meta-analysis of nine studies found low recurrence; long-term data on its use for gluteal volume are still limited.^[1]

Can slim body types avoid an implant?

Fat grafting harvests from the abdomen or thigh, so very low body fat can make adequate volume hard to obtain; a silicone implant creates consistent volume regardless of donor fat but is, by definition, an implant. Implants and autologous fat have been the two main studied approaches in gluteal augmentation, each with different advantages and complications.

BiVol avoids both large-volume fat harvest and a silicone implant, so it is a route to compare for someone with limited fat who does not want an implant. It is not automatically suitable for everyone slim: skin and subcutaneous thickness, existing tissue and the volume wanted determine the applicable range.

How does it differ from fat grafting and implants?

Fat grafting can also reduce fat at the waist or abdomen while adjusting overall shape — though in gluteal grafting the layer injected matters directly for safety, and recent work emphasises staying subcutaneous, avoiding muscle, and confirming placement with ultrasound.

An implant gives relatively definite projection but carries implant-specific problems such as wound dehiscence, seroma and displacement. Rather than declaring one method better, the volume wanted, body fat, tissue state and preference about implants should be compared.

In a one-year study of HA gluteal filler, satisfaction fell from 90% at day 30 to 62% at 12 months, and ultrasound showed the filler being gradually absorbed.^[2]

Read alsoFilling a hip dip with fat is covered in “Hip dip fat grafting: can a hollow pelvic line be filled naturally?” (Korean).

What should be checked before surgery?

More important than how many cc to add is identifying where volume is needed. With BiVol, assess upper, central and lateral buttock volume, the degree of hip dip, left–right asymmetry, skin and subcutaneous thickness, desired projection, the area over which ADM can be placed, and post-operative compression and posture management.

Also important is ADM's tissue integration and long-term volume change. ADM is a biological material into which cells and vessels can grow, but not every patient integrates to the same degree and the initial volume is not guaranteed to persist identically. Rather than relying on the single advantage of “no implant”, confirm how much volume can be expected, how it may change over time, and how much clinical experience and follow-up data exist for the technique.

BiVol hip-up: common myths and facts