Buttock Augmentation Revision: When and How It Is Planned

What complications can follow buttock augmentation?

Changes after buttock augmentation differ with the method used. Implant surgery can involve displacement, a palpable edge, seroma, infection or wound dehiscence. Fat grafting can lose volume as some grafted fat is absorbed, create left–right differences, or form fat clumps and firm nodules.

Both methods can produce bruising, swelling and temporary sensory change, and during recovery the buttock shape may not look as initially expected. If pain and swelling worsen, the skin reddens and feels hot, or a wound opens, prompt assessment is needed to check for complications such as infection.

In a meta-analysis of 32 implant buttock augmentation studies (2,682 patients), seroma and wound dehiscence were most frequent when the implant was placed in the subfascial plane — one reason the plane may be changed at revision.^[1]

When is revision considered?

Asymmetry and shape imbalance. If the two sides differ in size or height, or one side looks hollow while a specific area protrudes, revision can be considered. After fat grafting, differences in fat survival can lead to asymmetry; after implant surgery, the insertion position or changes in surrounding tissue can affect shape. The plan aims not only to add volume to the smaller side but to balance the upper, central and outer buttock and the curve from waist to buttock.

Implant displacement and protrusion. If the implant moves from its original position or shifts to one side, the contour can look asymmetric. Assessment is also needed when the implant edge is prominent, feels firm, or sitting and moving remain uncomfortable. The position and size of the implant and the state of the surrounding tissue are reviewed to adjust its position, or to replace or remove it. Where infection or implant exposure is present, treating that problem takes priority over cosmetic improvement.

Volume loss and irregular contour after fat grafting. Some grafted fat may be absorbed, so volume can fall over time and a hip dip or upper buttock hollow can become prominent again. Conversely, if fat is unevenly distributed or fat necrosis occurs, an irregular surface or a firm lump may be felt. In these cases the amount of remaining fat and the tissue state are assessed, and additional grafting or correction of the irregular contour is reviewed. When fat is re-grafted, the injection plane and volume, and the risk of vascular injury and fat embolism, must be considered in a safe plan.

Inflammation, pain and wound healing problems. If pain worsens, swelling and heat persist, or there is discharge or wound separation, the cause should be treated before cosmetic revision is judged. Implant-related infection can require implant removal, and after fat grafting infection or fat necrosis must be assessed. Revision aimed only at shape is not performed while inflammation or a wound problem is unresolved. A treatment plan is set first so tissue can recover, and volume and contour revision is considered afterwards if needed.

Read alsoThe options for revision are covered in “Buttock revision surgery” (Korean).

How is revision carried out?

Revision is planned around the type of previous surgery and the problem now present. The previous surgical record, the implant type used, the fat grafting sites and the postoperative course are reviewed, together with left–right height and projection, skin elasticity, subcutaneous fat thickness, scarring and adhesions. Options then include adjusting the implant position, replacement or removal, autologous fat grafting, or a combination of these. Where skin laxity is the main problem, adding volume alone may not create the desired shape, and skin excision or lifting may be considered.

The core of revision is to correct the problem from the previous surgery while considering overall buttock proportion and tissue stability together.

A report of 14 revision cases divided the approach by cause — implant removal, reinsertion into a deeper plane, and hybrid methods using fat.^[2]

What is BiVOL buttock augmentation?

BiVOL buttock augmentation is presented as a method that uses biological materials such as acellular dermal matrix (ADM) instead of a silicone implant to supplement buttock volume and shape. ADM is a dermis-derived material with the cellular components removed, used as a structural support. Not inserting a silicone implant distinguishes it from conventional surgery, and it can be an option where the feel or contour of an implant is a concern.

If you do not want another implant at revision, or want to improve volume and contour in a specific area, the availability of a BiVOL approach can be discussed. Because BiVOL differs in material and principle from implant insertion and fat grafting, it is important to confirm the material actually used, the treated area, the clinical evidence for that area and the expected range of volume. Experience and evidence in the buttock area in particular should be reviewed separately from implants and fat grafting.

What is hybrid buttock augmentation?

Hybrid buttock augmentation generally combines implant insertion with autologous fat grafting: the implant creates basic volume and projection, and fat refines the contour around the implant or in hollow areas. It can be used to soften curves that an implant alone cannot create and to fine-tune volume in the upper or outer buttock.

In revision, a hybrid approach is considered where an implant alone did not produce the desired contour, or where the implant border and hollows should be corrected together. If there is infection or significant tissue damage around the existing implant, that problem must be resolved first. The plan takes into account implant size and position, the areas available for fat harvest, and the thickness of skin and subcutaneous fat.

How is the revision method chosen?

The method is chosen on the basis of the current tissue state and the problem to be corrected, not on a desired size alone.

Implant position or shape is the problem: adjusting, replacing or removing the existing implant is reviewed.

Volume is lacking or the sides differ: fat grafting is considered after confirming available fat and tissue state.

Both implant projection and surrounding contour need correction: hybrid implant plus fat grafting is reviewed.

A volume method without implants is wanted: the feasibility and evidence of a biological material approach such as BiVOL are confirmed.

Skin laxity is the main problem: whether buttock lifting is more suitable than adding volume is assessed.

Before revision, the previous operative record and materials used should be reviewed and any current pain or inflammation assessed. Recovery time varies with the extent of surgery and tissue state, so exercise and prolonged sitting should be resumed gradually according to the surgeon's guidance.

Buttock revision: common myths and facts