When the buttock is flat or the side of the pelvis is hollow, the line from waist through pelvis to thigh can look flat. Rather than enlarging the buttock alone, hybrid hip-up considers projection and the lateral pelvic line together: a gluteal implant restores central volume while fat grafting refines the hip dip and outer contour. Which plan suits you depends on your existing shape, available fat and how much change you want.
Contents
What is hybrid hip-up?
Hybrid hip-up combines a gluteal implant with autologous fat grafting to restore both volume and contour. The implant creates central volume and posterior projection, while fat harvested from the abdomen or thighs, processed, and grafted into the lateral pelvis or outer buttock fills where volume is lacking.
Because the two methods play different roles, using them together addresses the central volume and the surrounding contour at once. Where the buttock is flat in profile and the side of the pelvis looks hollow from the front, the roles can be divided to plan the whole silhouette.
Not every body type needs the hybrid approach. Existing buttock volume, how much fat can be harvested and the degree of change wanted determine the appropriate method.
In a study of 147 patients combining implant and fat, the average was a 300cc implant with 380cc of fat, with the implant placed intramuscularly.[1]
Why do a flat hip and a hip dip appear together?
Buttock shape is not decided by fat volume alone: the structure of the pelvis and femur, the form of the gluteal muscles and the distribution of subcutaneous fat all contribute.
Without projection in profile, the buttock can look flat overall. Where fat at the side of the pelvis is relatively sparse, the line from waist through pelvis to thigh can appear to dip in the middle — the hip dip. It is a natural feature of many normal body types and does not necessarily mean low weight or insufficient exercise.
The same hip dip looks different in someone with adequate central volume and someone who is flat overall, so central volume deficiency and lateral hollowing should be assessed separately.
| Concern | What is usually seen | What the design checks |
|---|---|---|
| Flat hip | Insufficient projection in profile | Central buttock volume and height |
| Deep hip dip | Hollow between pelvis and thigh | Outer contour and pelvic junction |
| Narrow-looking pelvis | The line from waist to hip looks straight | Overall waist–pelvis–hip proportion |
| Volume concentrated low | Upper portion looks empty, hip looks low | Volume position and upper line |
| Left–right asymmetry | Size or curve differs between sides | Difference in volume needed on each side |
Which lines does hybrid hip-up consider?
Rather than simply making the buttock larger, the plan considers the line needed from front, side and back. In profile, posterior projection and upper volume are assessed: where the centre is flat, an implant supplements that volume. From the front, the curve from waist to pelvis matters: where the hip dip is prominent, fat grafting supplements that area. From behind, overall width, left–right balance and the connection into the thigh are reviewed.
The implant therefore handles central volume and fat grafting the surrounding contour. Note that grafting fat does not widen the pelvic bone itself: it adjusts soft-tissue volume to improve the external silhouette rather than changing the skeleton.
Read alsoCorrecting a flat buttock and pelvic line is covered in “Hybrid hip-up surgery: can a flat buttock and pelvic line be changed together?” (Korean).
What should be checked before surgery?
First assess central buttock volume and the lateral pelvic line together, since the extent of surgery differs depending on whether volume is lacking centrally, the hip dip is deep, or both are present. If fat grafting is included, confirm that enough fat can be harvested from the abdomen, flanks or thighs.
Grafted fat is not all retained — some is absorbed during recovery, so early and final volume differ. The implant should also suit the skeleton and gluteal tissue: rather than choosing the largest implant, the existing width, skin condition and desired projection should be weighed.
Gluteal fat grafting is a procedure in which the depth and location of injection are critical to safety. Fat injected into muscle can cause serious fat embolism, so the principle of grafting into the subcutaneous layer only, and the surgeon's technique, should be confirmed. Infection and implant displacement should be discussed with the recovery plan.
In a meta-analysis of 13 studies on combined implant and lipoplasty gluteal augmentation, implant removal rate was 1.70%, and complication rates differed by the plane in which the implant was placed.[2]
Hybrid hip-up: common myths and facts
| You may think… | In practice |
|---|---|
| "Enlarging the buttock fixes the pelvic line." | A hip dip is lateral hollowing that must be filled separately. |
| "More implant and more fat is better." | Placement and proportion, not volume, create a natural result. |
| "Hybrid recovers more easily." | Using both methods means each needs its own recovery care. |
In planning hybrid hip-up I set pelvic width seen from the front and buttock projection seen from the side separately. The implant takes projection, the fat takes the lateral line — dividing the roles is the point.
When the buttock is flat and the side of the pelvis hollow, the line from waist to pelvis to thigh looks flat. Hybrid hip-up addresses both: a gluteal implant for central volume and posterior projection, fat grafting for the hip dip and outer contour. In 147 patients the average combination was a 300cc intramuscular implant with 380cc of fat, and a meta-analysis of 13 studies reported an implant removal rate of 1.70% with complications differing by plane. Grafting does not widen the pelvic bone, and because fat must stay subcutaneous, the technique and safety principles should be confirmed.
🔬 The research behind this article
These are the international journal papers that support the content above. Select a title to open the abstract on PubMed.
- Plastic and Reconstructive Surgery 2019 — composite buttock augmentation in 147 patientsAslani A, Del Vecchio DA. Composite Buttock Augmentation: The Next Frontier in Gluteal Aesthetic Surgery. Plast Reconstr Surg. 2019;144(6):1312-1321.Key: average 300cc implant with 380cc fat, intramuscular placementText [1] · PMID 31764644 · DOI
- Aesthetic Surgery Journal 2026 — meta-analysis of 13 studies on combined implant and lipoplastyElsaftawy A, Bonczar M, Bonczar T, et al. Characteristics and Complications of Combined Implant and Lipoplasty Techniques in Primary Gluteal Augmentation: A Systematic Review and Meta-Analysis. Aesthet Surg J. 2026;46(7):720-727.Key: implant removal rate 1.70%Text [2] · PMID 41092126 · DOI
🎬 Watch: Dr. Park Seong-Soo on video
Korean-language videos from BongBong Plastic Surgery's official channel and Dr. Park's channel, “Seongsu-ro Doctor”. Titles are translated for reference; selecting one opens YouTube.
- Hip-up done properly at BongBong: a hybrid hip-up real storySeongsu-ro Doctor · 2018.10.08
- What is a good pelvic size? Not padding — this is the method nowSeongsu-ro Doctor · 2024.03.15
- Can you have an apple hip with a hip dip? BiVol hip-up without an implantSeongsu-ro Doctor · 2026.08.26
Frequently asked questions
Does hybrid hip-up always combine an implant and fat grafting?
A. It is a method that uses both, but not everyone needs both. The appropriate approach depends on existing buttock volume, the degree of hip dip and the shape wanted.
Is hybrid hip-up necessary for a deep hip dip?
A. Not necessarily. Where central volume is adequate and only the lateral pelvis is hollow, fat grafting alone may be considered; where both central volume and surrounding contour need improvement, the combination can be reviewed.
Can slim people have hybrid hip-up?
A. It depends on body type. Even with an implant for central volume, fat grafting requires harvestable fat, so very low body fat may limit the extent of grafting.
Can hybrid hip-up widen the pelvis?
A. The pelvic bone itself does not widen. Volume is added at the side of the pelvis or outer buttock so the waist-to-pelvis curve looks different.
Does fat grafted into a hip dip last?
A. Not all of it remains. Some is absorbed during recovery and some establishes itself, so volume can differ from the early result; outcomes vary with fat quality, the recipient site and technique.
📖 References
Select a [number] in the text to jump to the source, and ↩ to return. Only papers whose title, journal and year were verified on PubMed are included.
- Aslani A, Del Vecchio DA. Composite Buttock Augmentation: The Next Frontier in Gluteal Aesthetic Surgery. Plast Reconstr Surg. 2019;144(6):1312-1321. — Plastic and Reconstructive Surgery 2019 — composite buttock augmentation in 147 patients. ↩
- Elsaftawy A, Bonczar M, Bonczar T, et al. Characteristics and Complications of Combined Implant and Lipoplasty Techniques in Primary Gluteal Augmentation: A Systematic Review and Meta-Analysis. Aesthet Surg J. 2026;46(7):720-727. — Aesthetic Surgery Journal 2026 — meta-analysis of 13 studies on combined implant and lipoplasty. ↩
BongBong Plastic Surgery · Dr. Park Seong-Soo, Medical Director
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