The Dual Plane Gluteal Augmentation. An Anatomical Demonstration of a New Pocket Design.

BACKGROUND: Fat grafting is the favored option for buttock augmentation by most surgeons and buttock implants are mostly regarded second choice. Accepted options for buttock implant pocket dissection are subfascial, intramuscular and submuscular. To overcome the limitations of both intramuscular and submuscular pockets, and combine the benefits that both of them have, we present a novel dual-plane pocket dissection. The dual plane pocket means a submuscular plane in the cranial half of the pocket and switching to an intramuscular plane in the caudal half. With this study we want to describe our experience with this technique and analyze the dissection of the pocket on human cadavers.

METHODS: We have reviewed 82 consecutive composite gluteal augmentation cases from March 2019 to November 2019. In all cases the implant has been placed "dual plane". The clinical study has been supplemented by 10 hemigluteal dissections in 5 cadavers following the surgical technique, assessing afterwards the anatomical components of the implant pocket created.

RESULTS: Patients who underwent this technique showed excellent soft tissue coverage over the implants. Main complications observed were seroma formation (5 out of 82 patients) and temporary sciatic pain in 4 of the patients. The anatomical study confirmed double muscle coverage of both gluteus maximus and partial medius in the upper pocket pole, and intramuscular gluteus maximus implant position in the lower pole.

CONCLUSION: We present the dual-plane dissection technique as a valuable innovation to improve soft tissue cover for the upper implant pole in buttock implant surgery.