The history of gluteal augmentation is well delineated by Guasch and colleagues. The procedure dates back to 1969, when Bartles et al first described the reconstruction of a unilateral gluteal agenesis using a Cronin silicone gel breast prosthesis that was placed above the gluteus muscle. This breast implant served its purpose of augmenting the buttock but was prone to rupture and leakage because of its thin silicone shell. Over subsequent years, other authors described similar reconstructive procedures for the treatment of asymmetry and depressions. However, it was not until 1973 that the first successful augmentation for cosmetic purposes was published by Cocke and Ricketson from Nashville, TN. Cocke had Dow Corning (Midland, MI) make a round implant specifically for the buttock area that had more projection than a breast implant. A Dacron patch was also added to improve tissue fixation. Although this was the first implant specifically designed for gluteal augmentation, it had the same silicone gel density and shell thickness as the mammary prosthesis. A second case report was published in 1975, also reporting placement of implants for aesthetic purposes, but the devices had to be removed because of infection. At this time, the term “platypegia” was introduced by Douglas to refer to buttock adipose deficiency or flat buttocks.Despite its US origin, gluteal augmentation never developed a following in the United States. Instead, Latin American plastic surgeons, beginning with Gonzalez-Ulloa, popularized and refined the technique as a cosmetic procedure. Gonzalez-Ulloa placed the implants above the muscle through bilateral infragluteal crease incisions and subsequently wrote about his 10-year experience in 1991. He was also the first surgeon to create a line of gluteal implants, working with Dow Corning to develop 6 different sizes of almond-shaped (oval) implant. This implant also featured a thicker outer shell with higher silicone shell density that could withstand 300 kg/cm² of pressure, double the resistance provided by breast implants.

Among later publications on gluteal augmentation, Robles published a landmark 1984 article in which he presented his own line of round gluteal implants, manufactured by Silimed, Inc. (Garland, TX). The silicone density and outer shell thickness of these implants, which were manufactured in a variety of sizes, were similar to those of the Gonzales-Ulloa implants. Introduced through a single sacral incision, the implants were placed in the submuscular plane for the first time. About 10 years later, Jorge Hidalgo introduced the round solid silicone elastomer implant. It was modeled after the Robles implant but as measured by its dimensions (height, width, and projection), not necessarily by volume.

In 1996, Vergara developed the anatomic teardrop-style implant, designed for intramuscular placement. Another version of the anatomic implant, for subfascial placement, was designed by De la Pena. Both of these implants were manufactured by Silimed. Several other companies (eg, Hansom Medical, Spectrum Design, AART) now also manufacture solid silicone implants.

Clinical evaluation of the buttock

In determining the most appropriate procedure for buttocks augmentation, 3 components of the buttock must be evaluated: volume, shape, and skin quality/laxity. The buttock’s “bony structure” does influence its overall shape, but not much can be done to correct this. The buttock’s volume and shape are determined mainly by the distribution of fat and, to a lesser extent, muscle.

The buttock is divided into 3 sections: upper, middle, and lower. Each area must be evaluated and addressed independently for the optimal aesthetic result to be achieved.