Augmentation Gluteoplasty with Intramuscular Implants: Skin Marking and Rhomboid Pocket View PDF

^*Gabriel Noé
Medicine, Private Practice, Buenos Aires, Argentina
Alejandro Tuero
Medicine, Private Practice, Buenos Aires, Argentina
Carlos Martín Milani
Medicine, Private Practice, Buenos Aires, Argentina
José Héctor Soria
Medicine, University Of Salvador, Buenos Aires, Argentina
Ricardo Jorge Losardo
Medicine, University Of Salvador, Buenos Aires, Argentina

^*Corresponding Author:

Gabriel Noé
Medicine, Private Practice, Buenos Aires, Argentina

Published on: 2026-05-08

Abstract

Background: Increased volume and greater projection of the gluteal region are increasingly frequent reasons for consultation. Prosthesis placement in the intramuscular plane - the most used – offers satisfactory results but is not free of complications. We believe that respecting the limits of the gluteus maximus (GM) muscle reduces them. To this end, we propose a rhomboid-shaped pocket design, which allows the inclusion of larger implants and varied shapes, which provide volume and projection in the four quadrants with predominance in the lower pole.

Material and method: Between 2010 and 2023, 170 patients of both genders were analyzed, who underwent gluteoplasty augmentation. The anatomical bone accidents that we have taken as reference are indicated as the “four points” that give rise to our rhomboidal skin marking, in whose area the extension of the GM muscle is completely included, which was confirmed by ultrasound.

Results: With the creation of a “pocket” oriented by rhomboidal skin marking, the inclusion of larger prostheses was achieved and there were fewer positional complications. The relationship between the bone accidents used and the dimension of the muscle is constant, according to the ultrasound evaluation.

Conclusions: The intramuscular technique with a rhomboid pocket allows for the inclusion of larger implants by descending the dissection almost to the ischial tuberosity, obtaining a better volume effect in the lower poles of the buttocks.

Keywords

Gluteal prosthesis, Gluteal implants, Gluteoplasty, Aesthetic surgery, Surface anatomy

Introduction

In cosmetic surgery, the gluteal region has seen increasing demand, both among women and men, who, in addition to increasing gluteal volume, request improvements in their shape and projection.

Cosmetic surgery in this area is relatively recent, beginning in the 1970s. Initial contributions are recognized as those of González-Ulloa [1] and Buchuck [2], followed by the valuable contribution of Robles et al. [3], who, after an anatomical study, described the retromuscular technique, which obtains good results, but has some limitations that were overcome with intramuscular techniques. Vergara and Marcos [4] published the intramuscular technique with an interesting case series, which was later refined and standardized by González [5], enabling the use of larger, “anatomically shaped” prostheses or implants.

The history of gluteoplasty (a term of Greek origin) with silicone prostheses demonstrates that they can be placed in different anatomical planes, from the most superficial to the deepest. The planes describe are subcutaneous, subfascial (subaponeurotic) [6], intramuscular, and retromuscular (submuscular). Currently, based on the results obtained, the technique of choice is the intramuscular space.

Other surgical procedures are also used to enhance the contour of the gluteal region, such as liposuction and fat transfer, as well as respective surgery of excess gluteal dermo-fatty tissue [7-9]. In this way, great advances have been made in surgical tactics and techniques for the aesthetic improvement of the gluteal area. However, they are not without potential complications, such as the formation of hematomas or seromas, infections, wound dehiscence, implant extrusion, malposition of the prosthesis, asymmetry, compression of an important blood vessel or nerve, etc. Any of these eventualities may require unwanted re-intervention.

Reports from other studies [10-12] of malposition cases indicate that one of them may be caused by not respecting the boundaries of the GM muscle during dissection.

The objective of this article is to present the rhomboidal skin marking with a vertical major axis, which corresponds to the intramuscular space (“pocket”) that allows for the placement of larger prostheses. This marking-which we propose-consistent with the dimensions of the GM muscle. For its demarcation we used four bony landmarks that are expressed in the surface anatomy of the region and that we will describe in this work (Figure 1). We have added the ultrasound evaluation of the surface of the GM muscle, which helps to indicate the area of coverage that the prosthesis would need.