Abstract
Introduction Intramuscular gluteal augmentation with silicone implants is an established surgical approach aimed at improving implant coverage and contour stability. Conventional intramuscular dissection techniques involve limited visualization, which may affect pocket definition and intraoperative control. Direct-vision dissection represents a technical refinement designed to allow more controlled intramuscular pocket creation. The objective of this study was to describe a controlled direct-vision technique for intramuscular gluteal augmentation using macro-bipolar energy and to evaluate its clinical and aesthetic outcomes. Methods A single-center retrospective observational study was conducted including 17 consecutive female patients who underwent primary intramuscular gluteal augmentation with round silicone implants. All patients were considered unsuitable candidates for gluteal fat grafting and underwent implant placement entirely within the gluteus maximus muscle through direct-vision dissection of the FROD space assisted by macro-bipolar energy. Demographic data, operative characteristics, and postoperative outcomes were analyzed using descriptive statistics. Aesthetic outcomes were assessed through a combined approach including surgeon clinical evaluation, serial photographic comparison, and patient-reported satisfaction. Functional outcomes, particularly pain or discomfort while sitting, were actively assessed at each postoperative visit. Results The median age was 30 years (25-34), and the median body mass index was 28 kg/m² (27-29). The median operative time was 60 minutes (52-60), and implant volumes ranged from 360 to 415 cc. The mean postoperative follow-up was 24 months. Fifteen patients (88.2%) had an uncomplicated postoperative course. One late seroma and one postoperative hematoma were observed. No cases of infection, implant malposition, palpability, herniation, sciatic nerve injury, or revision surgery were documented. Adequate gluteal projection and bilateral symmetry were achieved in all patients based on clinical evaluation, photographic comparison, and patient-reported satisfaction. No functional limitations or persistent pain while sitting were reported during follow-up. Conclusions Intramuscular gluteal augmentation performed using a direct-vision dissection technique assisted by macro-bipolar energy appears to be a safe and reproducible approach in this retrospective cohort. The technique was associated with a low complication rate, efficient operative time, and consistent aesthetic outcomes. Further prospective studies are warranted to confirm these findings and to assess long-term results.