Introduction: One of the most requested aesthetic procedures is body contouring using liposuction. Adjunctive procedures using fat grafting can provide enhancement in most body areas, commonly used in both gluteal and hip augmentation. Performing processing and enrichment to optimize fat transfer survival can avoid the use of body implants. When there is insufficient fat for the desired degree of augmentation, silastic implant placement is an alternative treatment. Much has been written in the medical cosmetic literature regarding gluteal and breast implants, but nothing in terms of hip silastic implants. Material and Methods: Hip implant patient selection, the body frame analysis, associated enhancing body contouring procedures, implant design and fabrication, and implant surgical placement are analyzed. In 3 different cosmetic surgery practices, methods of patient analysis and the process of creating a custom hip implant is presented. Techniques and protocols in the use of fat grafting in association with both gluteal and hip implants are elucidated. Results: The minimally manipulating fat maneuvers to increase fat survival are detailed. This paper defines the process of planning, designing, and fabricating a custom hip implant with significant patient input. By definition, patient-specific or custom implants can be any shape, size, and projection. The patient and surgeon provide the implant fabrication company a paper tracing of the surface area of the proposed implant along with the maximum projection. Engineering creates a 2-dimensional drawing using a computational software for intelligent system design or CAD. The implants are fabricated with input from the surgeon on silastic durometer, implant alterations to lower weight and enhance ease of folding for placement, and shape. Caveats and pitfalls in surgical planning, implant design, fabrication, and surgical placement are identified. Discussion: Body contouring using ultrasound liposuction may provide the desired aesthetic result. When augmentation is requested, fat transfer is the preferred initial procedure. If there is an insufficient volume of fat to augment both the buttocks and hip area, hip fat grafting is preferred to avoid a hip alloplastic implant. The reason for this treatment recommendation is to avoid the hip implant with a higher risk profile. Once the indication for the hip implant is confirmed, usually because of either inadequate presence of fat or a desired maximum hip projection that cannot be attained by fat grafting alone, the body shape analysis is finalized. Conclusion: Custom silastic hip implants are designed, fabricated, and surgically placed to provide the patient desired cosmetic hip augmentation.
