Characteristics and Complications of Combined Implant and Lipoplasty Techniques in Primary Gluteal Augmentation: A Systematic Review and Meta-Analysis

Gluteal augmentation using a combination of implants and fat grafting has gained popularity for balancing projection, contouring, and safety. Fat grafting provides natural shaping but carries risks of variable survival and embolism, whereas implants ensure stable volume but may result in palpability, unnatural contour, or malposition. The composite approach aims to integrate the advantages of both techniques while mitigating their limitations. The objective of the authors of this study was to evaluate the characteristics and complication rates of combined implant and lipoplasty techniques in primary gluteal augmentation, with attention to surgical parameters influencing safety and outcomes. A systematic review and meta-analysis was conducted by searching major databases for studies reporting quantifiable outcomes of combined implant and fat grafting. Data extracted included implant type, surgical plane, fat grafting method, and complication rates. Random-effects models were applied, with heterogeneity assessed using the I2 statistic. Thirteen studies met inclusion criteria. The pooled implant removal rate was 1.70%, higher in the submuscular plane (1.69%) than the intramuscular plane (0.51%). The intramuscular plane had higher dehiscence (14.56%) and hematoma rates (1.10%), whereas submuscular placement carried a greater risk of sciatic neuropathy (3.91%). Drain use was associated with higher seroma rates (6.39% vs 1.88%) but lower infection (0.44% vs 1.75%) and hematoma incidence (1.73% vs 1.97%). Composite gluteal augmentation optimizes projection, soft-tissue coverage, and contouring while balancing complications. Implant plane selection, incision strategy, and postoperative management are critical to safety. Further standardized studies are needed to establish best practices and long-term outcomes. Level of Evidence: 3 (Therapeutic).