Complications following Primary Implant-Based Gluteal Augmentation: A Systematic Review and Meta-Analysis

BACKGROUND: Gluteal augmentation is a widely performed aesthetic procedure, with implants providing a reliable alternative for patients with insufficient donor fat or those seeking a more pronounced and predictable volume enhancement. However, complication rates remain a concern, and it is unclear how different surgical techniques influence outcomes such as wound dehiscence, seroma formation, capsular contracture, and implant malposition. This systematic review and meta-analysis aimed to evaluate the safety and complication rates associated with implant-based gluteal augmentation, with a focus on how different surgical and procedural factors may influence these outcomes. METHODS: A systematic search of MEDLINE (PubMed), Embase, Scopus, and Web of Science was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The Risk-of-Bias in Nonrandomized Studies-of Interventions, Version 2 tool was used to assess the risk of bias, and publication bias was analyzed using funnel plots and the LFK (Luis Furuya-Kanamori) index. RESULTS: A total of 32 studies comprising 2682 patients were included in the meta-analysis. Textured implants had higher complication rates, including seromas (7.50% versus 2.56%), dehiscence (13.98% versus 6.63%), and capsular contracture (2.06% versus 0.55%), compared with smooth implants. Subfascial placement had the highest seroma (22.25%) and dehiscence (27.07%) rates, whereas intramuscular and submuscular placements showed lower complication rates. The overall implant removal rate was 1.05%, with subfascial placement exhibiting the highest rate (5.23%). CONCLUSIONS: Implant-based gluteal augmentation remains a viable option, but careful selection of surgical technique is crucial to minimize complications. Although intramuscular and submuscular placement appear safer, further prospective, standardized studies with long-term follow-up are needed to refine surgical strategies and improve patient outcomes.