Biopolymer removal from the buttocks: how the area looks and what to expect

The buttock is the area where most biopolymers have been injected and, by some way, the one that generates the most repeated question in the consulting room: “am I going to be left with a hollow?”.

That question deserves a direct answer before anything else, because it is the one that decides whether someone books an appointment or goes on waiting. This page answers it, and then explains what is done exactly, what the published series say about complications and improvement, and what is checked before going into theatre.

The general process is in the guide to biopolymer removal. If you are still deciding, the page that deals with that is remove or monitor.

“Am I going to be left with a hollow?”

It is the real fear, and it is worth taking apart piece by piece rather than answering with a “no” that would be no use.

First: the material is not where people think. There is no bag of product that can be emptied leaving a hole. In the buttock, biopolymers infiltrate between the fat, the fascia and the muscle, and that is exactly why the surgery does not consist of “taking it out” but of removing the infiltrated tissue. The hollow does not appear because a filler is taken away: it appears, if it appears, because tissue that is no longer normal has to be resected.

Second: that can be planned. The prior MRI says how much there is, where it is and which planes it has spread through, and with that map the approach is decided along with what will be needed to cover the defect. It is set out in the page on which test detects it and what shows up.

Third, which almost nobody says: in some cases the contour improves. In the series of 199 patients operated on in Medellín between 2022 and 2024 with a three-flap technique, the authors describe improvement in gluteal droop after surgery, along with the improvement in symptoms and quality of life. It is not a promise — it is a series, from one team, with their technique — but it disproves the idea that having surgery necessarily means the shape gets worse.

And fourth, which is the honest part: there are cases where a contour deficit does remain, above all when there is a lot of material, it is widely spread or the skin has lost quality. When that is foreseen, it is discussed before surgery and what can be done about it is considered. That is subsequent reconstruction, not a surprise in recovery.

What is done exactly

There is no single operation called “gluteal biopolymer removal”. There are different approaches according to the quantity, the depth and the state of the tissue, and it is worth knowing the range because it explains why two people with the same diagnosis come out with different plans.

In the recent literature at least three approaches coexist:

• An open paramedian approach, described in a series of 35 patients with mild to moderate involvement. The authors present it as a safe alternative in those cases, with favourable aesthetic results.
• Flap techniques, for cases where removing the infiltrated tissue leaves a defect that has to be covered and supported. The series of 199 patients uses a three-flap technique in the gluteal and lumbar regions.
• An approach directed at deep structures, where the material has reached muscle or is compressing a nerve.

What the three have in common: the infiltrated tissue is removed, not a product, and the aim is to leave the area in the best possible condition of shape and cover.

How we do it

The approach is V-shaped or thong-shaped, and the choice comes from where the material is and how much skin has to be removed: they are two ways of distributing the same scar across the upper part of the buttock, where it is covered by underwear and by a swimsuit.

We always do the buttock lift in the same session. It is not an aesthetic extra offered separately: removing the infiltrated tissue leaves surplus skin over less content, and if that skin is not resected and tightened in the same operation, the buttock is left sagging and empty. Doing it at the same time leaves the result somewhat better than it would be without. That is the correct expectation, and no more than that.

And we preserve a flap of healthy lumbar tissue — tissue that is not infiltrated — to keep your own volume and reposition it where it is needed. It is the difference between reconstructing with what you have and simply leaving the area emptied.

🚨 The usual outcome is that some aesthetic deficit remains in the buttock, even with the lift done at the same time. There are cases where the result does not look bad, but that is not what to expect at the outset. This surgery is undertaken to resolve a health problem — removing a material that is causing symptoms — and the shape of the buttock is what we try to salvage along the way, not the objective. If what you are after is a good-looking buttock, this operation is not that, and it is worth knowing beforehand rather than afterwards.

All of the above depends on how much material there is, in which plane it sits and on the state of your skin: that is said by the examination and the MRI, not by this page.

The numbers, unvarnished

Two recent series, with different patient profiles, give the real range of what happens afterwards:

Two readings worth taking together:

1. The numbers get worse when the case is worse. These are not “better” and “worse” techniques: the series of 35 cases is of mild to moderate involvement, and the one of 199 includes cases that needed flaps. Comparing the figures without that context leads to false conclusions.
2. Most of the complications are wound-related, not material-related. Seroma, dehiscence, infection. They are what shapes the recovery and what explains why this surgery needs close follow-up and not a check-up at three months.

In the series of 35 patients, the authors also note that the complications described did not require further procedures. It is an important qualification: frequent is not the same as serious.

The sciatic nerve: the buttock’s own complication

This is the part that sets the buttock apart from any other area, and the reason imaging beforehand is not optional here.

Where the material was injected deep, it can end up in contact with the sciatic nerve or compressing it. It is described in the literature: in a case published in 2025, a patient with deep biopolymer injection in the gluteal region had sciatic compression, and the authors describe the surgical technique for removing the material from the subcutaneous tissue, from the muscle and from the nerve itself, with improvement in symptoms.

What that means for you, specifically:

• Pain running down the leg, tingling or loss of strength is not “just age” if you have gluteal biopolymers. It deserves investigating.
• It is one of the reasons the MRI governs before this surgery: knowing whether the material has reached that plane changes the operation.
• It is not the usual case. It is one published case, not the norm, and it should not be read as what is going to happen to you.

If what you have right now is symptoms and you do not know whether they come from this, the page that sorts it out is symptoms and warning signs.

What is worth checking before going into theatre

Here there is a little-known and quite actionable finding.

In a series of 20 patients operated on with open removal from the buttocks and lumbosacral region, with gluteal reconstruction using their own tissue, the authors found hypercalcaemia in 30%, raised LDH in 40% and raised parathyroid hormone in 15%. Their recommendation is explicit: measure LDH, serum calcium and parathyroid hormone to assess severity and guide management.

Put plainly: the chronic reaction to the material can leave a trace in a blood test, and that trace helps establish how active the situation is. It is not a diagnostic test for biopolymers — there is no such thing — but it is useful information that is not always requested.

Our pre-operative work-up includes calcium. It is the measurement with an immediate practical consequence — hypercalcaemia from a granulomatous reaction is treated, and doing so before surgery changes the management — and that is why it is in the routine blood tests for these cases, not only where there are symptoms.

LDH and PTH are not part of our pre-operative work-up. What is published about them stays above as what it is: a finding from the literature, useful for understanding the mechanism, which is not requested routinely here. If a particular case needs them, they are requested on indication, like any other test.

One more thing, if you are of childbearing age

It is a detail almost nobody knows and which can matter a great deal at a specific moment: gluteal biopolymers can migrate towards the lumbar region, and the presence of foreign material there is considered a relative or absolute contraindication to epidural or spinal anaesthesia.

The good news is that in the two cases published in 2026 on this, the solution was the same: studying the anatomy with imaging beforehand. In one, with migration confirmed on MRI as far as L5-S1, the epidural was placed higher — at L1-L2, under ultrasound guidance — and the birth and the subsequent caesarean went without incident. In the other, a patient who had previously been deemed not a candidate for epidural analgesia was able to have it after a radiological reassessment identified a safe approach.

The practical conclusion is simple and worth writing down: if you have gluteal biopolymers and become pregnant, tell the anaesthetic team in good time, not on the day of the birth.

Frequently asked questions

Will they be able to take it all out?

Complete removal is rarely achieved. The material infiltrates between the tissues and does not form a pocket that can be emptied, so the aim is to remove as much as possible and resolve the problem. The authors of the series of 199 patients themselves acknowledge that further studies are needed to quantify how much material is really removed.

How long does the operation take?

It depends a great deal on the case. As a published reference, in the series of 199 patients with a three-flap technique the mean duration was 270 minutes. It is a long operation, and knowing that is part of deciding with the information on the table.

Is the reconstruction done in the same session?

It depends on how much tissue has to be removed, on the state of the skin and on whether there is active inflammation. In some series the reconstruction is done in the same operation using the patient’s own tissue, and in others it is planned as a second stage. It is one of the things decided with the MRI in front of us.

Will I need drains?

It is frequent. In the series of 199 patients, 29.1% needed them, and in the series of 35 the commonest complication was a seroma — a collection of fluid — which appeared at 31 days on average. The drains and the frequent appointments are there for that.

Will I have scars?

Yes. This surgery leaves a scar, and its length and position depend on the approach your case needs. How it develops and how it is cared for is on the page about scars after removal, and the general approach to improving a scar is in scar improvement.

I have pain running down my leg — is it from the biopolymer?

It may be, and it deserves investigating. Compression of the sciatic nerve by deeply injected material is described. It is not the usual case, but it is one of the reasons imaging is requested before deciding anything.

Can I have a buttock implant afterwards?

It is a possibility that gets assessed, not an automatic decision, and it depends above all on the state of the tissue that is left. It is dealt with on the reconstruction page.

Do the general symptoms improve, not just the area?

In the series of 199 patients there were statistically significant reductions in muscle pain, fatigue and anxiety, as well as improvements in sleep and exercise frequency. It is an encouraging finding and it is worth reading with its context: it is set out in what results to expect after removal.

How long will I be off work?

It depends on the approach, on how much is removed and on your job. It is the question the recovery and sick leave page answers.

Sources

• Osorio E, Ramírez B, Herrera O, Suarez C, Ciro C, Varela A. Three-flap Technique: Comprehensive Approach for Biopolymer Removal in the Gluteal and Lumbar Regions. Plast Reconstr Surg Glob Open. 2026;14:e7870. A retrospective cohort of 199 patients operated on in Medellín between January 2022 and September 2024; pre-operative assessment with clinical classification, MRI and symptoms; mean surgical duration of 270 minutes and mean fall in haemoglobin of 3.3 g/dl; complications: need for a drain 29.1%, dehiscence 21.1% and tissue necrosis 3.5%; improvement in gluteal ptosis, in quality of life and in symptoms, with statistically significant reductions in myalgia (OR 0.15), asthenia (OR 0.03) and anxiety (OR 0.08); the authors note that further studies are needed to quantify the material removed and to compare with other techniques. https://pubmed.ncbi.nlm.nih.gov/42495057/
• Eusse Llanos JC, Posada López S. Paramedian open approach for gluteal biopolymers removal: a case series of 35 patients. JPRAS Open. 2025;45. A series of 35 patients with mild to moderate involvement; the most frequent complication was seroma (40%), with a mean time to formation of 31 days, followed by wound dehiscence and infection; there were no cases of flap necrosis or haematoma; 42.85% had no complication at all; the authors conclude that it is a safe alternative with favourable aesthetic results and that the complications did not require further procedures. https://pubmed.ncbi.nlm.nih.gov/40837208/
• Lancheros-Ramirez P, Guerrero-Calderón D, Ramirez-Folleco A. Surgical Approach for Sciatic Nerve Entrapment Secondary to Biopolymer Injection. Plast Reconstr Surg Glob Open. 2025;13:e7146. A case of deep biopolymer injection in the gluteal region with compression of the sciatic nerve; the technique for removing the material from the subcutaneous tissue, the muscle and the nerve is described, with improvement in symptoms and in the aesthetic result, alongside a structured review of the published surgical approaches. https://pubmed.ncbi.nlm.nih.gov/41040899/
• Pachón Suarez JE, Tello VZR, Cifuentes RCR, Cuadros AMP, Salazar MC. Biopolymers: Histopathologic Case Series of Patients with Permanent Synthetic Fillers Presenting Chronic Granulomatous Reaction and Hypercalcemia. Plast Reconstr Surg Glob Open. 2024;12:e6159. A series of 20 patients who had open removal from the buttocks and lumbosacral region with gluteal reconstruction using autologous tissue, in Bogotá between 2020 and 2023; hypercalcaemia in 30%, raised LDH in 40% and raised PTH in 15%; the authors recommend measuring LDH, serum calcium and PTH to assess severity and guide clinical practice. https://pubmed.ncbi.nlm.nih.gov/39410973/
• Mullins H, Spence NZ, Achu-Lopes R. Neuraxial Anesthesia in a Parturient With Migrated Gluteal Biopolymer: A Case Report. A A Pract. 2026;20:e02196. Gluteal biopolymer injections can migrate unpredictably to the lumbosacral region and pose a barrier to neuraxial anaesthesia; in the case described, with migration confirmed on MRI as far as L5-S1, an epidural was placed at L1-L2 under ultrasound guidance during labour and then used without incident for the caesarean. https://pubmed.ncbi.nlm.nih.gov/42024805/
• Foggi Viligiardi T, Matteoni C, Bitossi U, Micaglio M. Thoracolumbar labour epidural analgesia in a parturient with permanent gluteal silicone-like biopolymer infiltration. Anaesth Rep. 2026;14:e70060. Permanent fillers can migrate along fascial planes and induce chronic inflammation, fibrosis and a granulomatous reaction years later; the presence of foreign material in the lumbar region is considered a relative or absolute contraindication to epidural or spinal techniques; in the case described, a patient previously deemed not a candidate was able to receive epidural analgesia after a radiological reassessment identified a safe low thoracic approach. https://pubmed.ncbi.nlm.nih.gov/41971678/

Book your consultation

If you have biopolymers in your buttocks, what orders the conversation is not an opinion: it is knowing how much material you have, in which planes it sits and what state the tissue is in. With the MRI in front of us we can talk about the approach, the contour and what to expect, instead of talking about fears.

At the assessment we explain what can be removed in your particular case, what is expected for the shape and what would be needed afterwards.

Clinical confirmation by the surgeon

Dr Enrique Salmerón González

Specialist in Plastic, Aesthetic and Reconstructive Surgery
Registration no. 46/4624077

Dr Elena García Vilariño

Specialist in Plastic, Aesthetic and Reconstructive Surgery
Registration no. 46/4624503

Last reviewed: 6 September 2026. This content is for information only and does not replace an individual assessment by a healthcare professional.