Aesthetic Iliac Crest Surgery

The iliac crest is the widest part of the hip bone (iliac wing) and creates the top portion of the hips. While not often recognized and performed the iliac crest can undergo surgical changes to either make it wider (aiugmentation) or less prominent. (reduction) This is a newer type of aesthetic hip surgery has only be done over the past few years and is the result of increased patient demand and newer suirgical techniques.

Iliac Crest Augmentation (Pelvic Plasty)

Bony hip augmentation is also  known as Pelvic Plasty. While traditional solid silicone hip implants augment the soft tissue area below the  iliac crest and the greater trochanter, b bone hip implanst

Increasing pelvic bone width or Zone 1 hip enhancement has never previously been augmented because there has never been a method to do so.  Zone 1 augmentation requires increasing pelvic width by adding to the wing of the ilium with an implant attached to the iliac crest. This is now capable of being done by a special designed titanium  iliac crest implant that is fixed to the bone by screws. It is available in multiple widths of 15 to 50mms.  It is placed through a small incisi0n just below the anterior superior iliac spine.

Increasing pelvic bone width can often make the subiliac hip dip area deeper or more indented. For this reason many patients benefit by the simultaneous placement of a silicone hip dip implant that is designed to fit or hook into the underside of the titanium iliac crest plate.

There are two types of patients that may seek the Pelvic Plasty procedure. One is the cis-female who has a straight body profile with no curves or the transfemale who naturally has genetically more narrow hips and would benefit from wider pelvic appearance.

Iliac Crest Reduction

The iliac crest is the superior border  of the wing of the ilium and represents the most superior and lateral margin of the pelvic bone. Its front to back distance can be seen in front at the outer lower abdomen as the anterior superior iliac spine. (ASIS) It extends back along its bony rim to the back part of the pelvis at the posterior superior iliac spine (PSIS) which is not usually visible and lies much deeper in the subcutaneous tissues.

But the shape of the iliac crest is not uniformly convex in its front to back length. It is convex in its anterior half where it has its greatest width at the center of the crest. But as it goes posteriorly its shape changes to an inward curve back to the PSIS. This anatomic shape makes the crest’s contribution to bony hip width at its anterior half from the ASIS to the midportion of its length.

While the iliac crest has a substantial amount of bone marrow inside its outer cortical bone covering it can be safely reduced without excessive bleeding. Most reduction amounts are in the range of 8 to 20mms of width. It is necessary to strip off some of its soft tissue attachments at the outer lip (e.g., TFL fascia) to do the bone reduction and this will result in some temporary walking stiffness.

Iliac crest reduction is done from a small incision below and posterior to the ASIS. The iliac crest is reduced by a reciprocating same from the ASIS (including the ASIS) back to where it curves inward at its mid portion. This is usually an 8 to 10mm width reduction.The incision is closed without the need for a drain.

Some short-term disc0mfort with walking will occur but this will resolve with no long term physical limitations.