Background: Gluteal augmentation and reshaping have recently gained popularity due to growing patient demand. The rising number of intramuscular gluteal augmentation procedures has led to a corresponding increase in implants, although this has not reduced noticeable esthetic flaws and relatively common postoperative complications. The patient often opts for a secondary gluteal replacement implant. However, studies on this procedure are scarce. 

Methods: We describe our secondary submuscular gluteal implant replacement technique in patients complaining about dislocation or complications with the primary intramuscular gluteal implant. This procedure involved creating a new round implant pocket in a deeper anatomical plane while keeping the gluteus maximus muscle bridge that joins the intramuscular pocket with the submuscular pocket as intact as possible. To achieve this result, we describe the safest way to remove the intramuscular implant: a small incision is performed posterior to the iliac crest, through which the intramuscular gluteal implant is removed via a small intramuscular-subcutaneous tunnel. We reviewed surgical data, focusing on implant size choice and postoperative complications. 

Results: We performed this technique on 108 patients. The most frequent complications included three cases of laceration of the muscular bridge between the old intramuscular plane and the new submuscular pocket, resulting in both pockets merging, and eight cases with temporary nerve pain lasting a few days postoperatively. 

Conclusions: This study validates our approach for addressing and preventing dislocation or other complications from intramuscular gluteal augmentation procedures with implants by applying a safe technique that involves replacing the intramuscular implant with a submuscular one.