Pilot Study: Hourglass Technique for Male Gluteal Enhancement.

Background: The aesthetic demand for male gluteal augmentation is increasing; however, most existing techniques are designed for female anatomy, risking undesired feminization in male patients. This pilot study proposes the "hourglass technique" using hyaluronic acid (HA) fillers as a minimally invasive approach to enhance male gluteal contours while preserving masculine features. Methods: A total of 10 male patients 20-45 years of age underwent gluteal augmentation using a cross-linked HA filler (UP Max, Ilikia, CGBio). The hourglass technique targets 3 anatomical regions-upper pole, projection, and lower pole-while avoiding the trochanteric depression ("no touch area") to maintain natural contours. Injections were performed with an 18G cannula in the superficial subcutaneous plane. Safety, tolerance, and aesthetic outcomes were assessed clinically and via photographic documentation up to 30 days postprocedure. Results: All patients demonstrated enhanced gluteal definition and projection with the preservation of masculine traits and no feminization. No adverse events were reported, aside from mild localized pain and bruising. Results were stable and aesthetically satisfactory at the 30-day follow-up. Conclusions: The hourglass technique with HA fillers is a safe, effective, and reproducible option for subtle male gluteal enhancement. It preserves masculine anatomy and offers a minimally invasive alternative to surgery, warranting further investigation in studies with longer follow-up and larger samples.