Abstract Gluteal augmentation is typically carried out by implant placement or autologous fat grafting. Over recent years, there has been a significant increase in the number of gluteal augmentations being performed. However, as the number of procedures has increased, so too have the number of complications. We present a case of a 33-year-old female with an implant infection with concomitant sciatic nerve transection following bilateral gluteal augmentation with implants leading to a permanent foot-drop. While transient sciatica due to compression has been described as a complication of gluteal augmentation, this is the first reported case, to our knowledge, of transection. The many unusual management decisions that had to be made when faced with this rare and devastating complication are highlighted and the relevant literature on gluteal augmentation is discussed. Patients and surgeons alike need to take particular care when considering this procedure.