Butt Augmentation

Buttock Augmentation using a woman’s own fat is popularly known as a Brazilian Butt Lift, BBL.  A full, round butt is certainly in style and all the rage these days. It’s not just about a larger size, but more importantly the shape and contour of the entire midsection that gives an aesthetic derrière. 

The key to a successful transformation is to reshape a woman’s complete silhouette including smoothing out the flanks, narrowing the waist and lower back, enhancing the fullness and roundness of the butt and creating a smooth transition into the upper thighs.  At the same time, the tummy, upper back, and inner thighs are flattened and tightened. The result creates shapely & voluptuous curves, establishing a feminine curvature both from the side and front profile.

The idea is to fill, lift and reshape the buttocks using a patient’s own fat, taken from unwanted areas. The procedure starts with Liposuction of various areas of the body to remove unwanted fat (usually focused on the tummy, midsection, and waist circumferentially).  The fat is kept sterile and the liquid is separated to remove the saline fluid (that was injected to facilitate the liposuction). What is left are the healthy fat cells that can be then transferred back into the body, the majority of which will survive permanently in their new location. 

Is it safe?

There are some unique challenges with this surgery, which highlights the importance of choosing your surgeon wisely. There is the possibility to get a fat embolism if a significant amount of fat enters the bloodstream during the surgery. This is a much greater risk if fat is injected intramuscularly (into the muscle), instead of the safer (and less painful) plane of staying completely above the muscle. Secondly, using the modern technique of Expansion Vibration Lipofilling (EVL) helps the surgeon control and direct the fat graft into specific areas and with a steady pressure. The EVL technique breaks up adhesions in certain areas and helps expand the desired areas to make space for the new fat.  I published a paper recently in the Aesthetics Journal reviewing the ways to stay safe during Buttock Fat Grafting.

How much can be augmented at one time?

Typically between 300 – 1200 mL of fat can be augmented per side of the buttocks. This will strongly depend on the patient, in terms of what will look best for their proportions and stay safe.

Is it true some of the fat disappears?

Yes, as with any fat grafting to the body (face, breasts, buttocks) a certain percentage will be reabsorbed by the body within the first 3 months of the surgery. Usually approximately 65 – 70% of the fat cells that are grafted will survive, depending on the region and technique.

What to Know About the Procedure

Yes, unfortunately there is no way to use a fat “donor” or anyone else’s fat for fat grafting. The immune system would destroy the foreign cells and cause a significant reaction.  

Very thin patients may not have enough fat available for grafting to the buttocks, but even these cases we can often either find some hidden fat deposits, or sometimes encourage them to gain a bit of weight first

This can be discussed further during an individual consultation. This type of procedure can be excellent for woman who are mildly overweight as it allows us to remove excess fat by liposuction from the stubborn areas (tummy, upper abdomen, arms, upper back, inner thighs) to significantly improve the shape and contour of these areas, while also mildly tightening the skin. Secondly, the change to the buttocks is as much about the shape and smooth curvature as about just the size. By hollowing out the love handle area, and filling in the “hip-dip” depression of the lateral buttock, the shape and aesthetics can be dramatically improved.

In my opinion, and that of many experienced surgeons during my Aesthetic Surgery training, implants are far less desirable than using a woman’s autologous fat for a number of reasons. An implant requires a larger incision, looks and feels unnatural, and has several associated complications over time (contracture, implant malposition, infection, need for explantation or replacement). Finally, and perhaps most importantly, it does not address improving the overall silhouette or hour-glass proportions from the waist, hips, and thighs.

For the first 3 weeks after surgery it is necessary to avoid sitting directly on your butt. There is a special pillow that improves the weight distribution while sitting after surgery. It is best to avoid direct pressure on the area, so  you’ll  need to spend these 3 weeks standing, sitting only using the BBL cushion, or laying on your front/side).  You can begin being more active and doing exercise approximately 4 weeks after surgery and by 6 weeks should be able to gradually resume usual activities.

Interestingly it was not invented in Brazil, nor is it truly lifting the buttocks in the same sense as other common plastic surgery procedures (breast lift, face lift, etc.). The procedure was started in the USA, but a “cheeky” marketing campaign called it a Brazilian Butt Lift, paying homage to the more curvy voluptuous Brazilian woman and the name has since become synonymous with the procedure.