Buttock augmentation can be done by two different methods. The most popular method today is the Brazilian Butt Lift (BBL), more generically known as fat injection buttock augmentation. It is popular because many people have excessive fat and this is a method of fat redistribution that creates improved body contours. Conversely buttock implants is less commonly done and with a longer recovery time. It is reserved for those women who do not have enough fat for a BBL buttock augmentation procedure.
While often seen as an either/or approach, buttock implants and the Brazilian Butt Lift can be complementary to each other in certain patients. In women that do not have enough fat to harvest for a significant buttock augmentation effect, buttocks implants can be initially placed. Often this will be adequate for many patients. But for those buttock implants placed in the intramuscular location, the size limitations of the pocket or the lack of adequate lateral volume near the hip area may create a desire for a second stage fat injection treatment.
While the amount of fat a patient has may be inadequate for a full BBL procedure, most patients will have enough for a smaller contouring BBL procedure after buttock implants. A few hundred ccs of fat injected around the upper and outer perimeter of the buttock implants can create a fuller and more shapely buttock augmentation result. This is perfectly safe as the plane of the fat placement remains above the muscle and well away from the implant pocket.
Injecting around buttock implants that are above the muscle (subfascial plane) is a bit more treacherous. While fat injections can still be done, it is critically important the injected fat does not violate the implant capsule. If that should happen, there is a substantial risk of creating an implant infection.
Buttock augmentation by fat injections, more commonly known as the Brazilian Butt Lift (BBL), has become widely popular over the past decade. The simultaneous body contouring by a liposuction fat harvest and the use of the fat for buttock augmentation offers a dual body contouring benefit. Compared with the use of buttock implants, a fat transfer can create a better buttock shape with a lower risk of complications and a faster recovery.
To achieve a successful Brazilian Butt Lift, a fair amount of fat needs to be harvested. To make it really worthwhile from a size standpoint, as much as 500 to 1000ml of fat is needed per side. And this represents concentrated fat not just liposuction aspirate harvest. To get an adequate fat harvest in many patients, it is an effort dependent process on the part of the surgeon. The use of power-assisted liposuction (PAL) makes it less fatiguing for the surgeon and has become my liposuction device of choice in large liposuction harvests such as is needed in BBL surgery.
In the November/December 2015 issue of the Aesthetic Surgery Journal the article entitled ‘Power-Assisted Gluteal Augmentation: A New Technique for Scultping, Harvesting, and Transferring Fat’ was published. In this paper the authors describe their technique to large volume buttock augmentation that combined power-assisted liposuction (PAL) and fat harvesting of the zones around the buttock with autologous fat transfer. In 110 patients liposculpting and fat harvesting were done with a power-assisted liposuction device. Fat was then transferred to the buttocks with simultaneous power-assisted vibration and tunnelization. Harvested liposuction volumes ranged from 1400 to 5000mls and injection volumes ranged from 300ml to 900ml per buttock. Patients were followed for an average of 20 months. Complications included a persistent burning sensation (5%), persistent swelling in the lower back (3%) and a mild infection in one patient. (1%)
While the use of PAL for far harvest is well known, the use of the power-assisted device for fat injection/placement has not been described previously. Previous studies have shown that fat harvested from PAL offers superior fat cell yields to that of non-power assisted methods. Injecting the fat through a 3mm liposuction cannula under the vibration of the device is an interesting approach to the multiplanar delivery of fat to the buttock tissues. Whether this truly improves the fat graft survival rates has not been proven, and this study certainly does not do so, but it appears to have a good mechanical effect at dispursing the fat throughout the buttock tissues. It certainly appears to be easier to place the fat than through traditional syringe injection methods.
Buttock enlargement by fat injections (aka the Brazilian Butt Lift) is the most popular method for this procedure. The dual benefit of the body contouring effect from the liposuction harvest to obtain the fat needed for injection is one of its most appealing attributes besides its non-implant method. But it is not a complication free procedure and there are risks of infection, fat necrosis and oil cysts as well as the uncertainty of how much of the far will actually take.
Death from buttock injections is most commonly associated with the injection of silicone oil and other unapproved materials. Intravascular injection of the materials with pulmonary emboli is the usual identified cause of the fatal outcome. But such adverse events with fat injections from BBL is far more rare.
In the July 2015 issue of the journal Plastic and Reconstructive Surgery the paper entitled ‘Deaths Caused by Gluteal Lipoinjection : What Are We Doing Wrong?’ In this paper from South America the authors polled Mexican and Coliumbian plastic surgeons for deaths from fat injection buttock augmentation. Between these two countries a total of 64 deaths were reported from liposuction with 13 specific deaths related to buttock fat injections. All deaths occurred wither during surgery or within the first 24 hours after surgery. Autopsy results from some of the patients showed very evident fat pieces/particles in the lungs. The authors conclude that injecting fat into the deep muscle planes of the gluteal muscles was the source of the fat emboli and its subsequent morbidity.
The goal of injecting fat into the buttocks is to achieve maximum fat survival. One of the techniques to help achieve that end is to place some of the injected at into the muscles. The greater number of blood vessels in the buttock muscles compared to that of the subcutaneous fat is believed to result in improved fat survival. However deep in the gluteal muscles are the subpiriformis and supraprirformis channels were larger blood vessels exist.
What this paper alerts plastic surgeons to is that, while injecting fat into the buttocks can be beneficial for fat survival, it should be done only in the superficial part of the gluteus muscle just after piercing its fascia lining. Deep fat injections runs the risk of inadvertently piercing the large gluteal vessels with risk of lethal fat embolism..
Background: Buttock augmentation has emerged over the past decade as the fastest growing body contouring procedure that now rivals breast augmentation on overall interest and number of procedures performed. While implants can be used for the buttock augmentation material, fat grafting is by far more common and popular. Injection fat grafting offers a natural and potentially more effective buttock augmentation material than implants as it can provide a greater volumetric effect for many patients.
Fat injection buttock augmentation, better known as the Brazilian Butt Lift (BBL), has the unique quality of providing a dual body contouring benefit. The need for large amounts of fat obtained through liposuction creates an aesthetically desireable body contouring/thinning above the waistline. The more aggressive that liposuction is performed the more fat that is available to be injected and the greater the surrounding body shape reduction is. Any buttock augmentation result will appear bigger if the waistline above it is smaller.
But no matter how much fat is obtained for a BBL, the result will ultimately depend on the percent of injected fat that survives. While there are numerous methods of fat harvest, preparation and injection, the optimal method for fat grafting to any body area remains up for debate.
Case Study: This 38 year-old male wanted a combination of buttock augmentation and contouring of multiple body areas. While she already had a wide buttocks the overall volume and projection was lacking. She previously had been through breast reduction and a tummy tuck by other surgeons previously with satisfactory results.
Under general anesthesia, she initially had extensive liposuction done on the full abdomen, flanks and back obtained 5,500cc of aspirated fat. The fat was concentrated down to 1,600cc by a filter and double wash method with Lactated Ringer’s solution. The in the prone position 800cc of fat was injected into each buttock and hip areas.
When seen at 15 months after surgery, her buttock augmentation result was impressive. While the body contouring effect above it was extremely helpful in enhancing the size of the buttocks, the volume of fat take created much of the BBL result seen. While there is no way to really estimate what volume of fat survived, it is fair to say that as much as 75% may have lived. At over one year after surgery, this retained buttock fat volume would be deemed permanent.
1) The success of the Brazilian Butt Lift depends on how much fat can be harvested and injected.
2) The take of fat in the Brazilian Butt Lift procedure can be 50% or higher for many patients.
3) The body contouring effect around the buttock augmentation result enhances the overall buttock enlargement effect.
The Brazilian Butt Lift (BBL) is one of the most popular body contouring procedures today. Using the patient’s own fat which is harvested by liposuction and then concentrated, it is injected into the buttocks to increase its size. It is not really a buttock lift per se but one could argue that the increase in buttock size provides a bit of a volumizing lift. Regardless the name and its acronym, BBL, have stuck in the plastic surgery nomenclature.
Once the fat has been injected, there is no consensus as to how to keep fat in the desired buttock position or to help shape the fat-injected buttocks afterward. Most plastic surgeons use a general compression garment that is typically used for liposuction of the thighs and abdomen. It applies a generalized light compression force to the entire buttocks but it is certainly better than no wearing no after surgery garment at all.
But there are very specific types of buttock reshaping garments that are available that apply a circumferential compression around the buttocks, like a circular ring. This would seem to be a better method of force distribution, in theory keeping the fat localized to the desired area of maximal buttock projection. This forced projection is largely negated when one sits down but in a vertical or prone position helps keep the fat grafts localized. Such garments do the obvious, leave a large hole so that the buttocks is pushed up and out. These garments are available on eBay or Amazon at prices from 10 to 45 dollars.
While there is no real science behind the concept of shaping the fat-injected buttocks by an external garment, it seems to make sense and will certainly do no harm. Until one day an active buttock reshaping garment becomes available, these passive garments that provide buttock mound protrusion by compressing around it are an inexpensive option to help get the best buttock shape after fat augmentation.
The desire for fuller and more uplifted buttocks is one of the most popular body contouring requests in the past few years. When it comes to the buttocks, the issues mainly consist of its size and shape as well as the texture of the overlying skin. Implants, fat injections, liposuction and cellulite treatments are available for the cosmetic improvement of the buttocks. But because of their relative newness of buttock enhancement procedures, there are many misconceptions and myths about them. Here are some of the most common butt myths.
Liposuction can help get rid of cellulite on the buttocks. The search for an effective cellulite treatment has been ongoing for years and to say that it is elusive is an understatement. The buttocks is a prime location for the cottage cheese look of the skin. Over the years such treatments as Endermologie and VelaShape have been promoted but their effects are short-term and any improvement requires regular maintenance treatments. Liposuction surgery, however, is exactly what you don’t want to do. Liposuction removes the superficial layer of fat and removes the support from the overlying skin…this has the high likelihood to make the appearance of cellulite even worse. The newest cellulite treatment, Cellulaze, may offer improvement of buttock cellulite on a more sustained basis but long-term results (years) remain to be reported.
Fat injections are a better option for buttock enlargement than implants. The most popular method today for increasing the size of the buttocks is fat injections. Known as the Brazilian Butt Lift, its popularity is because it requires simultaneous liposuction for the fat harvest and a a result one also gets some body contouring through abdominal and flank reduction. (the largest sources of excess fat in most people) Fat injections also make the recovery from the surgery much easier as the real recovery is from the liposuction harvest sites not the buttocks. All of this makes fat injections so much more appealing than the intramuscular placement of implants which have a much longer recovery. With the exception of one thing…the survival of fat injections is unpredictable while implant produce a reliable and permanent means of buttock augmentation.
Sitting on buttocks that have been injected with fat will cause it to resorb. The take of fat injections into the buttocks depends on some of the fat getting an adequate blood supply (nutrition) and perhaps some of its stem cells that accompany it becoming fat cells themselves. This is a process that takes several weeks after surgery. But once the fat cells take, the y should be permanent provided one takes does lose a lot of weight later. But sitting on the buttocks over time is not going to cause the fat to resorb anymore than one’s natural fat there would. But it is important in the first few weeks after surgery to avoid prolonged sitting so as to not induce pressure on the newly implanted fat which may have a negative effect on its survival.
The buttocks can be enlarged and lifted by exercise. The gluteus muscles (maximus and minimus) are large-sized and occupy a significant part of the buttocks depending upon their natural size. Like any muscle, it can be toned and enlarged. So to say that exercise can make your buttocks bigger is true…but only by a minimal amount. Strengthening and toning of the gluteal muscles can definitely be done and this may provide a degree of a ‘buttock lift’ but not actual enlargement of the buttocks.
On the final day of 2012, it is interesting to look back and see what some of the trends and interests were in plastic surgery over the past year. While plastic surgeons may perform the surgeries, the interest of patients drive the number and type of surgeries that are done. For this reason, it is noteworthy to look at what procedures were most searched for online.
The popular plastic surgery website, Real Self, reported its top searches for 2012 based on over 50 million searches. The top 10 included tummy tuck, breast implants/augmentation, rhinoplasty, Brazilian butt lift, Botox, Coolsculpting, Breast Reduction, Cellulaze and Liposuction. The procedures that had the greatest increase in interest over the past year were the Brazilian butt lift (up 28%), Cellulaze (up 32%) and labiaplasty. (up 22%)
These search results, albeit just from one source but a very reliable one, provides insight into the public’s evolving interest in face and body modifications. Three of the historically popular and still highly performed procedures, tummy tuck, breast augmentation and rhinoplasty, remain on the top of the list. Not surprisingly, flatter stomachs and more shapely waistlines, larger breasts and nose reshaping are still highly desired. While they were far from being up on % increase in searches, it would be hard to do so when you have been so popular for decades.
The popularity of the Brazilian butt lift, a procedure that was largely unknown just less than a decade ago, is a reflection of society in general. Largely an ethnic procedure for Hispanics and African-Americans, it parallels the changing population mix of the U. S. It is also an indication of the influence of celebrities on plastic surgery. (the Kardashian effect) While buttock implants have been around for awhile, the allure of using one’s own natural fat and getting some fat reduction in other body areas as part of the procedure is undeniably appealing. The large percent increases in interest in the procedure over the past two years is primarily a result of its ‘newness’. But I would wager five or ten years from now, buttock augmentation will be a permanent member of the all-time top 10 plastic surgery procedures of any year.
Coolsculpting and Cellulaze have made their way on the list because they are new body contouring technologies. Both have been approved for use less than five and two years ago respectively and offer non-surgical methods for common concerns about fat reduction and improvement in the appearance of cellulite. Whether they will be on the top ten list a few years from now will depend on how effective they turn out to be in widespread use.
Botox, one of the few drugs used for aesthetic changes, keeps it place in the top ten list and may well be the number one cosmetic procedure performed in the U.S. by number of treated patients. (amongst surgery and minimally invasive procedures) Despite the large number of treated patients, it is not searched as much as some of the other popular procedures largely because its effects and benefits are so well known.
Labiaplasty, reshaping of the external vagina, is gaining in popularity and public awareness. Once just done by a few gynecologists, it is becoming more widely practiced by plastic surgeons as well. As women become increasingly aware of its potential benefits, the interest in how and where it can be done is rising as well.
While the overall number of plastic surgery procedures continue to slowly rise each year, some procedures have increased more than others. One such procedure is buttock augmentation, up nearly 40% last year. Plumping procedures have always been popular in plastic surgery and the buttocks represents the biggest body part to plump of them all. Whether it is higher, rounder or just smoother, there is a growing number of people who want a better one.
While increasing buttock size has been around for some time, the use of implants to do it limited the number of people who wanted to undergo it. One should not confuse the surgery and the recovery process of buttock implants with that of breast implants. While very effective and permanent, it is a harder procedure to go through with more discomfort and a longer recovery. After all, having to sit on your implants after surgery is much different than having them merely placed onto the front part of your chest.
What has led to a dramatic increase in buttock augmentation is two main factors. In an ever increasing multi-cultural society, the buttocks is a greater focus of body aesthetics and shaping. Amongst Black, Latino, gay and transgender people, the size and shape of the buttocks takes on increased emphasis. Add to that the exposure that certain Hollywood stars, such as Kim Kardashian and Jennifer Lopez, have placed on a shapely derriere and the public is sure to follow. The second factor for the procedure increase is the method now most commonly used to do it, fat injections.
Fat injections offer a more appealing alternative to the use of implants for buttock augmentation, not only because it is a more natural material but also because of the concomitant benefit of fat reduction and body contouring achieved at the same time. Getting fat for the injections requires a liposuction harvest and a generous amount to do it since the fat must be concentrated for injection. This always results in a significant body contouring effect, usually on the abdomen, flanks and along the upper back. This alone can make the buttocks look bigger or more shapely because the body is reduced around them. In essence, buttock augmentation with fat is a redistribution effort.
While buttock fat injections is an obvious plumping procedure, it has gotten a more commonly known name that is really a misnomer and even a bit misleading. Called the Brazilian Butt Lift and other such lifting names, it is not really a lift at all. It is no more of a lift than one would consider a breast implant as a breast lift. To some degree, there is a mild lifting effect from filling out the skin but it is primarily a volumizing effect.
It is also the one operation where being a little overweight is beneficial providing more donor fat to harvest. There are even some patients who gain weight for the procedure although I do not advocate that approach. At the least, it is not an operation like a tummy tuck or liposuction where you want the patient to have done everything beforehand to be as lean as possible to get the maximum benefit.
For those patients who do not have enough fat, however, buttock implants are the only way to do it. The good news is that buttock implants today are far more advanced with gel-like softness and a large number of sizes and shapes to use. Employing an intra-muscular plane of insertion, results are better and the risk of implant-related complications such as infections and fluid collections much reduced.
Background: The size and shape of the buttocks is an important part of the aesthetics of one’s body. The importance of size and shape varies amongst different cultures and ethnic groups. This has led to the popularity of buttock augmentation procedures, using either the insertion of an intramuscular implant or fat injections. Fat injections, known as the Brazilian Butt Lift, is the more popular due to its use of one’s own body tissues and the generous availability of donor material in most patients.
But regardless of one’s ethnic or racial background, a completely flat buttocks is not viewed as aesthetically desireable. Such a flat buttocks, and sometimes even an indented one, is prone to occur in those that are thin and lean. To no surprise, a thinner overall fat distribution in one’s body can lead to minimal fat over the buttocks as well. While the gluteal muscles are not small, much of buttock volume comes from the amount of fat between the skin and the muscles.
In the thinner woman who desires a buttock augmentation, specifically a Brazilian Butt Lift technique, the lack of sizeable donor material is a limiting factor. For very thin women, this procedure is an impossibility and an implant is the only treatment option. But moderately lean to average-size women may have a fat injection buttock technique if they recognize that the buttock size obtained will be more modest and always less than they ideally desire.
Case Study: This 31 year-old female had long been bothered by her flat buttocks. She had tried to build up her buttock size through different exercises but without success. She did have some excess fat on her stomach and around her waistline and wondered if this would be enough for a Brazilian Butt Lift. On feeling her stomach and flanks, it was felt that maybe a liter of fat aspirate could be obtained but not much more. She wanted to proceed with surgery as she did not want to have synthetic implants.
Under general anesthesia she first underwent liposuction harvest of the entire abdomen and flank regions in the supine position. A total of 1,150cc of aspirate was obtained after initial Hunstad infiltration. She was then turned over into the prone position where additional liposuction was done across the top of the buttocks, in the sacral triangle and below the buttocks in the infragluteal fold. This brought the fat aspirate to 1,275ccs.
The fat aspirate was processed by passing it through a sieve and draining off the excess fluid. This brought the concentrated fat amount to 450cc. Using an injection cannula, 225cc of the concentrated fat was injected into each buttock. The injection amount combined with surrounding buttock liposuction fat reduction gave her a visible amount of buttock enhancement.
When seen at her three month follow-up, her final result showed a slightly more rounded buttock shape and size. Her overall buttock shape was more pleasing even if it was not dramatically bigger.
An important question when considering the Brazilian Butt Lift is how much fat will end up being injected into the buttocks. As a general rule, expect only 1/3 to ½ at best ending up being the concentrated amount of fat available for injection. This means that one has to have at least a mimimum of 1,000cc to 1,200 available for removal. It is better that 1,500cc to 2,000cc can be harvested. When only 150cc to 250cc of fat is available for each buttock, the patient needs to appreciate that the buttock size gain will be modest. Some improvement will also come from the buttock sculpting obtained by the liposuction. It is the combination of both that creates the final result. In thinner women, the Brazilian Butt Lift is more of an overall buttocks reshaping effort than exclusively an augmentation outcome.
1) The results of fat injection buttock augmentation is limited by the size of the donor harvest areas. These come primarilyfrom the abdomen and hip rolls.
2) In thinner women, the enhancement of the buttock is contributed to as much by the surrounding fat reduction as the buttock size achieved by fat injection.
3) The Brazilian Butt Lift in thinner women is better thought as buttock reshaping than buttock augmentation.
Enhancement of the buttocks has become enormously popular over the past decade. Most methods of cosmetic buttock surgery are perceived as that of increasing its size through either implants or, more commonlytoday, fat injections. But buttock enhancement is as much about contouring and reshaping as it is about size increase alone. Large poorly-shaped buttocks are far less appealing than slightly smaller ones that have a more desireable shape.
When evaluating the buttocks, it is best to see it as an anatomic structure with different areas as zones that can be modified. There are essentially six aesthetic zones to the buttocks which can be described as follows: zone 1 is the midline lower back/sacral area, zone 2 is the upper lateral region or low flanks often also called the muffin tops, zone 3 is the middle lateral region where the muscle inserts, zone 4 is the low lateral or greater trochanter area, zone 5 is the upper inner thighs, and zone 6 is the amount of buttock projection seen in the side view.
The relevance of these buttock zones is that they all represent areas of either reduction (liposuction) or augmentation. (fat injections) Zones 1 and 2 are the areas of greatest liposuction fat removal while zones 3, 4 and 6 are the primary areas of fat injection augmentation.
Improving buttock shape is more than just injecting a lot of fat all over the entire buttocks. Skillful reshaping by fat removal combined with fat augmentation is a more successful approach. In many patients, it just isn’t possible to place enough fat or have enough of it consistently survive to create a better shape by simple volume addition alone.
In improving the shape of the buttocks the contour of the hips is a key area. Buttock projection can look diminished when the hip and back area has a good thickness of fat. This obscures any appearance of an upper gluteal shelf. When liposuction is done to reduce the hip and back fat, an inward skin retraction occurs. This creates an inward indentation or concavity which can match the curve of the lower of the lower buttocks as it dips inward towards the posterior thigh. By so doing, the illusion of a greatee central buttock projection is created. This can be further enhanced by concurrent fat injections into this central mound. This is a good example of the ‘ying and tang’ approach to increasing any body contour. The combination is always better than either approach alone.
The survival of fat injections in the buttocks is always an issue of concern. While there are numerous methods of processing fat prior to injection, none have been shown to be better than another. Some method of concentration is important to eliminate excess oils and fluids. In the buttocks, unlike many other face and body areas where fat is injected, there is a choice of injecting into the subcutaneous fat layer, the muscle, or both. The buttocks have a large gluteus maximus muscle and most of the fat injected should be into it. This will ensure the most amount of injected fat survival due to the better intramuscular blood supply.
Buttock augmentation is best done through a combination of zonal liposuction reduction and intramuscular fat injections. This is best for those patients that have an excess of fat around the buttocks in the hips, back and waistline.
Dr. Barry Eppley is an extensively trained plastic and cosmetic surgeon with more than 20 years of surgical experience. He is both a licensed physician and dentist as well as double board-certified in both Plastic and Reconstructive Surgery and Oral and Maxillofacial Surgery. This training allows him to perform the most complex surgical procedures from cosmetic changes to the face and body to craniofacial surgery. Dr. Eppley has made extensive contributions to plastic surgery starting with the development of several advanced surgical techniques. He is a revered author, lecturer and educator in the field of plastic and cosmetic surgery.