EXPLORE
Plastic Surgery
Dr. Barry Eppley

Explore the worlds of cosmetic
and plastic surgery with Indianapolis
Double Board-Certified Plastic
Surgeon Dr. Barry Eppley

Archive for the ‘buttock augmentation’ Category

Incisional Techniques for Buttock Implants

Saturday, August 29th, 2015

 

Buttock augmentation has become a procedure today that almost rivals that in public interest and in procedures performed like that of breast augmentation. By far the most common method of buttock augmentation uses the patient’s own fat as an injectable technique known as the Brazilian Butt Lift. (BBL) But not everyone is a candidate for a BBL due to either lack of fat for adequate injectable volume or has been through a BBL procedure where the fat has not adequately survived.

Buttock implants offers a method of buttock augmentation that exerts its effect by the placement of a non-degradable solid silicone implant. While it is a far more invasive procedure and has a longer recovery, it offers a permanent buttock size increase.

The biggest ‘controversy’ in buttock implants is the pocket location as to whether it is on top of the muscle (subfascial) or inside the gluteus muscle. (intramuscular) This decision has great relevance for options in implant size  and the risk of long-term complications. Intramuscular buttock implants permit only smaller implant sizes but have a better long-term prognosis and lifespan. Subfascial buttock implants permit much larger sizes but has a potentially higher rate complications. (e.g.,s seroma, implant visibility)

One controversy of buttock implants that is less written about or addressed is that of the incision used to place them. All buttock implants are placed through an intergluteal incision that should stay below the superior end of the crease to remain hidden. When one considers that the most common complication of buttock implants, regardless of pocket location, is wound dehiscence or incisional separation, how the incision is made and closed has considerable merit.  While usually a self-healing problem, an intergluteal incision can take a long time to heal and potentially exposes the implants to contamination and risk of infection.

The intergluteal incision for buttock implants can be placed as a single midline technique or a double parallel off midline incisional technique. Each has their own advantages and disadvantages.

Single Incision Buttock Implant Approach Dr Barry Eppley IndianapolisThe most commonly used intergluteal incision is the single midline technique. This has the advantage of a more limited single scar of usually 6 to 7 cms length and both right and left buttock implants can be placed through it. But it does expose both sides of the implant pockets to each other (less significant if the implants are placed intramuscular) should incision breakdonw occur. The incision is also located at the greatest site of wound tension and shearing and, as a result, has a 20% to 30% incidence of some degree of wound separation.

Double Incision Buttock Implant Approach Dr Barry Eppley IndianapolisThe double intergluteal incision technique uses two separate parallel incision 6cm to 7 cm in length that are off the midine by about one centimeter on each side. While requiring double the time to close the incisions, it keeps the two implant pockets separate by a healthy bridge of tissue. The incisions are also located in intergluteal buttock skin that is more pliable and elastic and less prone to separation by shearing forces.

Both the single and double intergluteal incision techniques can be used very successfully in buttock implants. Both seem to scar well and neither in my experience has necessitated scar revision due to their healed appearances. But I tend to favor the double incision technique as it has less risk of postoperative wound dehiscence problems which makea a patient’s recovery quicker and less problematic.

Dr. Barry Eppley

Indianapolis, Indiana

Avoiding Fat Emboli in Fat Injection Buttock Augmentation

Monday, July 20th, 2015

 

Fat Injection Indianapolis Dr Barry EppleyButtock 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.

Deep Gluteal; vessels in Fat Injection Buttock AugmentationThe 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..

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Large Brazilian Butt Lift

Wednesday, July 15th, 2015

 

Buttock Enlargement Dr Barry Eppley IndianapolisBackground: 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.

BBL results side view Dr Barry Eppley IndianapolisJBBL result back view Dr Barry Eppley IndianapolisUnder 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.

Full Body Result from BBL Dr Barry Eppley IndianapolisWhen 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.

Highlights:

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.

Dr. Barry Eppley

Indianapolis, Indiana

The Success of the Brazilian Butt Lift

Monday, May 18th, 2015

 

Buttock Fat Injections Dr Barry Eppley IndianapolisButtock augmentation is most commonly done today using fat injections. (aka Brazilian Butt Lift or BBL) It is popular because it not only offers a natural method of buttock enlargement but has a concomitant benefit of body contouring through the liposuction fat harvesting. Many good buttock augmentation results from this procedure are the result of the combination of both effects and no just the fat grafting itself. Waistline narrowing and buttock enlargement together can create a powerful change in the lower trunk/pelvic region.

This combination of waist and hip change has long been regarded as attractive in many cultures around the world. A waist-hip ratio of 0.7 in females is the aesthetic ideal and may be achievable with a BBL surgical approach. The question is how effective is this procedure in reaching this aesthetic ideal and how successful is the fat that is injected maintained.

In the May 2015 issue of the journal Plastic and Reconstructive Surgery, the article entitled ‘Gluteoplasty with Autologous Fat Tissue: Experience with 106 Consecutive Cases’. In this paper the authors looked at 106 consecutive female patients who underwent a BBL procedure over a three year period. One key inclusion factor is that they could not have a weight change greater than 10% during the follow-up period. The degree of satisfaction (patient and surgeon) was assessed on a scale of 1 to 4  with four being the highest rating. The average age of the patients was 33 years old and the average amount of fat injected into the buttocks was 505ccs. No patients experienced any medical complications. Five patients (4%) developed a seroma in the liposuction harvest area. The vast majority of the patients (103 out of 106, 97%) has high satisfaction ratings of 3 and 4. Only one patient (1%) reported aesthetically troubling fat volume loss months after the procedure. Two patients (2%)  had revision procedures for excessive gluteal fullness at the sides of the buttocks.

As can be seen in this study, BBL surgery has a high satisfaction rate with a very low incidence of any major problems. The autologous nature of the procedure is undoubtably the reason for few complications. Their experience shows that such fact injections are sustainable and not prone to a high rate of resorption after surgery. The one aesthetic problem that they did encounter infrequently was too much lateral fullness. This can be avoided by drawing a line laterally between the anterior and posterior hip area and not injecting in front of this line.

Buttock Augmentation results left side view. DR Barry Eppley IndianapolisThe authors point out that removal of excessive fat from the lumbosacral region is an important factor in obtaining a good buttock shape and must be done in every patient. This is the importance of performing the procedure in the prone position prior to the fat grafting.

Fat grafting to the buttocks is known to have a lower rate of resorption than that which occurs in the face. The exact reason is not known but may be a function of a larger muscle mass and higher volumes of fat injected. As a result, BBL surgery usually has better results and higher patient satisfaction than facial fat grafting. The fat redistribution effect is also more likely to achieve a pronounced recontouring than just fat grafting alone.

It is important to point out that no patients in this study was injected with mega volumes of fat (1,000ccs or greater) nor ws there an attempt to balloon out the buttocks to very large proportions. The success in this study’s patients may not translate to high volume buttock fat injections.

Dr. Barry Eppley

Indianapolis, Indiana

Subfascial vs. Intramuscular Buttock Implants

Monday, April 20th, 2015

 

Buttock Enlargement Dr Barry Eppley IndianapolisButtock augmentation has gained tremendous popularity as a surgical procedure in just the past decade. This has largely been due to the use of fat injections for buttock augmentation, an approach that offers a diametric effect with enlargement of one body area (injection site) and reduction of many other body areas (liposuction harvest) during the same procedure. While buttock implants have been around much longer, their use is a fraction of that of fat injections due to a more invasive procedure with greater risks and a longer recovery.

But despite the popularity and success of buttock fat injections (aka the Brazilian Butt Lift or BBL), it is not for everyone that desires buttock enlargement. The biggest reason is lack of adequate fat to harvest. Thin or even medium build patients may not have enough to harvest by liposuction to make an immediate or sustained buttock enlargement result. Gaining weight for a BBL can be a flawed approach since such fat volumes can be lost after surgery with dieting an exercise.

Buttock implants will continue to play a small but important role in buttock augmentation. And more buttock implants are done today than ever before because of the overall societal desire for larger and more shapely buttocks. But the rise in buttock implant procedures has given risen to some misunderstandings with their use. The main issue to consider is the pocket into which they are placed. Understanding the implications  between subfascial and intramuscular location is the most important buttock implant decision.

Subfascial Buttock Implants result back viewSubfascial Buttock Implants result right oblique viewThe subfascial buttock implant location has several advantages. It is technically easier for the surgeon to perform, has somewhat shorter and less uncomfortable recovery and permits the placement of much larger buttock implant sizes. Its disadvantages are that the development of seroma and the risks of infection are higher. The use of postoperative drains are critical to educe these risks. In addition, the occurrence of capsular contracture  and implant ‘show‘ is also higher as well as that of chronic discomfort. An important anatomic key is that one should have good soft thickness between the skin and the deeper fascia for this buttock implant location.

Intramuscular Buttock Implants back view Dr Barry Eppley IndianapolisIntramuscular  Buttock Implants right side view Dr Barry Eppley IndianapolisThe intramuscular buttock implant has several advantages. It has a lower risk of seroma and infection due to a partial muscular cover. It also has no risk of implant show and probably has the best long-term retention due to its thicker soft tissue cover. Its disadvantages are that it is technically harder for the surgeon to master, limits the size of implant that can be placed (rarely bigger than 350ccs) and has a longer and more uncomfortable recovery. Patients that have thin tissues over the buttock with a scant subcutaneous fat layer or only want a more modest buttock augmentation result are the best candidates for the intramuscular implant position.

As can be seen by their various advantages and disadvantages, buttock implant augmentation results are highly influenced by the pocket location. Besides the recovery, the biggest difference is the size of the implant that can be placed.

Dr. Barry Eppley

Indianapolis, Indiana

Subfascial vs. Intramuscular Buttock Implants

Saturday, March 7th, 2015

 

voluptuous back in pink pantiesThe use of implants is one effective method for buttock augmentation. It is far surpassed by fat injections (aka Brazilian Butt Lift, BBL) in number of buttock enhancements done, however, due to the appeal and usual availability of adequate fat to harvest to do the procedure. The exact numbers are not known but I would estimate that for every 25 to 50 BBL surgeries done in the U.S.,  only several buttock implant procedures are done. It is probably a 10:1 ratio of BBL to implant surgeries.

But the tremendous rise of BBL surgeries has also led to an increase in buttock implant surgeries. This is because some people are not good candidates for fat injections because they do not have an adequate donor source of material. There may also be some ‘failures’ in BBL surgeries due to fat absorption and minimal augmentation outcomes as a result.

Buttock Implants Augmentation Dr Barry Eppley IndianapolisButtock implants is the most reliable method of buttock enhancement because the implant’s volume is stable and does not change after surgery. Unlike BBL surgery, implants can achieve only a certain amount of augmentation due to the limits of implant sizes made and the tissue pockets that can be created to contain them.

Like breast implants, there are two locations in which the buttock implants can be placed. Buttock implants can be placed either intramuscular (not beneath but inside the gluteus maximus muscle) or subfascial. (above the gluteus maximus muscle) There are advantages and disadvantages to either implant location. Neither implant location is necessarily better than the other and each patient must be considered individually based on their buttock shape, tissue thickness and their buttock enhancement goals.

Subfascial Buttock Implants Dr Barry Eppley IndianapolisSubfascial Buttock Implants Indianapolis Dr Barry EppleyHistorically subfascial buttock implant placement has been most commonly done. It is somewhat simpler to technically perform, has a less painful recovery, and enables the largest buttock implant sizes to be placed. Since the implant is more superficial with less tissue coverage, it is best to place in patients that have some subcutaneous fat tissue thickness. Its disadvantages are that it has a higher rate of infection and seromas and the outline of the implants could be more visible. If intergluteal wound dehiscence occursm the implants are at greater risk of infection. It also has a higher long-term risk of tissue thinning and greater implant profile visibility.

Intramuscular buttock implants is becoming a more common surgical technique but it is still done far less than subfascial buttock implants. It has the advantages of providing good vascularized tissue coverage of the implants and has a lower risk of infection and seroma formation as a result. Because the implants are placed deep, one can still have fat injections done above them for further augmentation later if desired. Its disadvantages are that it is a more ‘complex’ surgical technique to master and its is more painful with a more difficult recovery in the first few weeks after surgery. Its most limiting aspect is that the intramuscular space offers only a limited capacity to handle implant size with the upper limits in the 300cc to 350cc range.

Buttock implants will never rival fat injections but they have a significamt role to play in buttock augmentation. They remain as the only option for those patients that have inadequate fat stores for the BBL procedure.

Dr. Barry Eppley

Indianapolis, Indiana

Unapproved Injectable Filler Complications from Body Augmentations

Saturday, January 31st, 2015

 

Brazil has almost as many plastic surgeons as the U.S. (around 5,500) but with just half of the population. (just over 200 milllion) As a result there are a large number of cosmetic surgeries done in Brazil and it is well known that the cultural standards of beauty and its pursuit have contributed much to the high number of procedures done there. In Brazil it is usually seen as a badge of honor (and status) to have had cometic surgery and people do not make much effort in camouflaging their aesthetic experiences. Some have phrased that visiting a plastic surgeon’s office is as common as visiting a shopping mall for many Brazilians.

But the high demand for cosmetic changes throughout the population creates a ripe environment for ill advised procedures and a subculture of unqualified and unscrupulous providers. It is estimated that while there are about 5,500 certified plastic surgeons, there are over 10,000 other doctors, paramedics and people with no medical training at all performing cosmetic procedures according to the country’s medical licensing counsel. Such unqualified providers, low prices and the hope of a quick fix set the stage for what has become a bit of an epidemic that is not exclusive just to the country of Brazil.

Injectable Filler Bodu Augmentation ComplicationsDr Barry Eppley IndianapolisThe Brazilian Andressa Urach became a reality TV sensation after having had numerous plastic surgery procedures from breast implants, rhinoplasty and other injectable treatments. As a result of her ‘success’ and celebrity status, she was a highly visible and outspoken advocate of cosmetic surgery. But after having some injectable material placed into her thighs recently, she went into septic shock and was placed on life support.

Such events are both tragic and completely avoidable and they always come from the same cosmetic procedure, injectable body augmentation with synthetic materials. While such injections create an instantaneous change, such as in buttock, hip or thigh augmentation, they are fraught with potential complications both immediate and long-term. The cause of  Urach’s medical crisis is always the same when large volumes of synthetic material are injected into the body…the risk of pulmonary embolism and infection. The very small particles of the synthetic material, often plastic beads, gels or oils, when injected under pressure can find their way into blood vessels which are often bigger in diameter than the material. When entering a vein they can be carried back to the heart and into the fine vessels in the lungs where they become trapped creating a life threatening pulmonary embolus. They can also enter a small artery blocking blood flow to a segment of the overlying soft tissue and skin causing necrosis and tissue death of portions of the augmented area. (tissue ischemia)

These ‘black market’ injectable complications, which happen in the U.S. as well as Brazil and other countries, result from a combination of women focused on attaining beauty through a quick fix. As plastic surgeons we often wonder how people could be so oblivious to the risks of untested and unapproved materials by some providers that have less training than their electricians or plumbers. Body augmentation is a surgical procedure and should only be done by established methods and materials board certified plastic surgeons who have the training and experience to do them. Even in the best of circumstances there are risks and potential complications. In the worst circumstances lifelong disability/deformity and death could be the outcome.

Dr. Barry Eppley

Indianapolis, Indiana

Plastic Surgery Case Study: Combined Tummy Tuck and Brazilian Butt Lift

Monday, November 24th, 2014

 

Background: Two of the most popular body contouring procedures today is one from the past and a relatively new one. Tummy tuck surgery has been around for over five decades and is highly successful at reshaping the abdominal wall often in a dramatic fashion. Conversely, buttock augmentation by fat injections (aka Brazilian Butt Lift) has been available now for only a decade and is the fastest growing body contouring procedure in total number done being done compared to just five years ago.

Brazilian Butt Lift Reshaping Garment Dr Barry EppleyWhile a tummy tuck works by removing and discarding unwanted tissues, a Brazilian Butt Lift works by recycling/redistributing them. Fat removal by liposuction is part of many tummy tucks to help extend its contouring effects around the waistline and is an additive ‘bonus’ to the procedure. Conversely, fat harvest by liposuction is an essential part of a Brazilian Butt Lift and the more fat that can be harvested the better the buttock augmentation result will be.

It is not uncommon that the desire for abdominal reshaping and buttock augmentation exist in the same patient. The first question is whether a tummy tuck and buttock augmentation can be safely done at the same time. Depending upon the magnitude of the liposuction harvest and the extent of the tummy tuck, the answer would be yes if neither one was particularly extensive.

The other question is whether any part of the excised portion of the tummy tuck can be used for the buttock augmentation. This is a debate between aggressively harvesting fat from under the tummy tuck prior to its excision or using the tummy tuck discard as a dermal-fat graft ‘autoimplant’ in the buttocks.  The vast majority of plastic surgeons today would use liposuction to harvest fat at the same time as the tummy tuck. There are growing numbers of reports in which the tummy tuck segment is being recycled and used like a buttock implant.

Case Study: This 30 year-old female wanted to have a tummy tuck to reshape her abdominal waistline as well as a buttock augmentation at the same time. It was agreed that she did not really have an optimal amount of fat to harvest to achieve a substantially larger buttocks. But she wanted to take any fat that could be harvested and place it into the buttocks as a ‘bonus’ to the procedure.

Tummy Tuck and Brazilian Butt Lift result front view Dr Barry Eppley IndianapolisUnder general anesthesia, liposuction was initally done very aggressively under the tummy tuck portion which was to be removed. Liposuction was also done around the waistline and into the flank areas to harvest as much fat as possible. The tummy tuck procedure was then completed. The harvested fat was processed and concentrated, obtaining a total volume of 480cc. Each buttock was injected with 240cc in a cross tunneling fashion.

Tummy Tuck and Brazilian Butt Lift result back view Dr Barry Eppley IndianapolisTummy Tuck and Brazilian Butt Lift result side view Dr Barry Eppley IndianapolisHer recovery was typical for a tummy tuck and the buttock augmentation do not prolong it. At three months afterwards, she showed marked improvement in her abdominal contour and mild enhancement of her buttock size. While the increase in her buttock size was not substantial (nor was it expected), its effect was greater due to reshaping of the waistline above both buttocks.

Some buttock augmentation procedures are done as a ‘bonus’ to other body contouring efforts. While the amount of fat that is often obtained by liposuction may be inadequate to justify a ‘stand alone’ Brazilian Butt Lift, some patients may want the fat used for the buttocks with the attitude that it can not hurt and anything they get is more than they currently have.

Case Highlights:

1) Combining a tummy tuck with a Brazilian Butt Lift is not uncommon and can safely be performed together.

2) The planned excisional portion of the tummy tuck can be aggressively liposuctioned as  part of the donor fat for the Brazilian Butt Lift.

3) Like all Brazilian Butt Lifts, the result is a combination of how much fat can be harvested and how much fat survives.

Dr. Barry Eppley

Indianapolis, Indiana

Plastic Surgery Products – Natural Contour Silicone Buttock Implants

Sunday, August 31st, 2014

 

Buttock implants are undergoing a renaissance today largely due to the popularity and widespread use of fat injection buttock augmentation. (Brazilian Butt Lift = BBL) The societal interest in the aesthetics of buttock shape and size combined with the body contouring benefits of liposuction has generated large numbers of such buttock augmentation procedures being performed.

But not everyone is a good candidate for a BBL procedure, due to inadequate fat to harvest, or has a satisfying result from the procedure due to graft resorption. This makes buttock implants as the only option for achieving a bigger buttock size. Most commonly the ‘ideal’ candidate for buttock implants is a relatively thin or small framed person who not only has little fat to harvest but does not necessarily desire a very large or disproportionate buttock size increase.

Buttock Implants Indianapolis Dr Barry EppleyThe use of buttock implants has a checkered history with a not insignificant incidence of complications. (although it is not necessarily higher than that of breast implants…it just seems worse since having to sit or walk with buttock implant problems is a lot more functionally disabling than that of breast implant problems) The debate is whether buttock implants should be placed above the muscle (subfascial) or in an intramuscular position. There are advantages to either approach but the intramuscular position offers the least risk of complications long-term even though it has a longer recovery.

Buttock Implant Surgical Technique Dr Barry Eppley IndianapolisThe intramuscular implant location logically requires a different implant shape and size that what may be used for the subfascial location. The intramuscular pocket is more limiting and it is very difficult and ill-advised to try and place implant volumes greater than about 350ccs in them.

Natural Contour Buttock Implant Dr Barry Eppley IndianapolisThe Natural Contour round buttock implant (Implantech) provides an option for buttock augmentation that are designed specifically for intramuscular use. The Natural Contour shape provides permanent volume with an implant profile that stresses the overlying tissues less and is easier to use. These buttock implants are touted as the softest and most natural-feeling silicone buttock implants available. Their flexibility and softness means they can be easily rolled and inserted through smaller incisions. The tapered smooth edges result in a more natural fit into the intramuscular pocket. They are available in sizes of 230cc, 275cc and 330cc with maximal projection of 3.2 cms. (base width 13 cms)

It is important to realize that intramuscular Natural Contour buttock implants are designed for long-term success and a lower incidence of complications. Their use will not be successful for someone seeking a very large or visible round buttock implant size and shape increase.

Dr. Barry Eppley

Indianapolis, Indiana

Dermal-Fat Grafts For Buttock Augmentation

Sunday, August 24th, 2014

 

Buttock augmentation continues to grow in popularity, largely driven by the acronym BBL. The Brazilian Butt Lift is a moniker for the transfer of autologous fat into the buttocks though injection using the patient’s own fat harvested by liposuction. Besides being a natural procedure, the additional benefit of body contouring from the liposuction part of the procedure complements the changes to the buttocks as well.

Fat Injections Buttocks Brazilian Butt Lift Dr Barry Eppley IndianapolisWhile getting the fat for a BBL is done by liposuction, which provides the greatest diversity of donor options, it is not the only potential fat donor source. There are more than just a few BBL patients who ask for and get a tummy tuck at the same time as their buttock augmentation. There are more than just a few plastic surgeons who have looked at the tummy tuck discard tissue and wondered if this would make for a good autologous ‘implant’…but were not brave enough to do it.

In the August 2014 Online First edition of the Aesthetic Surgery Journal, an article entitled ‘Abdominoplasty-Derived Dermal-Fat Graft Augmentation Gluteoplasty’. In this paper, nine (9) patients that had lower abdominal dermal-fat grafts used for buttock augmentation were reviewed. These were patients that were undergoing abdominoplasties (tummy tucks)  in which two oval-shaped dermal-fat grafts were harvested from their tummy tuck excisions and transferred to their buttocks in a subfascial location. The mean size of the dermal-fat grafts was just under 200 cm2 with a mean weight of 288 grams. One of the eighteen grafts became infected (5.5%) and had to be removed six weeks after surgery. All other grafts survived and provided a lasting increase in buttock volume and projection.

This study shows that large dermal-fat grafts in the buttocks are safe and do not have a high risk of infection or complete fat necrosis. The history of dermal-fat grafts goes back almost 100 hundred years but most of that experience has been in smaller graft sizes that do not approximate that used for the buttocks. It would be interesting to see long-term results (one year) of how much volume was obtained as even large dermal-fat grafts undergo some volume loss based on my experience.

I can not help but speculate that a large dermal-fat graft may be better suited to be placed in an intramuscular position as opposed to a subfascial one. Similar to the placement of an intramuscular implant, the improved vascularity may aid in its survival and volume retention.

For those tummy tuck patients who are also interested in buttock augmentation (or vice versa), the excised tummy tuck segment can be successfully used to create small to moderate amounts of buttock augmentation. If it is placed in an intramuscular location, fat injections could also be done in the subcutaneous location as well for improved amounts of volume increase.

Dr. Barry Eppley

Indianapolis, Indiana


Dr. Barry EppleyDr. Barry Eppley

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.

Read More


Free Plastic Surgery Consultation

*required fields


Military Discount

We offer discounts on plastic surgery to our United States Armed Forces.

Find Out Your Benefits


Categories