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Posts Tagged ‘buttock augmentation’

Complication Rates in Buttock Augmentation

Thursday, April 7th, 2016


Buttock augmentation has become the fastest growing cosmetic body procedure over the past five years. While the us of fat injections (aka Brazilian But Lift) accounts for the majority of these buttock augmentation procedures, buttock implants also has a role for thinner patients who have inadequate fat stores for harvest.

Buttock Implants Indianapolis Dr Barry EppleyJust like fat grafting the number of buttock implant procedures has also dramatically increased compared to just a few years ago. With the rise in the number of buttock implant requests from patients has been greater scrutiny and investigation by plastic surgeons of the various techniques to perform it. By history, buttock implants have a relatively high complication rate. This contrasts relatively sharply with fat grafting which, as an autologous technique, would be expected and is known to have a fairly low number of complications.  But newer buttock implant augmentation techniques are believed to be much better than what has occurred in the past.

In the April 2016 issue of the journal Plastic and Reconstructive Surgery, an article was published entitled ‘Determining the Safety and Efficacy of Gluteal Augmentation: A Systematic Review of Outcomes and Complications’. In this paper the authors performed a literature search on published papers that reported buttock augmentation techniques and their outcomes. Forty-four (44) papers were reviewed. The most common complications of buttock implants in 2,375 patients were wound dehiscence (10%), seroma (5%), infection (2%) and temporary sciatic nerve dysfunction. (1%) The overall complication rate with buttock implants was around 22%. In 3,567 fat grafting patients the most common complications were seroma (4%), undercorrection (2%), infection (2%) and sciatic nerve pain. (2%) The overall complication rate with buttock fat grafting was 10%.

Buttock Implants (intramuscular) Dr Barry Eppley IndianapolisRecent advancements in surgical techniques for buttock implants, particularly the intramuscular method, has definitely lowered their complication rates. While this study shows what appears to be a ‘high’ complication rate of 22%, the reality is that it compares favorably to that of breast implants. Yet the average patient or plastic surgeon would not view breast implants as having an unacceptably high number of problems. It is just a reality that autologous tissues like fat will always have a lower complication rate than a synthetic implant for any form of body augmentation.

Dr. Barry Eppley

Indianapolis, Indiana

Power-Assisted Fat Injection Buttock Augmentation

Sunday, December 13th, 2015


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.

Braziilan Buttock Lift results oblique view Dr Barry Eppley indianapolisBBL results back viewTo 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%)

Buttock Fat Injections Dr Barry Eppley IndianapolisWhile 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.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Buttock Implants in Asian Buttock Augmentation

Sunday, November 8th, 2015


Background: Buttock augmentation is the fastest growing body contouring procedure in the U.S. which is primarily done by fat injections. Known as the Brazilian Butt Lift (BBL) it is a natural procedure that has a coincidential body contouring effect from the liposuction areas. (primarily abdomen and flanks) When adequate fat is available this is the clear choice for buttock augmentation.

But not all patients that desire buttock augmentation have enough body fat to use. This is particularly true in the Asian population where many females are smaller and thinner and rarely are great candidates for the BBL procedure. This leaves buttock implants as the only buttock augmentation option in the fat deficient patient. While necessitating a longer recovery period, buttock implants offer an assured buttock augmentation result.

Buttock implants can be placed above the gluteus maximus muscle or inside the muscle. (intramuscular location) While there are advantages and disadvantages to either location, deeper placement of the implant  usually offers a long-term result with fewer potential complications. This is particularly true in the Asian female who usually has little subcutaneous tissue and a subfascial location will end up with a visible implant outline show.

Case Study: This 35 year old Asian female wanted buttock augmentation to correct a very flat buttock shape. She had no visible buttock contour and was very flat across the upper and lateral buttock surface.

Kelly Buttock Implants result back viewUnder general anesthesia she had natural contour silicone gel low profile buttock implants (300cc in size) placed in an intramuscular position. This was done through a single intragluteal incision of 7 cms in length.

Kelly Buttock Implants result side viewHer six months results show an uncomplicated buttock implants augmentation result with a visible improvement in the size and shape of her buttocks. The intergluteal incision was well healed with a slight widening of the scar line

Natural Contour Silicone Buttock Implants Dr Barry Eppley IndianapolisButtock augmentation in the Asian female often requires the use of buttock implants. Because their buttock augmentation goals are often more modest and designed to improve a flat buttock contour, large buttock volumes are not needed. Buttock implants provide the most assured method when there is a thin subcutaneous fat layer. To avoid an unnatural and too round of a buttock augmentation result, the lower profile natural contour buttock implant is an excellent choice for an intramuscular implant placement.


  1. Buttock implants are the only option for buttock augmentation in the fat deficient patient.
  2. Buttock implants offer assured buttock volume retention albeit with a more significant and prolonged recovery.
  3. The intramuscular location of buttock implants limits the ultimate size of the buttock augmentation result.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study: Brazilian Butt Lift

Monday, October 26th, 2015


Brazilian Butt Lift Dr Barry Eppley IndianapolisBackground: One of the most commonly requested body contouring surgeries today is that of the Brazilian Butt Lift.  (aka BBL) While sounding both Brazilian and touting a butt lift, it is really buttock augmentation by fat injections. Fat is derived from liposuction of any body area that one wants reduced. The buttock augmentation is then done by processing the harvested fat in a concentrated fashion and then injecting it in a dual plane location both at the subcutaneous as well as the intramuscular buttock locations.

While may patients have an ideal or dream goal for their buttock augmentation, the limiting factor is always how much fat does one have to harvest. Thinking in an incrementally decreasing fashion, the final result of any BBL procedure is a function of the original fat harvested reduced by a factor of 4. Less than half of the fat aspirate harvested will be able to be used for injection. (in females the capture rate for the injectate is usually about 40% of what is harvested) Then, on average, if only 50% of the fat survives that will be the final buttock augmentation retained. Thus, for example, a 2000cc fat harvest becomes 400cc injected per buttock with the final volume retention of 200cc. That would be a small but noticeable buttock augmentation improvement.

Case Study: This 32 year old female desired a Brazilian Butt Lift procedure. She wanted the fat harvested from her abdomen and flanks which she had been unable to lose since her pregnancies. She approached her BBL surgery with the concept that the most important goal was the waistline contouring and any increase in her buttock size would be a bonus.

Brazilian Buttock Lifts result front view Dr Barry Eppley IndianapolisUnder general anesthesia power-assisted liposuction (PAL) was used to harvest far from her abdomen and flanks. A total of 1,875cc f far aspirate was obtained. When filtered and double washed with Lactated Ringer’s solution a total of 700cc of concentrated fat was availablee for injection. That was split between her two buttocks for a total of 350cc per side.

Braziilan Buttock Lift results oblique view Dr Barry Eppley indianapolisBrazilian Butt Lifts results side view Dr Barry Eppley IndianaoplisAt three months after surgery her buttocks showed a nice shape improvement with an overall modest size increase. Much of her buttock dimpling had been improved. Her apparent buttock size increase is as much a function of the waistline reduction as it is the actual increase in buttock size. This dual effect creates  the BBL result for many patients who have less than large amounts of fat to harvest.


1) The success of a Brazilian Butt Lift depends on how much fat one has to harvest and how well it survives.

2) For many patients the success of Brazilian Butt Lift surgery is a function of the waistline narrowing above and the buttock augmentation below the waistline.

3) Many BBL surgeries (fat injections buttock augmentation) surgeries produce noticeable but more modest improvements which are quite satisfying to the patient.

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

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

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

Buttock And Hip Augmentation: Fat vs. Implants

Wednesday, August 6th, 2014


There are two effective and well established techniques for either buttock or hip augmentation. They are either fat injections using your own liposuction harvest  (Brazilian Butt Lift) or soft silicone elastomer implants that can neither rupture or leak. Each has their own advantages and disadvantages, as does every surgical technique, but both may not be appropriate considerations for every patient. For some only fat injections will work and for others implants may be the only option. Each patient must be considered individually based on their anatomy and the desired buttock or hip augmentation size they want to achieve.

Fat injection augmentation is, by far, the most commonly performed buttock/hip augmentation method because of its natural appeal, the side benefit of the body contouring from the liposuction harvest, and a quicker recovery. It has few real complications other than how well it works. The key qualifier is how much fat does one have to harvest. For those that try to gain weight for the surgery, be aware that the fat that you will lose first will be that which was gained as you return to your baseline weight…and it will be from your buttocks. Thus gaining weight for a Brazilian Butt Lift is a flawed approach. You either have enough fat to do it or you don’t.

In addition, at least 50% of the injected fat will be absorbed within months after surgery regardless from what part of the body from which it is harvested. This can even occur despite the best harvest and concentration methods. As a general rule, for every 1000cc (or liter) of fat that is harvested only about 30% to 40% will distill down to what should be injected. Better fat concentration equates to improved survival but a lower total volume of fat available to be injected.

When you simply don’t have enough fat, an implant approach is the only option. And that is how the decision for an implant should be primarily made. Buttock and hip implants have been around for a while now and the quality and size options of implants are so much better today. The implants are very safe but where they are placed and the surgeon’s skill and experience in placing them can significantly impact the rate of potential complications. Because they are implants, by definition, they will have a higher rate of complications (infection, hematoma, capsular contracture) than that of fat injections.

Implants will also have a longer recovery because placing them is more ‘invasive’ and involve areas that impact functions such as sitting and walking. Specifically for buttock implants, they should be placed within the gluteus maximus muscle. In this location, the implant will not be able to be felt nor sag or migrate later. Buttock implants on top of the muscle have an easier recovery but carry with it a higher incidence of problems later.

If you are a borderline candidate for fat injections or are uncertain if you have enough fat, make sure you have a consultation with a plastic surgeon that provides both fat and implant methods of buttock and hip augmentation. In this way your surgeon has no bias either way and will have enough experience to choose which method is best for you… rather than just the method or surgical procedure that they can do. There is no doubt that just about every buttock augmentation patient wants to use their own fat and it is easy to fall into the trap of hoping it will work out when it may never have had a chance to be as successful as you wanted.

There is also a combined approach with implants placed in the muscle and fat injections added above the muscle in the subcutaneous fat layer.  This may be considered when one only has a modest amount of fat to harvest but a very flat buttocks and wants to maximize volume. This makes anatomic sense and can be successfully done. There is the question of whether it should be done together or as a staged technique. This must be considered on an individual basis as there are some increased risks of implant infection.

Dr. Barry Eppley

Indianapolis, Indiana

Plastic Surgery’s Did You Know? Gender Differences in Buttock Aging

Wednesday, April 2nd, 2014


Did You KnowButtock reshaping through fat injections or implants has surged in popularity in the past decade. The vast majority of these buttock procedures, to the level of probably 99% of them, are done in women. There may be a lot of cultural and beauty standards for this gender bias but there may also be some age-related reasons as well. In a recent anthropometric study, the age-related changes of the gluteal region were analyzed in women and men from age 15 to 85 years old. Their study results showed that women’s buttocks aged more significantly and earlier with loss of fullness and sagging than in men. The female buttock appears to age faster and suffer more flattening and falling. Men may eventually develop a flat buttocks but it is not associated with much sagging. Such findings support the common plastic surgery procedures today, mainly for women, for buttock augmentation and lifts which either add or bring back the curves to the gluteal region.

Dr. Barry Eppley

Indianapolis, Indiana

Strategies for Successful Buttock Implant Augmentation

Sunday, February 23rd, 2014


While implants are used all over the body from the breasts to the calfs very successfully, their use for buttock augmentation is associated with a more checkered experience. Not that implants anywhere can’t be associated with complications, but buttock implants carry a disproportionate amount of criticism. This is partially due to the availability of fat grafting as a buttock augmentation method that doesn’t carry those same risks. It is also because the buttocks are associated with a unique set of recovery issues.

Buttock Implant Sizes Dr Barry Eppley IndianapolisThe successful use of buttock implants for augmentation depends on three critical issues, implant location, implant size and managing patient expectations. Errors in any of these three areas will result in either a postoperative complication or an unhappy patient even if no postoperative complication has occurred.

Intramuscular Buttock Implants Dr Barry Eppley IndianapolisButtock implants can be placed either above the muscle (subfascial) or into the muscle. (intramuscular) While surgeons can place them in either tissue plane, the subfascial location is technically easier to do, has an easier patient recovery and permits implants of almost any size to be placed. However, it is associated with a much higher rate of complications including seroma, infection, implant show, encapsulation and buttock deformity. While the intramuscular location is more technically demanding, has a longer recovery and allows only smaller implants to be placed, it results in a much lower number  of complications. With rarer exceptions, buttock implants should be placed in the intramuscular location.

Buttock Implant Surgical Technique Dr Barry Eppley IndianapolisWhen large buttock implants are placed in the subfascial plane, many will eventually migrate inferiorly toward the lower gluteal crease and often not very symmetrically. Conversely, intramuscular implants do not migrate and remain where they are placed as the tight muscular pocket holds them firmly and permanently in place. However the intramuscular pocket only allows smaller implants to be used, usually not bigger than 350cc in volume. In smaller women, volumes of 250cc to 300cc are more appropriate.\ Bigger implants than this volume make it impossible to close the muscle layer over the implant which is crucial to the success of the intramuscular location.

Between the intramuscular location and the size of the implants, patients opting for buttock implants must have realistic expectations. They will not get large or massively sized buttocks and the volume obtained is going to be in the upper half of the buttocks. This makes the best candidates for buttock implants as thin or lean women who do not have enough fat for the Brazilian Butt Lift option and can accept a modest increase in buttock size.

If properly done in the right patient, buttock implants can have very similar and success rates as that of the breast implants.

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.

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