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Dr. Barry Eppley

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Surgeon Dr. Barry Eppley

Posts Tagged ‘buttock enlargement’

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

The Brazilian Butt Lift Explained

Tuesday, December 8th, 2009

The Brazilian Butt Lift is a confusing term for those interested in buttock reshaping. The misleading part of its name is that of the lift. It is absolutely logical to assume that the buttocks are actually moved upward by some type of tissue lifting or relocation. This would usually mean that skin and fat is removed and tightened like that of a tummy tuck or a breast lift. But that is not the case.

The qualifying term is the Brazilian word that precedes butt lift. Understanding the significance of this country descriptor goes a long way towards appreciating the ethnic importance of larger buttocks and what is actually done during this cosmetic procedure.

The buttocks has long been associated as an important sexual feature of a woman. The buttocks are anatomically formed by the gluteal muscles of the hips and upper leg. The overlying skin and fat help make its overall shape but the size of the muscle plays the key role. This muscular feature has been given many cultural interpretations but it is largely aligned with the organs of reproduction. Thus when cosmetic surgery is performed on them, it is to increase their sexual attractiveness.

The buttock lift as we know it today comes out of Brazilian plastic surgery. The Brazilians downplay breast size but emphasize buttock size and shape…the exact opposite of American or  Northern hemisphere emphasis. This is the Brazilian view of the body. Given the large number of cosmetic surgeons in that country, Brazil has become an international center for cosmetic surgery and their techniques have subsequently been promoted all over the world.

Firming and tightening the buttocks has been around for over fifty years. But the historic approach of cutting out skin and fat, which leaves noticeable scars, never caught widespread popularity. Increasing the size of the buttocks, by volumetric addition, creates both increased fullness and a bit of a ‘lift’. The Brazilians have promoted the use of silicone implants for buttock enlargement for years and have refined that technique to an art form.

But the use of buttock implants is not complication-free and it has its set of problems…like any implant-related procedure does. The use of fat from liposuction has been developed as an alternative to an implant for buttock enhancement. As a natural alternative to a synthetic implant, fat injections into the buttocks offer a dual benefit. The donor fat removed makes for contour improvement in the harvest site, which is usually around the waistline and stomach. It is essentially a redistribution of  a problem into a benefit.

The Brazilian butt lift is, therefore, buttock enlargement by fat injections. The lift part comes as the buttocks is filled out and it gets a lift by skin expansion. The downside to using fat is that it is not always predictable and all of the fat injected will not survive. For some patients it may be necessary to do a second fat injection session.

Excisional buttocks lifts still do exist but they are reserved for two specific buttock problems. When the lower buttock skin hangs over the lower crease, known as the banana peel deformity, the overhanging skin can be removed and a new tighter lower crease made. (lower or inferior buttock lift) An upper buttock lift is done as part of a circumferential body lift for those patients who have under gone extreme weight loss, usually from bariatric surgery.          

Dr. Barry Eppley

Indianapolis, Indiana





The Brazilian Butt Lift for Buttock Augmentation

Sunday, March 1st, 2009

Buttock augmentation surgery continues to grow in popularity. One of these techniques is the Brazilian Butt Lift which helps to enlarge and reshape the buttocks to a more prominent and youthful appearance. Ironically, it is not a buttock lift in the traditional sense but a method of fat injections to do the reshaping and the ‘lifting’.

This method of buttock augmentation reshapes the tissues overlying the gluteus muscles by using one’s own fat in a transfer method. For thin patients who do not have enough fat to harvest and transfer, they will need to enlarge their buttocks by the insertion of a silicone implant. In a good candidate for the Brazilian Butt Lift, liposuction is first done in areas around the buttocks such as the hips, lower back, and on the posterior thigh up to the lower buttock crease. The removed fat is then carefully prepared and concentrated through differing methods of purification and isolation. (there is no universal agreement as to the best fat concentration method) The fat is then re-injected back into the gluteal area for reshaping and augmentation. The method of fat injection is important and I prefer placing small amounts of fat at different depths with the hope of decreasing the amount of fat absorption after surgery.

The procedure is usually performed all in one surgery. While multiple smaller injection sessions may lead to better fat volume retention, this approach is usually not economically practical for most patients. However, additional or touch-up injections months later can enhance the results or correct any minor deficiencies or irregularities that may remain.

The aesthetic objective of buttock fat transfer is to give the buttocks more of a bowl shape in its central regions. This means that the identified central region of the buttocks receives the most fat and it is tailored out from there. While no one knows a magic number as to how much volume of fat can be injected that will ideally survive, 250 to 300 ccs is what I usually inject. This will make most buttocks fairly tense and tight at that volume and more than that seems that one is only injecting ‘ free fat into free fat’.

Most patients can return to work and activities fairly quickly, one week for work and ten days for exercising. Any discomfort is more from the liposuctioned sites than it is from the injected buttock area.

Dr. Barry Eppley

Indianapolis, Indiana

Gluteal Implants vs. Fat Injections for Buttock Enlargement Surgery

Sunday, January 4th, 2009

Enlargement of the buttocks or buttock enhancement is a plastic surgery procedure that has become more commonly requested and performed in the past several years than ever before. Ten years ago, this was a procedure that was unheard of and rarely done. Due to cultural influences and a changing population mix, the shape and size of the buttocks has become an aesthetic issue of importance.

The buttocks is a three-dimensional structure of which its size and shape are both important. For some patients, their buttocks is too flat and lacks any definition, for other patients it is an issue of size more than shape.  As a result, when it comes to buttock recontouring, one has to consider what procedures can increase size as well as shape. It often takes a combination of procedures to create the best buttock result.

When it comes to increasing buttock size, it is a choice between natural fat injections or the use of synthetic implant. Both work and are capable of adding volume to the buttocks, but they are different in the results achieved and their associated potential risks and complications.

Buttock implants remain the gold standard for buttock enlargement. They have a long-standing history of success and their primary advantage is that the volume they add to the buttocks is both stable and permanent. The implants will not change in size over time as the material of which it is made (silicone rubber) does not degrade in the  body. While implants do have traditional risks of malpositioning, infection, and seroma (fluid) development, improved surgical techniques with intramuscular placement has gone a long way in decreasing these issues.  Nonetheless, these potential risks still exist and a patient must be willing to accept that a small percentage of buttock implants will develop these problems.

Fat injections, using the patients own fat, is a ‘newer’ buttock implant approach that has only become popular in the past few years. Its recent popularity is linked to the emergence of fat grafting in plastic surgery in general and as an easier alternative than traditional implant placement. Fat injections into the buttocks is less invasive and has a quicker recovery than an implant. It also uses the patient’s own fat which, if one is having liposuction anyway uses the discard, or if done by itself offers an aesthetic contouring benefit from the donor site. The primary disadvantage to fat injections is their unpredictability and that only a modest gain in buttock size can be achieved with one surgical treatment. It is far to say that fat injections can not create the same volume size that an implant can……in one surgical session. Multiple fat injections sessions, however, can create the same volume but at the disadvantage of considerable more expense and effort.

Which is better for any buttock enlargement patient….fat injections vs implant?  If one is opposed to the thought and risks of an implant, then fat injections are the way to go with the understanding of the limitations in size that can be obtained. Or if one is having liposuction anyway, then fat injections are worth trying since enlargement of the buttocks may not be the sole objective of the surgery. But if considerable buttock size is wanted and one wants the most predictable result, buttock implants are the best choice…..if one can accept their risks.

Dr. Barry Eppley

Indianapolis, Indiana

The Many Options for Buttock Reshaping

Tuesday, December 25th, 2007

An Overview of Techniques to Beautify the Buttocks

The appearance and shape of the buttocks has taken on great interest in the past few years. Whether it be too big, too flat, or sagging with age, the interest in improving one’s buttocks has never been this great in the world of plastic surgery. Much of this recent interest in the appearance of the buttocks in the United States is due to the northern immigration of South American culture. Each of the many different buttock problems is treated with various plastic surgery techniques. As I consult with patients here in Indianapolis, it is important to carefully analyze the shape of the buttocks and the patient’s desires and then match the appropriate plastic surgery procedure(s).

By far, the ‘simplest’ buttock problem to treat is the one in which the buttock is too big. The problem is ‘simple’ only because the only treatment approach is that of liposuction. The results from liposuction of the buttocks is usually modest. One must avoid too aggressive liposuction as this may cause the skin of the buttocks to sag after being ‘over-deflated’ by the fat removal. In rare cases, liposuction combined with a lower buttock lift (cutting a strip of skin and fat from the lower buttock crease) may produce a better overall result.

The flat buttock is treated either by implants or fat injections. Solid rubbery implants (which cannot leak) can be placed inside the muscle through a small incision in the upper buttock crease. Buttock implants are best for those patients who don’t have enough fat to transfer and want extra fullness in the upper portion of the buttocks. The implants generally don’t add much fullness to the lower portion of the buttocks. The discomfort with buttock implants is considerable and physical activity must be restricted for several weeks after surgery. Once you have buttock implants, removing them (if necessary) will lead to further disfigurement due to the extra skin that has been created. Fat injections are useful when only a small increase in buttock size is needed. It is unpredictable how much injected fat will survive and multiple surgery sessions may be needed to get the desired result. As fat is needed to inject, a double benefit is achieved by contouring two areas at once, reduction in size of the donor site (usually abdomen or thighs) and a larger buttocks.

The sagging buttock can be treated by two types of buttock lifts. When only a small amount of skin is sagging over the crease, a lower buttock lift as previously described can be used. The trade-off is a scar in the lower buttock crease. When a larger amount of buttock skin is hanging down (after bariatric surgery, for example, where a lot of weight loss has occurred), the buttock shape is addressed by a circumferential body lift where a low back scar is the result of removing a wedge of skin and fat from above.

As you can see, there are a lot of different approaches to buttock reshaping and a consultation with an experienced plastic surgeon can help you pick the right buttock operation(s) for your problem.

Dr Barry Eppley
Indianapolis, Indiana

Fat Injections for Buttock Augmentation

Tuesday, December 25th, 2007

Buttock Augmentation by Autologous Fat Injections


I have previously discussed buttock enlargement through the use of implants, known as implant or alloplastic gluteoplasty. Another popular option is buttock enlargement through the use of fat injections or transplants, known as autogenous gluteoplasty. Fat injections as a method for soft tissue volume enhancement is well known and has a good track history in the face where smaller amounts of fat are needed, usually in the range of 1 to 10ccs. In the buttocks, however, much larger amounts of fat are needed to make a significant size difference, usually in the range of hundreds of ccs per buttock.

Here in my practice in Indianapolis, I always discuss the merits of buttock implants vs fat injections for buttock enlargement. Fat injections to the buttocks have several advantages. First, it eliminates the need for a synthetic implant and all the inherest risks such as infection, implant malpositioning, and notoriously a seroma build-up or fluid collection. Second, the buttock enlargement operation is much simpler, less invasive and has less pain after surgery. Thirdly, the amount of recovery is dramatically different with no activity limitations after surgery unlike implants. Fourth, there is an added cosmetic bonus from the harvest at the donor site. Some other body area gets to be reduced at the same time, usually the abdomen, waistline, or thigh areas. A two-for-one bonus if you will.

However, despite these significant advantages, fat injections to the buttocks for enlargement has one big potential disadvantage. How much of the fat will survive and get the volume that was put in at the time of surgery? That is an unknown question. And the issue of volume retention of injected fat has persisted with the use of this fat technique since its inception. What we do know for certain is this; 100% of the fat will not survive. Somewhere in the range of 1% – 99% will be the amount of fat that will persist. In larger fat injection volumes, such as the buttocks (and there is no larger amount of fat that is injected anywhere), a good result is probably in the 50 – 60% range for most patients. Therefore, I always tell my patients here in Indianapolis this: I will over-correct with fat injections to the buttocks (I don’t think you can ever inject too much fat or get the buttocks too big as they will only hold so much) and be prepared that it will likely take more than one fat injection session to get the best volume improvement. Unlike a buttock implant, which remains the same after one surgery, fat injections to the buttocks are unstable and require more than one surgery to get close to the same result.

The most important question for patients who want to avoid a buttock implant by undergoing fat injections for buttock enlargement then is; is the price and recovery from possibly two surgeries better than having a buttock implant? That is a question that each patient has to decide on their own in consultation with their plastic surgeon.

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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