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Background:  Buttock augmentation by fat grafting is a well known procedure commonly known as BBL surgery or Brazilian Butt Lift Surgery. It is based on the principle of ‘fat recycling’ or fat redistribution. Taking fat by liposuction from one body area (reduction) and transferring it to a desired area where soft tissue volume is desired. (addition) This is done by fat injections because it is extracted in a liquid particulate form. While fat survival is not completely predictable its greatest value is the versatility provided by being able to place it by an injection technique.

While fat injections are by far the most common form of fat grafting done today, and for good reason, it is not the only method. The historic method of fat grafting was en bloc or by dermal-fat placement techniques. Essentially larger segments of fat are harvested and placed as ‘big pieces’ into defect sites. This technique is far more limited in application because of the harvest and the open method needed to place it, but its history and in my experience is that the survival is far better than one would think. In the right application and size fat graft retention can be as high as 80% to 90%.

Case Study: This female was part of a prior case study where her congenital buttock defects of unknown origin were treated by scar contracture release and the placement of dermal-fat grafts. The dermal-fat grafts were harvested from her lower abdomen with a larger graft on the right side where the deepest indentation and scar contracture existed. Her immediate intraoperative results shown the buttock recontouring effects.

She was initially seen six weeks after surgery where her buttock incisions were healing nicely and her buttock contours were improved. She was not seen again until 3 years later when she desired to undergo BBL surgery with a tummy tuck. Comparing a 6 week and 3 years result shows a completely stable buttock contour and less hyperpigmented scars.

Dermal-fat grafts are almost a forgotten technique in plastic surgery and are often not appreciated for what they can do. Their survival is always considerable in my experience. Their use was more appropriate in this case than fat injections because of the severe scar contractures which can limit the interoduction of injected fat and the smoothness of the augmented contours. Moving forward it is a much better tissue bed to place secondary fat injections.

Case Highlights:

1) Large buttock defects associated with scar contractors can be successfully treated by large dermal-fat grafts.

2) The abdomen in most women provides the best donor site for larger dermal-fat grafts.

3) In buttock reconstruction this long-term case study shows that large dermal-fat grafts maintain good volume and provide a platform for further volume addition efforts by injectable fat grafting.

Dr. Barry Eppley

Indianapolis, Indiana

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