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Background: One of the common and popular body contouring surgeries today is the Brazilian Butt Lift or BBL surgery. The goal of the surgery is to create a larger buttock appearance. The name, however, doesn’t really describe how the procedure creates this effect and is even a bit misleading. In reality this is a fat redistribution procedure that works by creating a diametric waistline reduction and buttock enlargement change for the new body shape look. Liposuction removes fat around the waistline (and anywhere else it can be harvested to get the maximum volume) and it is re-injected into the buttocks. The amount of waistline reduction makes the buttocks look bigger and a bigger buttocks makes the waistline look smaller.

While BBL surgery can be very effective it is dependent on how much fat can be harvested and how much can then be re-injected. In thin patients without adequate fat stores BBL surgery is not an option. Even in patients with questionable fat availability they may have tried BBL surgery but have found the results inadequate. For the buttock augmentation effect this leaves buttock implants as the only remaining surgical option. For the waistline reduction, if liposuction offers no substantial improvement, this only leaves rib removal surgery.

The combination of buttock implants and rib removal surgery is the BBL surgery for those patients who are not candidates for BBL surgery or for those ‘failed’ BBL patients. I would always recommend patients undergo BBL surgery first if there is any chance that it can be reasonably successful.

Case Study: This female had prior BBL surgery with only modest results. Rather than undergo a second BBL procedure with limited effects she opted for buttock implants and rib removal surgeries as a combined procedure.

Under general anesthesia and in the prone position 400cc buttock implants were first placed through a midline intergluteal incision in the intramuscular location. Next flank liposuction was performed followed by removal of ribs #11 and #12 through 4.5cm flank incisions with wedge resections of the latissimus dorsi muscles.

Her intraoperative results showed good immediate improvement.

Her long term results showed a favorable outcome with a narrow waist and larger buttocks in an otherwise thin patient.

Case Highlights:

1) The combination of buttock implants and rib removal surgery is a form of BBL surgery that works best in the thin patient who doesn;’t have enough fat for a more conventional BBL surgery.

2) Intramuscular buttock implants can have as much as 400cc volume in most patients.

3) The combination of lower rib removals and LD muscle wedges resections provides an effective waistline narrowing effect.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

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