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One of the most popular body contouring procedures in the past decade is BBL surgery or the Brazilian Butt Lift. It is commonly performed not only due to the rise in modern culture of the desire for a larger buttock size but also because it uses a natural material to do so. (fat) An ancillary benefit is that the liposuction to acquire the fat  creates a concurrent reductive in body contour above the level of the buttocks.

While the term BBL implies that the buttocks are lifted this is not actually the effect that occurs. The fat expands the buttocks making them rounder and fuller but a true buttock lift does not occur…as defined by a change of the infragluteal fold or the elevation of the buttocks up over the fold should ptosis exist. The name BBL persists in modern lingo, and it is a catchy and easily remembered acronym, but not anatomically accurate.

The original buttock lift dates back many decades before BBL surgery became popular and refers to a direct excision at the lower buttocks. It is used for correcting sagging lower buttock tissue that either hangs over the existing infragluteal fold or when the infragliuteal folds has dropped creating an elongated buttock shape. Often the vertically elongated buttocks will have an indistinct fold.

In marking the lower buttock lift or tuck it is important to perform the surgery in the flexed prone position, proving a wide open view of the infragluteal fold and markings. Because the original markings were done in the standing position them amount of marked tissue removal will appear much larger in the prone flexed position. Thus it is important to back off the markings a bit and cut insider them to avoid an over resection and too much tension on the wound closure. Once the skin and wedge of fat down to the fascial are excised, the dermis on both sides of the excision is initially tacked down to the muscle fascia. A dermal layer is then sutured with a final subcuticular closure.

A lower buttock lift removes a wedge of tissue which creates a more distinct infragluteal fold that is often higher. Besides the more distinct fold a shorter and more round buttock appearance can result. This explains why for some patient it is more of a tuck while for others a real lifting of the fold can result.

While it is an historic buttock contour procedure there is still a role for it today and can be performed any the same time as a BBL procedure if the buttocks is too long or an indistinct infragluteal fold exists.  

Dr. Barry Eppley

World-Renowned Plastic Surgeon

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