BBL Surgery using Fat Transfer
A Brazilian Butt augmentation, aka BBL Surgery using fat transfer/grafting is one of the most popular cosmetic surgery procedures in the US that has come to give butt contouring a new dimension. With the rise of revolutionary techniques, cosmetic surgery now provides women and men alike with an excellent option to help reshape a flat or sagging derriere and make it look rounder, perkier, voluptuous, and sexier. Admittedly, patients do not only gain a more youthful appearance but also watch their self-confidence peak.
Women who want to have bigger, rounded derriere or enlarged hips can consider butt lift surgery.
In short (BBL), the Brazilian Butt Lift uses the patient's own fat to help reshape the rump. Fat is extracted from the areas where it is the least desired, such as the abdomen, waist, love handles, thighs, arms, and back, is purified, and then re-injected into the treated area (the buttocks, in this case). Therefore, not only does the patient get fuller, rounder buttocks but also a firmer body shape due to the liposuction performed! The results are always impressively natural as opposed to buttock implants; another procedure used to enhance the buttocks.
Are you a BBL candidate
Generally speaking, to qualify for a buttocks lift one must be a non-smoker (or willing to give up the habit for a while), in good general health, and able to avoid alcohol for some time before the procedure and during the recovery period.
Good General Health
The butt lift is a surgical procedure and, although minimally invasive, it requires patients to be able to tolerate anaesthesia and the rigors accompanying each surgical process. Patients with chronic disorders, cardiovascular issues or diabetes should consult with their doctor first to determine whether a BBL is the right procedure for them.
Fair Amount of Fat
One of the main consideration when evaluating a patient's candidacy is whether they have enough fat stored in their body – distributed in such a way throughout the body so the doctor can easily access the donor site(s) - so that the surgeon can harvest enough fat cells to use during the fat transfer phase. Considering that only 25% of the harvested fat will eventually qualify for transplantation, the doctor will need to be able to collect fat from, at least, two donor areas to guarantee the transfer only of the best donor cells into the buttocks.
Ideally, the fat must not be stored under the abdominal muscles rather than subcutaneously. For patients with insufficient fat deposits, the doctor may advice weight gain before the BBL to qualify for the procedure.
Smoking is proven to reduce blood circulation in the body, which is something we do not want as it can lead to the death of the newly transplanted fat cells. The same applies to alcohol, which prevents the new fat cells from developing a blood supply quick enough to survive transplantation. Therefore, it is crucial to quit smoking and abstain from alcohol consumption before an augmentation procedure.
Have Reasonable Expectations
Undeniably, a bbl surgery can deliver exceptional results if a patient needs to add volume to the buttocks. However, patients need to have reasonable expectations regarding their final results as excessive butt augmentation can look disproportionate on some body types.
It is also important to have a full understanding of what exactly their body will look like (buttocks contour) after the completion of the procedure. All that will have to be discussed with a board-certified cosmetic surgeon specialized in BBL procedures, during the initial consultation, who will consider the physical attributes and the physiology of the patient to determine whether BBL is the best option for them.
A butt Lift appeals to two groups of patients:
- Younger women that wish to transform their bodies into more curvaceous silhouettes, like their favorite Hollywood stars (see Beyoncé and J. Lo)
- Women that have aged who want to replace sagging areas and restore a more youthful backside with butt fullness.
That being said, a bbl surgery is ideal for patients whose buttocks are:
- Disproportionately small
- Irregularly-shaped, after extreme weight loss
After the BBL procedure, there is a significant improvement in the way the clothes fit the patient's body in the derriere area. If combined with WaterLipo liposuction, the patient can achieve a dramatic change in their overall appearance so it is no wonder that fat grafting is one of the most preferred cosmetic procedures available at the moment.
Before the surgery
The buttocks lift is a 3-stage process that lasts about 3 hours on average. However, the duration largely depends on the number of treated areas and whether the surgery is combined with another cosmetic surgery process, such as breast augmentation or liposuction. Patients are usually put under local anesthesia and sedation (particularly effective for nervous patients).
The patient arrives at the clinic or hospital and is asked to put on a sterilized gown. The doctor will then designate (by making markings on the body) which areas of the patient's body they will use to harvest fat from, as well as the areas on the buttocks that will receive the extracted and purified fat cells. Then, the patient is prepared for surgery by receiving local anesthesia and IV sedation. Mild stinging and/or pressure are the most common sensations felt at this stage. Once the sedation takes effect, the patient enters a state where they feel a bit drowsy and they will be briefly awakened only to change positions, if necessary.
Which type of butt surgery is best for you?
Discuss your options with your surgeon, who will help you choose the best type of traditional butt lift that fits your particular requirements. Keep in mind that traditional butt lift does not add volume; it creates a more lifted appearance to the derriere through the removal of excess skin and the tightening of the underlying muscles, as described above. Plus, you can expect much more scarring than with a Brazilian Butt Lift (which also gives you a much shapelier, curvier physique).
All in all, if you have excess skin and not much fat in the buttocks, a traditional butt augmentation might be a great option for you while if you have excess fat in your body (other than the buttocks), then the butt augmentation probably the procedure that can benefit you the most.
How to Choose your Plastic Surgeon
The plastic surgeon that will take on your case should be board-accredited and certified, with a wealth of experience in buttocks reshaping procedures, and affordable for yourbudget. However, as noted above, do not choose a plastic surgeon based on their fee; you might be sacrificing quality. It is advised to contact, at least, three different plastic surgeons and get a detailed price and treatment plan and an initial consultation from each of them.
They should also perform many butt augmentation procedures every year (check their competence by looking at before and after photo galleries) and have a constant flow of patients coming to their practice or clinic and requesting a butt lift procedure.
- The operating room and practice they run should be stellar.
- The surgeon has 5-star reviews and excellent references.
- The plastic surgeon works with the best medical team (all board-certified professionals).
- The doctor does not only focus on liposuction to enhance the buttocks and is diligent about the methods used to purify the fat cells.
After going through your medical history and case, the plastic surgeon will give you detailed instructions on how to prepare for the procedure, some of which are highlighted below:
- Get prescriptions filled prior the augmentation so that you won't have to worry about getting them after the surgery.
- Get someone (friend/family member/certified nurse) help you during the first 24 hours after your surgery (i.e. with cooking, showering, taking medications).
- You might be asked to gain some weight to make sure there are enough fat cells to harvest during the procedure.
- Stop smoking (if you smoke), at least, four weeks before the procedure.
- Stop taking aspirins a week before the procedure.
- Ensure you have baggy, comfortable clothes to wear after the procedure (bring some with you to the clinic or hospital) and during the recovery phase.
- Always have clean clothing to wear during your recovery to prevent infections. You may need some help with the laundry during this stage so better talk to your relatives and friends about that.
- Follow a healthy diet that provides you with the proper amount of nutrients before the procedure and during recovery. It will help you recover faster. Also, drink plenty of water to help the newly transferred fat cells survive the implantation process.
The 3 steps of the Surgery
1. Liposuction/Fat Extraction
The plastic surgeon harvests fat from the patient's body where there is an excess. Liposuction can be performed using a number of techniques, most of which do not affect cell viability. Some of the most widely used are:
- Conventional Liposuction – The surgeon uses a syringe with vacuum suction to harvest fat.
- Power-assisted Liposuction – Liposuction with the use of a specialized cannula with mechanized movement.
- Hand-held syringe Liposuction - Liposuction using a syringe with manual suction.
- External Ultrasound-Assisted Liposuction – The surgeon applies ultrasonic energy through the skin.
- Internal Ultrasound-Assisted Liposuction – The surgeon uses a specialized cannula that transmits ultrasound vibrations within the patient's body.
There are also devices that help harvest fat. In total, the doctor may remove up to 5 liters of fat during the liposuction while carefully sculpturing the patient's body to ensure optimal aesthetics.
Note that after the purification process (below), only 500-1000cc of that fat will be injected into each butt cheek (there is a specific fat cell selection process that helps eliminate fat cells of not high enough quality – described below).
The procedure only requires a very small incision in the skin, through which the surgeon removes fat cells with the help of a cannula or a hollow tube, depending on the method they have selected to use. The fat cells suctioned through the tube are stored in a sterilized container, waiting to be purified (see phase 2).
2. Processing Fat/Fat Purification
The surgeon takes the fat cells harvested and purifies them using the fat processing method they prefer (i.e. filtration, washing or centrifugation). This stage helps retain viable adipocytes, which are the types of fat cells necessary for fat grafting, in a highly concentrated form to enhance graft take.
The doctor carefully assesses the fat cells removed and rejects those that are not of high enough quality, which is why it is important the patient has a sufficient surplus of fat stored in their body. In any other case, the doctor will suggest the patient follows a high-fat diet for a specific amount of time.
3. Re-Injecting Fat
After the harvested fat is purified, the doctor carefully transfers fat cells into each buttock. To do so successfully, they will put tiny incisions in the butt cheeks and use a hollow tube to insert small amounts of fat cells into each side of the buttock (micro-fat injections). It is a procedure that will be repeated several times in various regions of the buttocks until the desired result is achieved.
Their skills and expertise of the plastic surgeon will determine the final outcome as every stage demands a wealth of experience in the specific procedure performed at the time. This is because the process does not only involve the injection of fat cells in the buttocks; it demands in-depth knowledge of cosmetic surgery and human anatomy as fat cells will need to be inserted in different levels within the gluteal muscles. It is also important the surgeon has the necessary experience to be able to deliver a symmetrical, natural-looking, aesthetically pleasing result, which is accomplished during this stage of the process.
There will be no need for stitches to close the incisions in the buttocks as they are too small, which, besides leaving almost no scarring, it also diminishes the risk of infection that is associated with larger incisions.
At no point of the procedure is the patient unconscious. On the contrary, they are fully conscious and in a very relaxed, pain-free state. Kindly note that the exact surgical details are dependent on a variety of factors that affect the process, such as the number of donor areas (where fat is harvested from), among others. The more areas treated, the more time the doctor will need to perform the procedure. This also affects the position the patient should be placed on the operating table.
What type of results to expect after the surgery
The main issue to worry about with any fat transfer procedure is how much of the re-transplanted fat into the buttocks will survive and how much will dissolve. Not all of the fat injected after the Brazilian butt lift surgery will live. If the doctor did a good job the survival rate will be about 65-85%, and the rest will die off and be reabsorbed by the body. The reason why fat cells die when reinserted into the body is that they initially have no access to blood supply.
The surgeon will try to inject the fat as deep and as close to the muscle tissue as possible so that most of fat will remain.
You will need to expect that there will be a great deal of swelling after the surgery. These two combined factors of swelling and fat survival means that results you see the day of the surgery will be different three to six months down the road. Your new Brazilian butt lift will likely get smaller as swelling goes down and some of the injected fat dissolves. The doctor should explain this to you during consultation so you can plan accordingly.
- Ensure you have comfortable furnishings available as you will not be able to sit or put any kind of pressure on the buttocks for, at least, three weeks.
- Follow the surgeon's instructions regarding the use of the compression garment you will need to wear all day long for the first 2 weeks after surgery. This garment will help enhance the results of the BBL and prevent inflammation.
- Expect some soreness during the first 3-7 days after the procedure. However, your surgeon will give you pain medication to handle any pain that might be involved and help you feel much more comfortable.
- Take your medications according to the doctor's instructions and don't skip doses.
- After the first 3-7 days, you will notice that the swelling, soreness, and pain will begin to fade away.
- You will see significant improvement in the way your body feels and looks in the following 2 weeks. Be patient during these 2 weeks and you will then begin to see the final results of your Brazilian Butt Lift procedure.
- Eat healthy foods, fruits, and vegetables, and drink lots of water to help speed up the healing process.
- Some light walking might be advised after the first week of the recovery. However, do consult with your surgeon about it as each case is different. Most patients return to their everyday routine about 5 weeks after their BBL procedure.
- Smoking or sitting on the buttocks too soon after the butt enhancement will result in volume loss due to the death of the newly transplanted fat cells.
- Avoid sex for, at least, two weeks after surgery. However, if your doctor says you can have sex, ensure it does not involve too much pressure on the buttocks and there are no violent movements in the region (i.e. spanking or forceful grabbing).
Risks Involved with BBL
As with every surgery, there are some risks, such as fat embolism, numbness, infection, pain and bruising, excessive blood loss, deep vein thrombosis, fluid shifts, anaesthesia-related complications, and lidocaine toxicity. However, an experienced, board-certified, and specially trained plastic surgeon can help diminish those risks significantly.
Benefits of Fat Grafting
Fat grafting is the new, advanced method to help provide volume in the body where it is most needed per the patient's preferences. Some of the major benefits of fat grafting over other techniques used to reshape the body, and buttocks, in particular, are listed below:
- Fat transfer is a 100% outpatient procedure that does not use any synthetic material; only the patient's own fat. That alone is enough to eliminate the chance of an allergic reaction.
- The procedure itself is performed under IV sedation anesthesia, which minimizes the risk of complications compared to performing general anesthesia.
- Fat grafting can be combined with other procedures, such as liposuction, breast augmentation and facelift, to enhance other body areas in one go.
- Results are always natural-looking and immediate (they will continue to improve over the course of the nest few weeks following the procedure).
- There are no large scars. In fact, the procedure requires only tiny incisions for the needles required to remove and re-inject the fat.
- The complication rate is extremely low compared with other similar procedures.
- Results are long-lasting. The majority of patients retain up to 80 percent of the transferred fat for life.
- The healing period of fat transfer is only a few days. If combined with another cosmetic procedure, it might be lengthier. In general, there is very little downtime.
A BBL in Las Vegas will cost approximately around $10,000 and can go up to more than $15,000, while the price can vary from $9,000 to $12,000 in Phoenix. There are significant price fluctuations between major cities and minor populated areas, especially for the plastic surgeon's fees. See a complete table of average butt augmentation prices in the top 30 US cities.
At the end, several factors affect the final cost of the procedure, which are highlighted below:
The Location of the Clinic
The different costs of living in different geographical locations affect the cost of a BBL procedure. In general, the higher the cost of living, the more expensive the butt surgery. Of course, this has an impact on all related costs, such as the cost of the operating room (usually $60/minute) and anesthesia.
The Doctor's Fee/Experience
A more experienced plastic surgeon that specializes in buttock surgeries will probably charge a higher fee, especially if they receive a high demand from patients. However, it is strongly recommended not to make decisions based on the surgeon's fee rather than who is the most appropriate doctor for the cosmetic procedure they wish to undergo. It is always much better to work with the most qualified doctor and stay on the safe side instead of paying a lower fee and risk complications. In the long term, you will realize that an experienced, board-certified surgeon will cost you less than what you had imagined.
Type of Anaesthesia
Most patients go under local anesthesia and sedation. However, there are cases when general anesthesia is most preferred. Each practice or clinic should have a well-trained, experienced anesthesia team, which the patient also pays a fee for, that ranges from $500 to over $3,000 for general anesthesia administered by either an anesthesiologist or registered nurse in an office setting and a hospital operating room respectively.
The cost usually includes the anesthesiologist's fee, the cost of the supplies, equipment, and medications used, as well as the fee of the staff used for anesthesia. Also, a registered nurse will charge less than a board-certified anesthesiologist; however, it is best to trust a plastic surgeon that has teamed with a certified anesthesiologist to avoid critical safety issues.
Number of Target Areas
The complexity of the case can increase the overall cost of the procedure. For example, if a patient wishes for a 5-inch increase in their measurement, the BBL will be a lengthier and more difficult process. In such cases, we usually suggest a combination of fat transfer and liposuction is used for better and safer results.
Some patients choose to have a Brazilian Butt Lift and a tummy tuck, breast augmentation or facelift at the same time. This also increases the cost of the procedure, which, by the way, is significantly less than the cost of the two or three surgical procedures performed separately.
The cost of prescription medications, medical tests (if necessary), wound dressings, aftercare costs, and the cost of the surgical garments used are usually not included in the price quote. Watch out for the small letters as many doctors do not include the anesthesiologist's fee and/or operating room charges in their quote.
Patient's Health/Medical History
The complexity and level of difficulty of a BBL increases is the patient is suffering from a chronic condition (i.e. uncontrolled diabetes) or an immune deficiency, which also affect the recovery of the patient (the longer you need to recover, the more medications you will need to take and the more time off work you will require). Anemia, high cholesterol, arthritis, high blood pressure, and depression are also medical conditions that perplex things.
Finally, patients not willing to comply with the doctor's recommendations regarding quitting smoking and avoiding alcohol will be called to pay a higher fee should they insist on going ahead with the surgery and are ready to take full responsibility for any complications that will be a direct result of their recklessness.
Also called gluteal implants, butt implants comprise another option to add volume to the buttocks. They come in varying sizes, styles, and volumes, depending on the desired need and look the surgeon feels is appropriate to achieve the best appearance. They are either oval or round in shape and feature textured or smooth surfaces. Most of the times, they are filled with solid silicone that has to be extremely durable, considering that butt implants experience significant weight/pressure each time a person lies down or sits.
The problem with butt implants, which is one of the many reasons that have led to the development of an alternative method – that of BBL – is that they are related to various risks and/or complications, resulting from the implants themselves, such as fluid collection, implant displacement, and capsular contracture; all of which compromise the final outcome and can put the patient's health at risk.
That aside, the final feel and look is far less natural than the results one can obtain through a butt aumentation procedure. Also, undergoing butt implants does not offer a permanent result and patients are called to undergo a butt implant replacement surgery around 8-12 years after the initial procedure; that is if nothing has gone wrong in between.
Finally, post-op care is much more demanding and painful than with BBL, and it involves a handful of medication/pain killers and the placement of drains within the pocket(s) the doctor has created on top of the crease between the buttocks or between the buttock and the posterior thigh, to help evacuate fluids and blood for, at least, a week after surgery.
Traditional excisional butt lift
There are 2 types of buttock augmentation procedures at the moment (1) Traditional Excisional Butt Lift and (2) Brazilian Butt Lift, with the first being much more invasive than the latter. Traditional butt reshaping is a preferred method for sagging buttocks (i.e. after great weight loss) as it helps lift that area and remove the excess skin in that region. Generally speaking, when skin needs to be removed, a Traditional butt lift is the suggested procedure. In this case, no volume is added, although the patient may opt for butt implants that will be inserted during the lift.
How is traditional excisional butt lift performed?
It is a procedure that lasts between 2-4 hours and is performed under general anesthesia or sedation and local anesthesia so that the patient is kept comfortable and safe throughout the procedure. The surgeon makes a large incision into the buttock to manually remove thin layers of tissue, skin, and of course, fat. The plastic surgeon will use a scalpel or even liposuction to remove any stubborn fat and reposition the remaining tissue to give the patient a firmer, perkier look. Most of the times, they will also tighten the underlying muscles and make sure the now-smooth buttocks are held in a lifted position by created sutures deep within the hip muscles or, in some cases, the hipbones.
If the patient decides to have solid silicone butt implants, they will be placed at this point of the surgery. Finally, the plastic surgeon will pull the skin tight across the buttocks and ensure a smooth appearance is given by trimming the excess skin. For those that wish to combine traditional butt lift with fat transfer, this is the phase that they receive the fat injections. It should be noted that in traditional butt augmentation, the patient should not have too much surplus fat; otherwise, they are ineligible for the procedure.
Types of traditional excisional butt lift
Based on the incision the plastic surgeon makes to correct sagging, there are 4 principle types of traditional butt lift procedures:
1. Upper butt lift
The surgeon incises across the contours of the buttocks (the top of the region) and uses this incision to access the underlying tissue so that they can reposition or remove any excess tissue to give a more aesthetically pleasing appearance. It is a more intensive surgery compared to the other 3 types.
2. Bottom butt lift
It is more preferred for patients with mild to moderate sagging. The surgeon excises tissue from the bottom of the buttocks and gives a more lifted appearance by moving the bottom crease of the buttocks upward while removing any unwanted tissue.
3. Butterfly butt lift
As its name suggests, the incision of this type of traditional butt lift procedure looks like a butterfly. The doctor incises from the central crease of the buttock and moves their way up and outward. It is a method mostly used to address sagging tissue and not to lift or reposition the buttocks.
4. Lateral incision butt lift
This type reduces mild sagging and limits scarring in the edges of the buttocks and the hips. The surgeon makes a lateral incision on either side of the buttock.