Dr. Dirk Lazarus

Plastic, Reconstructive & Cosmetic Surgeon

MBChB (UCT), FCS (SA) Plast & Recon Surg

Butt Augmentation

Butt augmentation or the Brazilian butt lift is a procedure to enhance the shape and size of the butt. The procedure is a large volume fat graft to the butt. Butt implants are less successful than breast implants. Butt implants are inserted into the muscle (breast implants go either above or below the muscle) and this is a big, bloody dissection with its attendant problems. The butt is for sitting on and this can stress an implant. For these reasons I prefer to do butt augmentation by fat grafting. Perhaps the volumes achieved might not be as great as with implants, but I think fat grafting is the preferable option for butt augmentation. Liposuction on its own can also provide some butt improvement. Removal of fat from above (love handles, lower back) and below (saddlebags, thighs) can enhance relative butt projection. It may not always be necessary to recycle the fat for butt fat grafting, but it certainly can be used if more butt volume is required. Butt fat grafting is performed with liposuction as day case surgery in my own facility, Tranquillity Clinic. The details of the anaesthesia, surgery, complications and recovery are as for liposuction. When doing a liposuction for fat grafting I harvest the fat with syringes. This is more gentle on the fat and allows the fat to be collected. Fat harvest is done from the usual liposuction areas and once collected the fat is treated (the tumescent or wetting fluid removed by gravitation or centrifuge) and transferred to smaller syringes for injection into the butt. Injection of the fat is done through 3 or 4 small (<5 mm) incisions per side. These usually heal with inconspicous scarring. The average volume of fat injected per side is around 300 to 400 ml. The volume provides augmentation (enhancement) and some degree of lift. Recovery and complications are as for liposuction with the additional factor that your butt will be tender, bruised and sore. It will be difficult to sit.

Fat

Multiple syringes of fat ready for injection

The fat is transferred as a large volume fat graft. For it to survive it needs to acquire a blood supply, a process called vascularisation which takes a few weeks to months. In the interim, the fat lives by a process of diffusion (diffusion of nutrients to and waste products from the fat cells), but this is sub-optimal and some of the fat cells will die. It is unknown how much of the fat will survive, perhaps around half to three quarters, and there is therefore some unpredictability about the procedure. In fact it will appear that a lot of the fat is lost and then usually it sort of fills up again to some extent as the grafted fat becomes vascularised. Nevertheless, in this early period, hard areas may occur and these can also form cysts or collections of fluid due to fat necrosis (fat cells dying due to insufficient nutrition). Later complications include asymmetry, irregularity or inadequate correction. Nevertheless butt fat grafting combined with liposuction can give satisfactory results.

Download Sunday Times Article, 22 January 2017 (.PDF)

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We have met before – about 10 years ago – I was kicked in the face by my horse and you performed the surgery (rather brilliantly). Now I am interested in something else…

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