Butt Augmentation

Welcome to the most viewed page on my website! Is it thanks to Kim that everyone wants to be bootylicious? But beware, there are issues.

1. Danger/Death
   BBL, or Brazilian Butt Lift, is one way to enhance the butt. Unfortunately this is the most dangerous procedure in surgery – not just plastic surgery, ALL surgery. And by dangerous, I mean mortality rate. Death. A 1 in 3000 death rate for any cosmetic surgery procedure is unacceptable. See the advisory from a number of Plastic Surgery Societies.
2. Expectations
   Happiness with cosmetic surgery happens when outcomes match expectations. Many patients seeking this procedure have unrealistic expectations as to what can be achieved – they want a big increase, lift, firmness. Starting with a clean sheet of paper I could achieve this, but of course no one is a clean sheet of paper – that is the realm of Art. With cosmetic surgery one is working on what you already have (your anatomy), and there are limits as to what can be achieved with cosmetic surgery. Many patients want more than that which is achievable.

What is BBL?
The procedure basically involves the injection of fat into the buttocks. There are a few important points to know:

• The fat needs to be harvested from you (you cannot use fat from someone else). Harvesting that fat is done with some form of liposuction. So every patient who has a BBL needs lipo. The fat is then prepared and then injected.
• The fat injected is a graft – a graft is a non-vascularised tissue transfer – in other words the fat is transferred without a blood supply. To survive all tissue, like the fat injected, needs a blood supply. The blood supply brings in nutrients and oxygen, and removes waste products – that is one of the functions of blood – it transfers stuff around the body.
• Take is the medical term for vascularisation, the process of the blood supply growing into the grafted fat. This process can take several months. What happens in those months before the graft has taken, before the blood supply has fully grown into the new transferred fat cells? Some of the fat cells will not survive because they do not receive enough nutrition or oxygen and those which do survive are likely to shrink and shrivel until the blood supply is robust and healthy. (There is a flow of nutrients and waste products in the fluid between cells, but this is a trickle compared with the blood supply.)
• Typically, therefore only a portion of the fat will survive, usually no more that 50% and even that is likely to be optimistic. Also, the amount of fat which survives tends to vary depending on patient and surgical factors. At this stage, plastic surgeons do not know how to optimise fat survival with fat grafting.
• Because considerable fat may be lost, patients are usually warned that they may require multiple procedures to obtain the result that they want.

What are the alternatives to BBL?
Butt Implants: Implants are routinely used in the breast to increase breast size (breast augmentation), so it would be natural to think they can be used in the butt also? Well, no. Firstly, you don’t sit on your breasts. Sitting on your implants (if they are in your butt) can cause rupture, deformation and other issues. Secondly, the breast is a gland and there is a well defined plane under the gland or even under the muscles of the chest where the implant can be placed. There is no such surgical plane in the butt and so the implants are usually placed in the butt muscles – a destructive procedure which can cause significant bleeding, scarring. I do not offer butt implants in my practice.

Liposuction alone: This is about hills and valleys. By shaping the areas around the butt – treating the love handles (the hip bulges above), the saddle bag (the hip bulges to the side) and perhaps some of the overhang areas of the lower butt – one can try and improve the general shape and contour of the butt. Also, this serves to shorten the vertical height of the butt which is a good thing and which can help it appear more curved and round. Sometimes, the fat obtained with the liposuction can be used to contour the butt – only the upper outer part – or to fill hip dents.

How is BBL done?
BBL is performed 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. 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.

For risks and complications see my page on complications. Specific to the procedure include hardness, irregularity, lumps, cysts, loss of fat and hence result. 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)

Page last updated 13 November 2022