Buttock Augmentation

How is a buttock augmentation procedure performed?

The two most popular methods for buttock augmentation are autologous fat transfer (using your own natural fatty tissue), also called the Brazilian butt lift, and gluteal implant surgery with or without fat transfer for additional contouring.

Autologous fat transfer
This procedure, referred to as a Brazilian butt lift, takes fat from one area of your body and uses it to enhance and reshape your buttocks.

• Liposuction with suction tubes (cannulas) is used to remove fatty tissue from areas of your body with excess tissue, such as the abdomen, hips, back, or thighs.
• The fat is then processed for fat transfer.
• The fat is reinjected using syringes connected to cannulas.
• Usually three to five small incisions are needed for injecting the fat, but these incision sites are easily hidden by clothing.
• The fat is grafted in layers at multiple levels, with the cannula moving back and forth to ensure that a smooth, linear deposit of fatty tissue is left to reshape and augment the buttocks area.
• The liposuction incisions are closed with sutures.
• Drains are inserted and a compression garment is worn following surgery.

Not all the fat transferred in a BBL procedure is expected to survive. The final result may be somewhat smaller than initially projected. Repeat BBL procedures (a 2nd or 3rd round) are occasionally advised depending on a patient’s initial results.

While popularly called a “butt lift,” the BBL procedure is primarily about improving body torso contours, improving the waistline, reducing back rolls, and providing a more curvaceous figure. Skin is not removed in a typical BBL and the “lift” effect is primarily an increase in projection of the buttocks.

Buttock implants
Implants are most appropriate for treating flat or poorly defined buttocks, particularly for patients who have limited fatty tissue. Butt implants are not as effective for treating sagging buttocks that may occur after significant weight loss.

• With this procedure a soft, shaped silicone implant is placed through an incision hidden inside the natural buttock crease, or an alternate incision site may be used. Your plastic surgeon will provide further details about these incision locations during the consultation.
• The implant is positioned in a pocket below the large buttock (gluteal) muscle and above the pelvic bone.
• The incisions are closed with sutures, drains are inserted, and a compression garment is worn following surgery.

What are my options?

There are two main approaches for buttock augmentation: autologous fat transfer (Brazillian butt lift) and buttock implant surgery. Your cosmetic surgeon will recommend an approach based on your aesthetic goals and body shape. Buttock implants may be chosen if you desire a more rounded appearance to your buttocks while fat grafting is an excellent way to contour and reshape your butt. If you are very slender with little excess fat, then implants may be appropriate; however, if you have sagging buttocks after massive weight loss, then fat grafting or a combination of fat and butt implant surgery may be more effective.

Silicone injections – patient safety warning
Silicone injections are an unsafe and unacceptable option for buttock augmentation. These injections are often offered by unlicensed individuals and should be avoided. Always consult with a board-certified plastic surgeon if you are considering a buttock augmentation procedure.

What will my buttock augmentation incisions and scars be like?

Depending on the type of procedure your surgeon recommends, the following incisions may be used:

Autologous fat transfer
The liposuction incisions are very small and just large enough to allow the suction tube, or cannula, to go under the skin and remove the fat. The incisions used for injecting the fat into the buttock regions are equally small.

Implants
Typically an incision is made in the fold between the buttock “cheeks.” Alternative locations are the outer corners of the upper buttock and at the bottom in the gluteal crease.

Select a surgeon you can trust

It’s important to choose your surgeon based on:

• Education, training, and certification
• Experience with buttock augmentation surgery
• Your comfort level with him or her

Members of the American Society for Aesthetic Plastic Surgery are experienced and qualified to perform your aesthetic procedure.

After finding a board-certified plastic surgeon in your area who is experienced in performing buttock augmentation, you will need to make an office appointment for your consultation. Generally, because of the in-depth nature of the consultation, there is a cost associated with the initial visit.

Your initial consultation appointment

During your initial consultation, you will have the opportunity to discuss your cosmetic goals. Your surgeon will evaluate you as a candidate for buttock augmentation and clarify what a butt augmentation surgery can do for you. Understanding your goals and medical condition, both alternative and additional treatments may be considered. (see related procedures).

Your plastic surgeon will examine your buttocks and most likely take photos for your medical records. Your surgeon will consider:

• The size and shape of your buttocks
• The quality of your skin
• What kind of butt augmentation is appropriate depending on your goals and body type
• Appropriate fat donor sites, if a Brazilian butt lift is planned

You should come to the consultation prepared to discuss your complete medical history. This will include information about:

• Previous surgeries, including prior liposuction, tummy tuck or other abdominal surgeries
• Past and present medical conditions
• Allergies and current medications
• Any history of prior injections to the buttocks

It is important for you to provide complete information. If you are planning to lose a significant amount of weight, be sure to tell your plastic surgeon. He or she may recommend that you stabilize your weight prior to undergoing surgery.

Your treatment plan

Based on your goals, physical characteristics, and the surgeon’s training and experience, your surgeon will share recommendations and information with you, including:

• The approach to your surgery, including the type of procedure or combination of procedures.
• Outcomes that you can anticipate.
• Your projected financial investment for the procedure.
• Associated risks and complications.
• Options for anesthesia and type of surgical facility.
• What you need to prepare for your surgery.
• What you can expect to experience after surgery.
• Show before-and-after photos of cases similar to yours and answer any questions

Questions to ask your aesthetic plastic surgeon

It is important for you to take an active role in your surgery, so please use this list of questions as a starting point for your initial consultation.

• Am I a good candidate for buttock augmentation?
• Are the results I am seeking reasonable and realistic?
• Do you have before-and-after photos I can look at for the procedure I am undergoing?
• Will my scars be visible? Where will my scars be located?
• What kind of anesthesia do you recommend for me?
• What will be the costs associated with my surgery?
• What will you expect of me to get the best results?
• What kind of recovery period can I expect, and when can I resume normal activities?
• What are the risks and complications associated with my procedure?
• How are complications handled?
• What are my options if the cosmetic outcome of my surgery does not meet the goals we agreed on?

How do I prepare for a buttock augmentation procedure?

Your surgeon will provide you with pre-operative instructions, answer any questions you may have, take a detailed medical history, and perform a physical exam to determine your fitness for surgery.

In advance of your procedure, your surgeon will ask you to:

• Stop smoking at least six weeks before undergoing surgery to promote better healing.
• Avoid taking aspirin, certain anti-inflammatory drugs, and some herbal medications that can cause increased bleeding.
• Regardless of the type of surgery to be performed, hydration is very important before and after surgery for safe recovery.

Buttock augmentation is usually performed on an outpatient basis. Be sure to arrange for someone to drive you home after surgery and to stay with you at least the first night following surgery.

What can I expect on the day of my procedure?

Your buttock augmentation surgery may be performed in an accredited hospital, a free-standing ambulatory facility, or an office-based surgical suite. Most buttock augmentation procedures take at least two to three hours to complete but may take longer.

• Medications are administered for your comfort during the surgical procedure.
• General anesthesia is commonly used during your buttock augmentation procedure, although local anesthesia or intravenous sedation may be desirable in some instances.
• For your safety during the surgery, various monitors will be used to check your heart, blood pressure, pulse, and the amount of oxygen circulating in your blood.
• Your surgeon will follow the surgical plan discussed with you before surgery.
• After your procedure is completed, you will be taken into a recovery area, where you will continue to be closely monitored. You will have drains in place. After fat transfer, you will have a compression garment over the liposuction areas and over your buttocks. After implant surgery, you will be placed in a surgical dressing that includes a support or compression garment over your buttocks.
• You will probably be permitted to go home after a short observation period unless you and your plastic surgeon have made other plans for your immediate postoperative recovery.

Your surgeon will discuss how long it will be before you can return to your normal level of activity and work. After surgery, you and your caregiver will receive detailed instructions about your post-surgical care, including information about:

• Drains, if they have been placed
• Normal symptoms you will experience
• Potential signs of complications

Immediately after your buttock augmentation
The incisions where your surgeon inserted the cannula or the implants may drain fluids for several days. Drainage tubes are often inserted to channel this fluid away from the wound. Significant fluid drainage is not uncommon after large volume liposuction, and bruising is common.

You will wear special tight garments to keep your buttock area compressed. Your doctor will tell you how long to wear these, usually for weeks. Some doctors provide these garments, but others will tell you where to purchase them before your surgery.

When the anesthesia wears off, you may have some pain. If the pain is extreme or long-lasting, contact your plastic surgeon. You will also have some swelling after the surgery. In some cases, this swelling will remain for weeks or even months. Contact your cosmetic surgeon to determine whether your pain and swelling is normal or a sign of a problem.

Your surgeon may recommend a treatment called lymphatic massage to try to reduce swelling and facilitate better drainage of any fluid buildup.

Recovery time frame after buttock augmentation
It is vitally important that you follow all patient care instructions provided by your surgeon after a butt augmentation procedure. This will include information about wearing compression garments, care of your drains, taking an antibiotic if prescribed, and the level and type of activity that is safe. Your surgeon will also provide detailed instructions about the normal symptoms you will experience and any potential signs of complications. It is important to realize that the amount of time it takes for recovery varies greatly among individuals.

The first two weeks

• The recovery period is slightly longer and more painful in the buttock area, because this body region is used for physical activities such as walking, running, and even standing.
• On the first day after surgery, you may be instructed to stay in bed with the compression garment on and to periodically move your hands and feet to maintain good circulation. You will be able to get up and walk after the second post-operative day.
• When transported home or to your first post-op follow-up visit, you will be instructed to lie on your stomach in the back seat of the car to avoid pressure on your buttocks. This position should also be used to maneuver and stand for the first 3 days.
• You will also be instructed to lie on your stomach or side while sleeping and while watching TV or reading.
• You can expect some bruising and swelling in the buttock area during recovery; this may spread up to the abdominal or thigh area. This is normal and will begin to subside after a few days or weeks.
• Your buttocks may be sore and painful, but this usually begins to resolve after just a few days. Pain medication will be prescribed for the pain.
• Drains will be in place for the first seven days to eliminate fluid buildup and oozing from your incisions.
• An oral antibiotic may be prescribed to be taken as long as the drains are in place.

Many surgeons do not allow sitting in the first 10-14 days except for using the toilet and eating. After this time, you can sit with a soft pillow placed beneath your hamstring muscles but not touching your buttock, so that your buttock is in the air and there is no pressure on the newly augmented buttock. This has not been proven to impact surgical results but is often advised as a precaution.

Weeks two to eight

• Direct pressure must be kept off the buttocks for at least eight weeks, so sitting without a pillow is not allowed for that period.
• You must wear a compression garment for six to eight weeks.
• The final results of your buttock augmentation may be initially obscured by swelling. When the swelling subsides, sometimes taking three to six months, your true results will be more evident.
• You are advised not to go clothes shopping for at least three months
• After fat grafting, you can return to work, drive, or go to the movies after ten to fourteen days, but you must use a pillow when sitting so that there is no pressure on your buttocks. You can resume normal activities and exercise after eight weeks.
• After implant surgery, you can return to work in two to three weeks, but you must use a pillow when sitting so that there is no pressure on your buttocks. At the third postoperative week, you are cleared for sitting and driving (using a pillow) and are encouraged to start stretching exercises. You can resume exercise eight to ten weeks after surgery. However, if there are wound complications, you may have to wait three to four months before you go back to the gym.

Under normal circumstances, the results of your buttock augmentation surgery will be long-lasting.

After a successful fat transfer buttock augmentation, the fat that remains will stay there for the rest of your life. Like the rest of the tissue in your body, this fat will grow and age with you. If you have implants placed, these devices do not need to be removed unless you develop a late complication.

Although the procedure improves the shape and contour of your buttocks, you should make necessary lifestyle changes to maintain the appearance of your new shape. A healthy diet and exercise regimen can be incorporated into your daily routine to maintain your look.

Maintain a relationship with your aesthetic plastic surgeon
For safety, as well as the most beautiful and healthy outcome, it’s important to return to your plastic surgeon’s office for follow-up evaluation at prescribed times and whenever you notice any changes in your buttocks. Do not hesitate to contact your surgeon when you have any questions or concerns.

Your specific risks for buttock augmentation will be discussed during your consultation.

All surgical procedures have some degree of risk. Some of the potential complications of all surgeries are:

• Adverse reaction to anesthesia
• Hematoma or seroma (an accumulation of blood or fluid under the skin that may require removal)
• Infection and bleeding
• Changes in sensation
• Scarring
• Allergic reactions
• Damage to underlying structures
• Unsatisfactory results that may necessitate additional procedures

Other risks specific to buttock augmentation are outlined below:

Fat transfer

• Fat absorption – may be as much as 40% – which may produce asymmetry, making this procedure more difficult to predict and requiring additional fat grafting sessions over time to attain the desired “look”
• Fat embolism – this is a risk of fat being injected into a blood vessel and traveling (embolizing) to the heart or lungs. Most surgeons have never had a patient with this complication, but in the unfortunate event that it occurs, this can be a fatal event.

Implants

• Implant slippage, causing asymmetry

Any complications or changes in shape may require additional surgery.

You can help minimize certain risks by following the advice and instructions of your board-certified plastic surgeon, both before and after your buttock augmentation surgery.