Brazilian buttock lift (BBL) has increased in popularity over the last few years.  Perhaps in part due to the so-called “Kardashian effect”, many women are interested in a more voluptuous buttock contour.  BBL may be appealing to many patients given that it uses one’s own body tissue to increase buttock volume.  Fat is suctioned via low intensity liposuction, gently prepared, and then reinjected into the buttocks to desired volume and contour.  In addition to increasing buttock volume, reducing fatty tissue at the donor sites is another advantage, which achieves further body contouring.  Many women are interested in BBL given that it may reduce or eliminate risks of implant-based buttock augmentation, including infection, implant-related complications, palpability, and delayed wound healing.  Although BBL may provide a more natural alternative and avoid the need for implants, here are 5 things every woman must know before considering the procedure:

  • Risk of mortality

As more BBL cases have been performed, it became apparent that differences in surgical technique may relate to increased risk of serious complications, including mortality.  This topic was the focus of a recent urgent advisory from the American Society of Plastic Surgeons.  The risk of mortality associated with BBL is 1/3000, which is significantly higher than other plastic surgery procedures.  Research has shown that mortality associated with BBL relates to fat injections performed within the muscle layer, leading to damage of the gluteal veins and resultant fat emboli.  Fat grafting performed within the subcutaneous plane – the layer between skin and above the underlying muscle – has not been associated with any fatalities and is considered a safe zone of injection.

  • Potential need for staged procedures

Since fat injections are recommended in the subcutaneous plane alone – not within or deep to the muscle layer – this may limit the amount of fat that may be safely injected in one surgery.  What does this mean for patients?  Limiting fat injections in the safe subcutaneous zone may limit the achievable volume of buttock augmentation.  Alternatively, it may take a few surgeries to achieve the desired aesthetic outcome to lower risk of complications.  Staging the procedure would be considered a safer approach by limiting the injections in the subcutaneous plane and allowing the tissues to stretch between surgeries to achieve a greater final volume.

  • Risk of fat resorption

Although BBL may increase buttock volume, the final outcome may be less predictable than an implant-based augmentation.  Not all injected fat will establish a new blood supply.  Revascularization – which determines how much of the injected fat will survive – depends on many factors relating to surgical technique, patient comorbidities, and aftercare.  Liposuction must be performed under low suction to minimize barotrauma to fat cells.  Centrifugution should similarly be avoided to reduce trauma to the fat.  Harvested fat may settle under gravity alone to remove the oil and water from the purified fat cells.  Injecting small amounts of fat along different paths in the subcutaneous plane may also maximize how much fat survives, as opposed to injecting a large amount in one region.  Aftercare is also important.  Patients should minimize how much time is spent sitting or lying on the buttocks during early healing, which may reduce pressure as the fat establishes a new blood supply.  Other patient factors, including comorbidities — diabetes, connective tissue disease, certain medications — and smoking status may also affect wound healing and final results.

  • BBL may be difficult to reverse

While trends may change over time in plastic surgery, it is important for patients to understand that the results of BBL may not be easily reversible.  Should one’s aesthetic goals change in the future, reducing buttock volume following BBL may be difficult.  Liposuction at this site carries risks of contour irregularities, including rippling, depression, and asymmetry.  Redundant skin may also result, which may compromise aesthetic results and potentially require skin removal and lead to additional scarring.

  • Results of BBL may vary based on weight fluctuations

BBL uses autologous tissue to increase buttock volume.  If weight fluctuations occur, whether during pregnancy or weight gain or loss, buttock volume will similarly change.  Patients often ask if they should gain weight prior to BBL to increase availability of donor site fat.  This is inadvisable given that volume will likely not be maintained following weight loss after surgery.  It is recommended for patients to achieve a stable and healthy BMI prior to undergoing body contouring procedures.

Before considering any type of plastic surgery, patients should fully understand the associated risks and benefits.  Given increased risk of complications of BBL, it is even more important to carefully research the procedure, surgeon, and surgical centre.  Proceeding with BBL by a board-certified plastic surgeon experienced with the procedure, associated risks, and current guidelines in a fully accredited facility may lower risk of complications and enable a patient to achieve her aesthetic goals.

Please contact us if considering buttock augmentation in the Toronto area to schedule a consultation with female plastic surgeon, Dr. Stephanie Power.

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