We use your own body fat to fill out, plump up, shape and lift the buttocks. But we need more fat than you think! Imagine this: Step one – the fat you hate is removed and sculpted away from every place on your body where you have “a little too much” through some simple liposuction. Step two – once it’s been removed, your fat is no longer the bad guy, in fact, it’s as precious as gold. It is carefully collected, measured and kept sterile and not merely discarded as medical waste.
It’s purified, cleaned and concentrated and loaded into special syringes. Step three – while you are still under anesthesia, the fat is then injected, sculpture style, into the buttock mounds to enhance their fullness, shapeliness and create some fill-out and lift. The more fullness you desire, the more fat your body will need to donate to the cause. Everyone thinks that they have more than enough, but even for more modest “trunk filling” goals, they often have just barely enough. How so? Because there is always less fat in those problem spots than you think, because not all the fat that is removed is of good enough quality to use, and after it is all concentrated, the “donor” fat must then be divided between two buttock cheeks! And then there is the risk for absorption, so we always want to get a little extra in there to allow for that. Add that all up and the amount of fat we need to start with is significant. Probably more than you thought. Hopefully, not more than you have to give. Sorry, no, your friends can’t donate – it has to be your own fat.
Some of the transferred fat will be absorbed. In the old days, absorption rates as high as 50% or more were commonly seen! Simply using everything that comes out with liposuction, the absorption rate will be even higher. We’ve made many improvements in techniques over the past few years – less traumatic handling of the fat during the harvesting, and better concentrating and injecting methods, but absorption is still a well-known risk. Another way to limit absorption is by using better quality fat. When the fat is first collected, some of it is too watery, some of it is too bloody, some of it is too fibrous, etc. During the processing and concentrating of all the fat, only the best fat is obtained and then used for sculpting – this fat has the greatest chance for providing a nice, long-term result with minimal absorption. While this strategy further limits the actual volume amount of fat available for buttock sculpting, it increases the chances of overall success. To counteract the potential for absorption, injecting a slightly greater amount than ultimately desired is preferable. Again, this is why we need a respectable, healthy amount of donor fat. And yes, we have asked some patients to intentionally gain weight in preparation for their Brazilian Buttock Lift!
Fat injection/sculpting can be repeated if needed or desired…and often is. Long-term, most patients are very happy with their new shape and fuller, rounder buttocks. Nevertheless, some will find that the degree of fat absorption was more than expected. Many more will love their results but just “want more”. As long as there is someplace we can still take fat from, this is not a problem. Secondary fat injection/sculpting can be performed at any time to add to what is already there. It’s probably best to allow for the full healing and maturation process to be near completion for both the donor and the “recipient” buttock areas before proceeding with procedure #2 – that would typically be around 9 – 12 months from procedure #1.
Your own fat vs. implants? Fat wins. The buttocks are not an ideal place for an implant. The buttock area takes a lot of pressure on a daily basis – that is not a good thing for a prosthetic device. The implant might migrate as a result, even in the short-term, and move out of its original position, rotating and looking “funny” or pressing on something like a nerve or a bone and become a lot of trouble. Implants can migrate to the extent that they become exposed and thereafter infected. Implants are always at risk for becoming infected regardless – and this area of the body has a lot more bacteria around it than do most other areas. Again, this is just not an ideal location for an implant. Buttock implants are hard and dense, not mushy, soft and jiggly like a buttock is supposed to be. Any of these problems could necessitate the removal of buttock implants.
Now let’s talk about fat. It’s yours, not synthetic, not foreign. There’s no rejection. Once transferred into its new home, the fat is alive and happy to be there – it’s got nowhere to go and no intention of migrating. If an infection develops, your body will fight it like it does anywhere else – there’s no need to remove anything – there is no artificial material in the body to worry about that could perpetuate an infection until it is removed. Fat is soft and mushy and jiggly and can’t press or impinge upon anything. Fat is what is supposed to be in there. And more can be added if you want it. If you don’t have the fat to spare, that is clearly a problem. Otherwise, fat wins.
The key to a more sensual buttock shape is as much about the “frame” as it is the “portrait”. When we perform liposuction to reshape the body, some of the most important definitions we must create are for the zones which frame and indirectly shape the buttocks: the small of the back needs to be curving in and help to highlight the “shelf” of the upper peak of the buttocks; the flow of the upper hips must be such that they are narrow at the waist but then sweep into a graceful, curved arc to form the beautiful outer sweep of the buttock (the upside-down heart shape); the area of the back of the thigh, just under the crease of each buttock (called the “banana”) must lie flat and not bulge; the part of the inner thigh that meets the inner buttock crease should be smooth and flat; the curvy, little smile of each buttock crease should sweep up toward the outer thigh and look friendly and happy.
This is all done with special liposuction techniques which, even without any fat injection/sculpting, will reshape and highlight a better overall and more sensual look to the buttocks. On the other hand, when these areas are in need of re-shaping, even a full, round buttock will not look as good as it should. The frame, or the areas directly surrounding the buttocks, have this power when shaped right. But the true Brazilian Buttock Lift is a combination of these techniques and the adding of volume directly to the buttock cheeks using your own fat – the icing on a very nice cake (i.e. the portrait)!
Dr. Lyle Back is originally from New York City, receiving his medical and surgical training at Rutgers Medical School, Cooper Hospital – University Medical Center, and Ohio State. He is Board Certified in General Surgery (ABS) and Plastic Surgery (ABPS). He is a Fellow of the American College of Surgeons (ACS), the American Academy of Cosmetic Surgery (AACS), and a longstanding member of the premier American Society of Plastic Surgeons (ASPS). He served as a Professor of Plastic Surgery at Temple University and St. Christopher’s Hospital for Children and performed reconstructive surgery with “Operation Smile” in Vietnam. He specializes in the full range of the most modern and state of the art cosmetic surgery procedures for the body and non-surgical cosmetic enhancement techniques available today.