Brazilian Butt Lift (BBL)

Brazilian Butt Lift (BBL) Overview

While aesthetic tastes change over time, the natural hourglass shape will likely always be sought-after. That is why the Brazilian butt lift is one of the most requested procedures in cosmetic surgery.

The Brazilian butt lift, abbreviated BBL, is also known as liposuction with fat transfer to the butt. A BBLbegins with liposuction or liposculpture of unwanted or excess fat. Then, the fat is processed and cleaned. Finally, the fat is grafted or injected into the buttocks for shape and volume.

I developed such a passion for this procedure that I literally put it in our name! In our practice, I value a natural shape that is balanced with the body over an extreme shape. If a patient seeks artistic and aesthetic harmony with an hourglass figure, it can be accomplished with a Brazilian butt lift.

Let us look into the first portion of the procedure in more detail.

Liposuction

What Are the Terms Liposuction, Liposculpture and Body Contouring?

Have you ever wondered why some physicians say liposuction and others call it liposculpture? The procedure is the same. Sometimes, I use the term liposculpture to refer to the sculpting aspect of liposuction. However, all liposuction I perform has liposculpting as the main goal.

Is Liposuction a Universal Term? Does Liposuction Mean the Same Service/Technique From Surgeon to Surgeon?

No. There are a number of different types of liposuction technology, and each surgeon may use different technologies and orders of the technology. These are the main types of liposuction I utilize during a BBL:
Tumescent Liposuction

I begin with tumescent liposuction. Tumescent is a solution of fluid with epinephrine and lidocaine. These medications decrease blood loss and reduce pain from liposuction.

VASER® Liposuction (UAL)

Next, I perform VASER liposuction. VASER utilizes ultrasonic vibrations to release the fat cells (called adipose cells).

Why is this important? Because all cells are attached to the body by connective tissue (called stroma). VASER helps release the fat cells from this connective tissue, making the liposuction easier and less traumatic. From a practical standpoint, this typically means less blood loss, less bruising and less pain. From a results standpoint, the easier the fat is to remove, the more I can focus on the artistic sculpting.

I am an international VASER Liposuction Body Contouring Trainer. I travel the globe and surgeons travel to me to learn the art of VASER liposuction body sculpting.

MicroAire® Power Liposuction (PAL)

Then, I perform power liposuction with MicroAire. This may also be abbreviated PAL (power-assisted liposuction). MicroAire utilizes powered vibrating suction to increase the amount of fat removed and decrease the time it takes to remove the fat.

Renuvion®

Finally, I typically finish with Renuvion soft tissue coagulation. The addition of Renuvion technology has significantly improved my liposuction results. Renuvion technology helps the skin and soft tissues to tighten and/or compress over the next six months. The addition of Renuvion technology has significantly improved my liposuction results by increasing the soft tissue tightness after fat volume is removed.

On average, the soft tissue tightens by 30%.

Will I Be Awake or Asleep During Liposuction?

Liposuction can be performed either under general anesthesia (also known as asleep) or while awake (also known as local anesthetic, Monitored Anesthesia Care (MAC), and sedation). We recommend patients have general anesthesia for liposuction due to the large body surface area (or number of areas) and the fat transfer to the buttocks portion. We find patients are simply more comfortable and have a better experience when asleep.

Where Does the Fat Come From for a BBL?

During the consultation and preoperative surgical marking, we will identify the areas of fat we want to improve and shape. Most commonly, we want to shape the torso with Liposuction 360, which targets these areas:

• Abdomen (the tummy)
• Flanks (the waist)
• Back

Liposuction 360 goes from the armpits (also called the axilla) to the pubis and buttocks, 360 degrees around the body. Removing fat from these areas helps to sculpt the body and define the curves that create an hourglass figure.

Does Liposuction Leave Scars?

All surgery creates a scar, and each individual patient scars differently. We attempt to minimize the impact of scars by placing incisions in the belly button, skin wrinkles or skin shadows, and within the underwear lines.

We also utilize scar massage and scar therapy treatments. In our practice, I use Silagen silicone scar strips to minimize scarring after surgery. Scar massage begins three weeks after surgery. Both Silagen and scar massage are continued for one year after surgery.

Fat Grafting (Fat Transfer)

Now let’s look at fat transfer, the second part of a Brazilian butt lift.

After I have extracted fat with liposuction, the fat is prepared for injection. The fat processing and purification steps are multiple stages that consist of separating fat (adipose cells) from any excess fluids or tissues, then washing and cleaning the fat with antibiotic solution.

In our experience, these steps are often skipped by other surgeons. We feel the fat processing and purification stage is extremely important because it allows for a better fat graft survival rate and, therefore, better long-term results. Taking the extra steps of processing and cleaning the fat gives the fat a higher chance of staying; thus, keeping your investment safe.

The processed fat is then injected into the hips, hip-dips and buttocks to increase the sculpting of the hourglass shape. Once the correct frame is shaped, the remaining fat is injected to volumize and sculpt the butt. The fat injection process may be called either fat transfer or fat grafting.

How Many CCs of Fat Are Injected During a BBL?

The amount of fat injected during a BBL depends on three factors:

1. Amount of fat available
2. Butt volume goals
3. Stretchability of the buttock skin and soft tissue

The first two are the main determining factors. However, we cannot neglect the importance of number three. The skin and soft tissue of the butt must stretch and allow the added volume. I use the analogy of blowing up a balloon. The balloon is full when it will no longer stretch any further. Likewise, the fat transfer is “full” when the skin and soft tissue will no longer stretch to accommodate the added fat transfer volume.

The following cc (or mL) of fat are averages and may vary depending on your available fat, goals and soft tissue stretchability:

• Hip Dip Only BBL – 350cc per side (800cc total)
• Skinny (Small Volume) BBL – 700cc per side (1,400cc total)
• Standard BBL – 900cc per side (1,800cc total)
• Large Volume BBL – 1,200cc per side (2,400cc total)
• Exaggerated BBL – 1,500cc per side (3,000cc total)

How Much Do I Need to Weigh to Get a BBL?

The larger, fuller and rounder you want your butt, the more fat is required to create those results. In our office, our maximum BMI for BBL candidates is 32. However, our office has a number of patients who are in excellent physical shape and simply want a little bump in shape, i.e. filling in the hip dips or a small increase in volume. We recommend these patients consider a skinny Brazilian butt lift.

What Is a Skinny BBL?

A skinny BBL, sometimes called a mini BBL, involves liposuction and fat transfer on smaller or thinner patients. The liposuction volume is smaller; therefore, the amount of fat transferred is smaller, too. The results can be amazing.

Typically, the patient undergoing a skinny BBL has excellent muscle tone and fitness with a BMI of 22 or less. Due to the lower BMI and good muscular tone, liposuction can be utilized in a High Definition form to shadow and sculpt the muscles. In women, the goal is to create a soft, natural fit shape. In men, the goal is to create hard lines and muscular edges.

In general, the patient’s buttock volume is good because the underlying gluteus maximus muscles (glutes) have volume from muscular fitness. However, the fitter the glutes, the larger the hip dip and less round the buttock shape. The skinny BBL focuses on correcting the hip dip and rounding the shape.

Brazilian Butt Lift Recovery

The most critical part of BBL recovery is understanding that it is longer than most cosmetic surgeries. On our Instagram, @SoCalPlasticSurgeon, we regularly show different patients’ recovery progression on our Stories.
Brazilian butt lift recovery can be divided into six important categories: (1) Lymphatic Massage, (2) Self-Massage, (3) Sitting and Laying Protocol, (4) Activity Restrictions, (5) Compression, and (6) Time Off Work.

Lymphatic Massage

Lymphatic massage is a critical part of post-operative recovery. It helps to decrease scarring, which in turn reduces the risk of having a “lumpy-bumpy” appearance after liposuction. This appearance is also known as contour irregularities and/or fibrosis.

Our goal is to start lymphatic massage as soon after surgery as possible, ideally the following day. Plan to continue lymphatic massage over the next four weeks. Typically, this amounts to 15 massage treatments scheduled as follows:

• Week 1: 4-5 massage treatments
• Week 2: 3-4 massage treatments
• Week 3: 2-3 massage treatments
• Week 4: 1-2 massage treatments

We have lymphatic masseuses that we recommend. However, you may utilize your own recommendation and/or masseuse.
Learn more about lymphatic massage techniques here.

Self-Massage

In addition to lymphatic massage, you must massage all liposuction areas yourself to speed-up recovery and soften/decrease scar tissue. The goal is to start self-massage as soon as possible. Most patients start self-massage around three to seven days after surgery. The protocol is twice a day for roughly 10 minutes at a time.
Learn more about self-massage techniques here.

Sitting and Laying Protocol

The sitting and laying protocol is the single most important recovery item to decrease the risk of fat re-absorption after a BBL. The main goal is to keep as much pressure as possible off the fat transferred areas (the buttocks and hips) during the first six weeks of the healing process. Laying/sleeping should be done on the abdomen (tummy) in the prone position.

In week one, sitting is allowed only for bathroom use. In weeks two through six, sitting is allowed in all situations with a pressure-offloading pillow. However, the goal is still to put as little pressure on the buttocks and hips as possible. The pressure off-loading pillow will be given to you during your preoperative appointment and you will be instructed on its use.

Activity Restrictions

Upper body gym workouts can start after one week. Basic treadmill walking without incline can also start after one week.

Lower body exercises and exercises that put pressure on the buttocks or hips can start after six weeks.

Compression

When recovering from liposuction and fat transfer, bruising, swelling/inflammation and firmness are common immediately after surgery. Compression is used to limit swelling as much as possible. Typically, 80% of swelling is gone by three months post-surgery. As such, we recommend wearing compression for three months after a BBL procedure.

Time Off Work

Plan to take one week off work and responsibilities after BBL surgery.

Does a BBL Hurt?

The majority of our patients are off pain medications by 48 to 72 hours after surgery. After three days, almost all of our patients are on Ibuprofen and Tylenol. Our liposuction techniques and technologies produce less pain than traditional liposuction.

In general, individuals describe the pain from a BBL as minimal to mild. My multifaceted pain protocol helps minimize discomfort and create a more positive experience for my patients.

With this protocol, pain medications are administered before going back to surgery. Beginning at this time is shown to significantly improve pain control after surgery.

After surgery, the protocol focuses on decreasing inflammation, nerve signaled pain (neuropathic pain), muscular pain and general discomfort. The medications that may be utilized during this time include:

• Gabapentin (Brand name Neurontin) – treats nerve pain
• Diazepam (Valium) – treats muscular pain
• Celecoxib (Celebrex) – treats inflammation and cellular signaling pain
• Hydrocone (Norco) – treats general pain and discomfort
• Tylenol – treats cellular signaling pain.

With my protocol, most of our patients now describe pain from a Brazilian butt lift as mild or even simply akin to soreness after an intense workout!

Brazilian Butt Lift Safety

The Brazilian butt lift has sometimes been referred to as the riskiest plastic surgery. Fortunately, this is no longer true.

BBL surgery garnered this reputation for two reasons: (1) Surgeons were injecting fat into the buttock muscles and (2) A limited and flawed study from 2017.

What Can Cause Death During a BBL?

The risk of death is during the fat transfer portion. The fat could be accidentally injected into large blood vessels only found in the buttock muscle or below the buttock muscle. If this occurred, fat would then cause a fat clot (similar to a blood clot) called a fat embolism or a Pulmonary Fat Embolism (PFE).

Injecting fat into the butt muscles increases the risk of death by over 16 fold. Therefore, the vast majority of surgeons are not willing to inject fat into the butt muscles. In our practice, we do not perform intra-muscular (in the butt muscle) fat transfers.

Injecting fat above the butt muscle has extremely low risk. In fact, it is even safer than some other cosmetic procedures. The risk of death from a BBL is quoted at 1 in 14,500 to 1 in 20,000, depending on the study and the fat injection technique. For comparison, the risk of death in a tummy tuck is 1 in 13,000. This means that the BBL is safer or less risky than a tummy tuck.

Why Was the 2017 BBL Study Flawed?

The study from 2017 on BBL safety interviewed less than 700 surgeons. For perspective, the current studies interviewed over 4,000. Lacking a sufficient number of data points, the 2017 study gave a falsely elevated risk with a death rate of 1 in 3,000.

At the time, the majority of board-certified plastic surgeons performing BBLs felt this study was flawed. We have since taken the time to perform the appropriate research, studies and education to confirm the safety of this procedure.

Do Surgeons Still Inject Fat Into the Butt Muscle?

Sadly, there are surgeons who still purposefully inject fat into the buttock muscle. Why? Because fat injected into the buttock muscles gives a significantly better result in butt volume, shape and projection. But, the improved result is NOT worth the over 16 fold increase in the risk of death.

Patients frequently travel outside of the United States to developing countries for BBL surgery because they feel the results are better. Unfortunately, the better results are because those surgeons are willing to take the risk and inject fat into the buttock muscle. The death rates in developing nations known for BBL medical tourism reflect the use of intra-muscular injections.

A portion of patients within the US also seek out the cheapest option for BBL surgery. Frequently, those patients end up at discount plastic surgery locations. While there are many great plastic surgeons with excellent facilities and investments in your safety, the discount centers are typically not those. “Discount centers” are responsible for 60 to 70% of the BBL deaths. A large portion of those deaths are located at discount centers without a board-certified plastic surgeon performing the operation. Fat embolisms are a risk of a BBL, I am not saying that fat embolisms are impossible at other locations or with board certified plastic surgeons.  However, the data shows a higher risk at “discount centers” and with non-board-certified-plastic-surgeons.

How Much Fat Dies After a BBL?

Not all of the fat transferred will stay after a Brazilian butt lift. Anywhere from 20 to 50% of the fat transferred will disappear after the surgery, and 50% to 80% of the fat will stay. In my opinion, the two most important factors in fat grafting survivability are (1) fat processing and (2) staying off the fat transfer areas after the procedure.

Fat Processing

Only some of the liposuctioned fat is viable or alive. In addition, up to 30% of liposuction may be fluid. Therefore, fat processing is crucial in order to isolate healthy, living fat cells from dead fat cells and fluid.

Keeping Pressure Off the Butt After Transfer

Increased pressure on the buttocks after transfer results in less fat staying. The increased pressure also results in a flatter buttocks shape with reduced projection.

In our practice, we process all fat prior to injection. We also recommend at least six weeks off the buttocks to maximize fat take and shape.

When Will I See the Final Results of My Brazilian Butt Lift?

Your butt will go through stages of healing. Initially, your butt is swollen from the fat transfer. Then, at roughly two weeks after surgery, the fat transfer swelling decreases, and the fat cells shrink in volume. How much the fat cells shrink is directly related to how much pressure you place on your buttocks. Less pressure equals less shrinking.

At roughly one year after surgery, your fat cells will increase in volume, and your buttocks will increase in volume, soften in appearance and round out in shape. This process is called “fluffing,” and you may hear it referred to as the “fluff fairy.” From a scientific standpoint, the transplanted fat cells are incorporated into the surrounding tissues and growing in size.

Does a BBL Make Your Stomach Flat?

A BBL includes liposuction of the abdomen, which flattens tummy bulges due to excess fat. During your consultation, we will review the degree of flatness that could be achieved by liposuction alone, and we will discuss whether other procedures are required to meet your goals.

Does a BBL Leave Loose Skin?

Liposuction removes excess fat and then the fat is transferred to your buttocks. I utilize Renuvion with my liposuction. Renuvion is not a substitute for skin excision procedures, such as a tummy tuck, arm lift or thigh lift. In general, soft tissue contraction after my liposuction technique is ~ 30% on average. Unfortunately, each person responds differently and we cannot guarantee a specific amount of soft tissue contraction from liposuction.

Does a BBL Fix Hip Dips?

The “hip dip” is a natural depression in the gluteal muscles. In normal anatomy, the gluteal muscles (the medius and maximus) insert along the thigh bone (iliotibial tract). The insertion creates an anatomical depression called the “hip dip.”

Hip dips are more noticeable in smaller or more muscular patients because the insertion point has little muscle mass or volume. Working out increases gluteal muscle volume and tone, but the insertion point has little muscle mass and therefore cannot increase proportionally. This creates an exaggerated hip dip.

The hip dip is corrected during a BBL by injecting fat over the insertion points. This provides added volume and fills in the hip dip. Overall, the torso then transitions from a square shape to a rounder shape.

Will I Lose My BBL If I Work Out?

Fat transferred to the butt undergoes a process of decreasing in volume after two weeks. Beyond two weeks, the transferred fat is incorporated fat cells (adipocytes).

We do not recommend any buttock, seated or lower body workouts until after six weeks. At this time, the transferred fat behaves like other fat on your body. The fat increases in size as you gain weight and decreases in size as you lose weight. Some patients may feel their butt looks too small at certain weights.

The important concept to understand is this: beyond the first six weeks after surgery, the transferred fat may decrease in size with weight loss, but you do not “lose” the fat cells. Gaining weight back increases the size of the fat cells and returns the volume.

What Happens to a BBL After 10 Years?

Fat cells that survive the transfer to your buttocks are permanent after six weeks. The fat cells will increase or decrease in size as you gain or lose weight. On average, 50-80% of the transferred fat is permanent.

Does a BBL Sag After Years?

Buttock sag (or lack of sag) is related to buttock muscle tone, buttock muscle size and skin elasticity. Lasting results are maximized by maintaining a healthy lifestyle with regular exercise focusing on the gluteal muscles and maximizing sun protection to minimize sun damage to the skin.

How Much Do Brazilian Butt Lifts Cost?

A Brazilian butt lift is two procedures in one: Liposuction 360 of the abdomen, waist and back and Fat Transfer to the Buttock. Our approach typically also includes the use of Renuvion skin tightening.

The average price for a BBL is $12,500. Many patients also include liposuction of the arms, inner thighs and chin. With these additional areas, the price range is $13,500 to $18,000, depending on the size of the additional areas.
Our Brazilian butt lift price increases as BMI increases because there is more fat to remove and this takes longer. In general, our price increases $1,000 when the BMI is at 28, 30 and 32. Our BMI limit for surgery is 32 or under.

Is a BBL Worth Getting?

The majority of our patients are extremely satisfied with their BBL. The procedure currently has an 84% “Worth it” rating on the website Realself.

Are BBLs Reversible?

Yes, a BBL is reversible. The way to reverse a BBL is to perform liposuction to the areas on the buttock and frame where the fat was previously transferred.

Interested In a Brazilian Butt Lift in Southern California?

If you feel you could benefit from a Brazilian butt lift, or are interested in learning more about the procedure or other procedures we offer, contact our office. Consultations can be done either in person at our offices in Newport Beach, Orange County or Upland, CA in the Inland Empire. We also offer virtual/digital meetings and consultations. Call (949) 416-0038 or fill out our online contact form to get in touch with us today!