The term Brazilian buttock lift or BBL is a misnomer because it is mainly designed to increase the backside’s volume—and ultimately its shape and proportion—with fat grafting or injection. Simply put, it is not for someone with a significant amount of sagginess unless a simultaneous excision-based surgery is performed as well.
Most patients will need at least 800 cc of fat to see a noticeable improvement in the shape and volume of their buttocks and hips. Hence, BBL typically requires large volume liposuction, says leading Los Angeles plastic surgeon Dr. Tarick Smiley.
Meanwhile, sagging buttocks—i.e., they droop over the lower butt fold—are often caused by massive weight loss. The only way to improve their appearance is to remove the redundant skin, typically made above the buttocks, specifically at the junction with the lower back.
Oftentimes, an elliptical shaped excess skin and fat is removed from the upper buttock before the remaining skin is sutured back together. The resulting scar lies across the uppermost aspect of the buttocks and is hidden along the bikini line to allow the patient wear a bikini bathing suit without having to worry about visible surgical stigmata.
Weight loss-induced sagging buttocks may also appear flat; hence, it is not uncommon to combine excision-based butt lift with BBL. Depending on the extent of surgery, they are sometimes performed separately to minimize risk of complications and to promote high survival rate of fat grafts.
However, a BBL alone approach will often suffice if the patient only has mild sagging. Just like breast augmentation via implant, adding volume into the flat buttocks can have a mild to moderate lifting effect.
The lifting effect becomes more potent when the excess fat is removed from the lower back and V zone (between the butt cheeks), while the apex of the buttock is filled with the fat collected during liposuction.
Regardless of the skin quality, it is important to avoid over-injection particularly in the lower buttock aspect near the fold to avoid harming the fascia, which holds the skin to the muscle. Aggressive augmentation may also cause too much weight, which of course makes the buttocks more susceptible to the effects of gravity.