Butt Augmentation

Large volume liposuction is almost a prerequisite for patients having a Brazilian buttock lift in which the basic principle is to collect and transfer unwanted fats to improve body proportions. Scientists and artists alike suggest that a waist-to-hip ratio of 0.70, or at least near this volume distribution, is the most ideal feminine physique.


Having a 0.70 WHR means that the waist circumference is 70 percent o the hips measurement.


large volume liposuction before and after photos

The “after” photo shows the results of Brazilian buttock lift preceded by large volume liposuction.


Recently, leading Beverly Hills plastic surgeon Dr. Tarick Smiley has shown large volume liposuction before and after photos on his Snapchat account. Fat transfer to the buttocks and hips was immediately performed thereafter.


The patient shown in the photos had liposuction to her abdomen, flanks, lower back, “bra rolls,” and axilla (around the armpit).


In regard to cosmetic goals, African-American patients tend to ask for curvier results and so they typically require large volume liposuction. Caucasians, meanwhile, often prefer subtler improvements—i.e., they are focused more on improving the shape of their buttocks, with minimal to moderate amount of augmentation.


Despite strong predilection to certain beauty goals due to cultural influence, Dr. Smiley says it remains imperative to identify the specific goals of patients through an honest and comprehensive consultation with them.


“It is inimical to assume that everyone has a standardized beauty ideals. Hence, I always ask my patients about their specific goals. After all, elective surgeries are here to elicit a smile from them, says Dr. Smiley on his previous Snapchat post.


As seen in the recent videos, Dr. Smiley injected tumescent fluids into the fatty area to help expand the fat cells, paving way for their gentler and more precise extraction. The solution also contains epinephrine, a drug known to reduce bleeding by up to 90 percent compared to the dry technique.


Dry liposuction is an antiquated technique in which no wetting solution is infiltrated into the fatty area.


Meanwhile, epinephrine works by constricting the blood vessels, which in turn provides another auspicious consequence: It prolongs the numbing effects of local anesthesia, thus allowing the patients to avoid or at least take less pain relief in the first few days post-op.


Thanks to large volume liposuction, Dr. Smiley was able to inject more than 1,000 cc of purified fat into each butt cheek to meet the patient’s desire for additional augmentation. Furthermore, he injected about one-third of the fat volume into the hips, which is basically the outer-lateral aspect of the buttocks, to deliver a more feminine physique.

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Most plastic surgeons recommend BBL compression garments to control swelling of the liposuction or donor sites and to help remodel the tissue of the buttocks and hips.


Leading Orange County plastic surgery expert Dr. Tarick Smiley often recommends his patients to wear a one-piece compression garment that covers the upper back to the knee level.


bbl compression garments

The vast majority of Dr. Smiley’s patients require liposuction of the bra rolls, lower back, flanks, and anterior abdomen to collect large volume of fat, which is immediately purified and injected into the buttocks and hips.


Swelling due to edema is not uncommon after liposuction because once the “compartments” are depleted with fat, bodily fluids have the tendency to take over. Hence, effective compression garments should fit snug but not too tight as to cause pressure problems.


Symptoms of pressure problems include skin discomfort, difficulty of moving around, and inability to sleep due to excessive tightness.


Excessive pressure (more than 10 lbs. of force) is particularly detrimental to the buttocks and hips or any recipient site. It takes about three weeks for the fat grafts to form their new blood supply needed for their long-term survival, and another month or two before they fully stabilized and become well integrated with the surrounding tissue.


While many BBL compression garments cover the buttocks, there is no or very little pressure around them. Also, they often come with a “crotchless” design so the patients can use the toilet without having to remove or pull down their garments.


In general, compression garments are worn the entire time (unless when bathing) for three weeks, which are the most critical period. Afterwards, patients may use the second-stage compression, which has less pressure since at this time swelling has subsided to a significant degree.


Nonetheless, each surgeon has his own instructions that they deem fit.

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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.


Actual results from Dr. Smiley’s meticulous BBL surgery.


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.

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BBL surgery, also called Brazilian butt lift or buttock augmentation via fat grafting, is a two-step procedure: liposuction to collect fats from multiple donor sites followed by fat injection into the buttocks and hips to achieve a more feminine curve.


While fat or volume distribution is the key to achieve a more feminine silhouette—i.e., narrow waist juxtaposing the curvy hips and buttocks—symmetry also plays a critical role in patient satisfaction following BBL.


bbl surgery

Photo credit: kidshealth.org

One way to ensure a good level of symmetry (“perfect” mirror image between the left and right side is simply impossible) is to identify any existing asymmetry prior to surgery. This is particularly true for patients with scoliosis, a disorder in which the spine curves sideways.


(Note: The spine should appear straight when looking from the front.)


Orange County plastic surgery expert Dr. Tarick Smiley has previously performed BBL on a female patient with scoliosis.


The patient’s spine curved to the right and thus it appeared to have more volume compared to the left side. Hence, during liposuction Dr. Smiley removed a bit more fat to the “bulging side” to achieve a more symmetric appearance.


A meticulous performed liposuction of the flanks and lower back also allowed Dr. Smiley to reduce the appearance of skin fold caused by the sideway curve of the spine.


It should be noted that scoliosis also affects the appearance of hips, making one side appear more prominent. This asymmetry must be taken into account during fat injection so as to allow the surgeon to make some adjustment in volume distribution.


During fat injection, Dr. Smiley says that microdroplet technique is critical in creating infinitesimal compartments of fat, which allow for blood vessel ingrowth that is the key to achieve near permanent results.


Without blood vessel ingrowth, Dr. Smiley has warned that fat would simply die and become resorbed by the surrounding tissue.

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Celebrity Beverly Hills plastic surgeon Dr. Tarick Smiley has recently shared a photo of a patient who had BBL after one year. In general, the surgery’s longevity varies greatly from patient to patient, although most can expect to maintain their results between seven and 12 years.


BBL, which is an acronym for Brazilian buttock lift, typically involves large-volume liposuction to collect fats from multiple donor sites. After they are purified, they are injected into the buttocks and hips at a varying layer to ensure high survival rate of fat grafts.


bbl after one year

Dr. Smiley says it is also critical to inject fats not too close to the skin to minimize bruising and swelling. It should be noted that too much swelling results in additional pressure, which is the enemy of high survival rate.


Aside from meticulous surgical techniques, Dr. Smiley says that long-term results also depend on the patient’s commitment, especially in the first three weeks when the fat grafts are in their most delicate stage, as they are still developing their own blood supply and the extracellular matrix, a mesh-like anatomy that integrates the grafts with other tissues, is yet to stabilize.


“In the first three weeks postop, we ask our patients to use medical donut pillow, Boppy, or pregnancy cushion. The goal is to eliminate or at least minimize pressure on the fat grafts, thus allowing them to stabilize in their new location,” he says in a video posted on Snapchat.


“We even teach our patients on how to sit on the back of their legs, as opposed to their buttocks,” he further explained.


To further promote high survival rate, Dr. Smiley says he recommends a “special sleeping position” in the first three weeks postop.

before BBL

“Pillows are put behind the knees and back to somewhat elevate the buttocks when the patient is in supine position,” he added.


Patient commitment should also include avoiding tobacco products particularly in the first few months postop because they contain nicotine that robs the body of its oxygen, which is the key element to promote high survival rate of fat grafts.

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Beverly Hills plastic surgeon Dr. Tarick Smiley has recently shared Brazilian butt lift photos demonstrating a female patient who used to complain about her square buttocks that primarily stemmed from the lack of hips.


It should be noted that patients with square buttocks, or H-shaped backside, also have thick waist line and ultimately poor waist-to-hip ratio. According to studies, there is a strong preference for WHR that is near 0.7, a predilection that is seen across different cultures and socio-economic backgrounds.


Brazilian butt lift photos

(Note: This mathematical ratio is gender specific.)


Interestingly, the 0.7 WHR is seen across different body sizes, height, and weight. From curvier stars such as Beyoncé to lithesome beauties like Natalie Portman, this ratio is seen.


To narrow the patient’s waist, Dr. Smiley performed liposuction (fat removal) around her midsection, particularly focusing on the excess fat along her flanks and lower back that contributed to the flat-looking buttocks.


Then, Dr. Smiley purified the fat before he injected it into the buttocks and hips, resulting in an inverted heart shape backside, which is generally considered to be the most feminine butt shape.


The inverted heart shape butt has a tapered waist line and more fat distribution around the hips and lower portion of the buttocks.


Right after surgery, the surgeon was able to create a WHR of 0.6, which is expected to gradually turn into something near 0.7 after the swelling around the buttocks and hips subside, and some of the fat grafts are resorbed (about 25-30 percent of the original volume).


After 3-6 months, any volume that remains is expected to be near permanent, thanks to blood supply ingrowth.


Meanwhile, Dr. Smiley has warned that any attempt to create a 0.55 WHR and below leads to fake-looking results as this “volume distribution does not occur in nature.”


“What we aim for is the creation of subtle difference with S curves. We don’t want small legs juxtaposing huge buttocks,” he says in the video.


Aside from disproportionate results, the celebrity plastic surgeon has warned that over injection could also predispose patients to increased risk of cellulites, dents, and other surface irregularities, along with risk of sagging appearance.


The key to natural results, aside from the WHR guideline, is to take into account the patient’s anatomy such as the skin elasticity, shoulder width, and height.

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