Butt Augmentation

BBL, which stands for Brazilian buttock lift, is one of the most commonly performed body contouring surgeries to date. This basically combines liposuction to collect donor fats from multiple areas; the fats are then immediately purified and injected into the backside to improve its shape and fullness.


While the vast majority of patients require fat injection into their buttocks and hips, which are the outer or lateral area of the butt region, some women only want hip enhancement.


bbl and hips

Photo Credit: Dr. Tarick Smiley


Leading Los Angeles plastic surgeon Dr. Tarick Smiley says it is possible to enhance the hips alone or anywhere additional volume is needed.


“That is the beauty of fat grafting or fat injection. We can put them anywhere and thus we have more control over the final results. Butt implants, meanwhile, can be limiting because they are placed above the patient’s sitting area and so only the upper half of the buttock region is enhanced,” says Dr. Smiley in a previous Snapchat video.


Fat injection to hips alone is ideal for patients who have sufficient butt size but want to achieve a more hourglass physique, which is believed to be the most attractive feminine figure.


A hip alone “enhancement” may also favor women who want subtle results—i.e., they want better shape instead of additional volume or forward projection to the buttocks.


“It is important to identify each patient’s goals so we can deliver results that can make them happy,” says Dr. Smiley.


Dr. Smiley says the vast majority of his patients require both BBL and hips enhancement, which are possible with at least 800 cc of purified fats. However, people who want more augmentation may need more than 1,000 cc to achieve their desired result.


The celebrity plastic surgeon says the best donor fats come from the lower back and flanks because of two main reasons: First, because they are adjacent to the buttocks and hips they tend to have impressive survival rate, and second, sculpting the area further emphasizes the contour and projection of the backside.


Including the abdomen as a donor site further improves the patient’s physique.


“By removing the excess fats through liposuction, we can significantly improve the patient’s waist-to-hip ratio. Studies have suggested a strong preference for WHR of 0.7, meaning the waist circumference is 70 percent of hips measurement. This is seen across different cultures and demographics, says Dr. Smiley.

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Sculptra for buttocks is a minimally invasive procedure that uses an FDA-approved injectable material that triggers more collagen production, resulting in up to fourfold increase in soft tissue volume.


Dr. Tarick Smiley, a prominent Los Angeles plastic surgeon, says the right candidate for Sculptra injection is determined by the underlying anatomies, cosmetic goals, and “acceptable tradeoffs.”


sculptra for buttocks

Dr. Smiley says lots of Sculptra vials are needed during buttock enhancement to achieve the desired outcome.

* Patients who do not have enough fat to undergo fat transfer buttock augmentation, or more commonly referred to as Brazilian buttock lift, is a good candidate for Sculptra.


Nonetheless, most surgeons would first still consider fat transfer before they would recommend Sculptra or any other filler material because fat provides near permanent results for almost the same price.


Dr. Smiley says that Sculptra’s results can only last an average of 3-4 years.


* Patients who can’t or don’t want surgery. Fat transfer to the buttocks often requires large volume liposuction or multiple donor sites to achieve the desired results. While this concomitant surgery results in a more holistic improvement of the physique, this entails 2-3 weeks of recovery.


Sculptra for buttocks, meanwhile, is performed under local anesthesia because it does not involve liposuction. Thus, most patients can return home about an hour after their procedure.


* Patients who want subtle to moderate improvement might be a good candidate for Sculptra injection. The amount of augmentation is quite conservative, although most can expect a rounder backside; this is particularly true when the surgeon focus on the lateral buttock, which anatomically speaking is the hips.


Meanwhile, fat transfer remains the best approach if one desires for bigger augmentation and more pronounced curves. Fortunately, the concomitant liposuction in the lower back and flanks makes these goals easier to achieve.


* The ideal candidate should understand that unlike fat transfer in which the results are near permanent (12-15 years), Sculptra is resorbed after 3-4 years and so it requires a more regular touch-up if one likes to maintain the curvier appearance of her buttocks.

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The use of compression garment after BBL, or Brazilian butt lift, is known to minimize swelling, decrease discomfort, and promote healing and smoother contour of the liposuction sites.


Most compression garments used after BBL resemble a girdle that extends from the upper back to just above the knee. However, it has a “butt out” design, meaning it has no or very little compression or tight fabric over the buttock region.


compression garment after BBL

Leading Beverly Hills plastic surgeon Dr. Tarick Smiley says that excessive compression on the buttocks, which are the recipient of the fat grafts, can lead to low survival rate and less than optimal results.


However, the liposuction sites can benefit from some moderate amount of compression to keep swelling to a minimum. The idea is to compress the “empty” compartments where the fat has been removed to prevent edema or excess fluids from accumulating.


The right amount of compression over the liposuction sites can also help remodel the tissue and allow the skin to heal closer to the body, which in turn promotes the smoothest results possible, says Dr. Smiley.


While each doctor has his own specific instructions on how to use compression garment after BBL, many agree that it should be worn for at least three weeks religiously, meaning it is only removed when the patient uses the toilet or takes a shower.


The garments should fit snugly over the liposuction sites, causing no discomfort and pressure problems (the fabric or elastic edges should not dig into the skin).


As the swelling resolves as the patients move forward to their recovery, it is common to switch to a smaller garment or even a Spanx-like standard girdle provided that most of the postop symptoms are gone. Meanwhile, people with redundant skin and persistent swelling will have to wear them longer.

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Many surgeons agree that the growing popularity of Brazilian buttock lift can be attributed to celebrities like Kim Kardashian and Kylie Jenner who are known for their sizeable bottoms.


Brazilian buttock lift reshapes and augments the patients’ hips and buttocks using their own fat collected through liposuction. The flanks, lower back, and anterior abdomen are traditionally considered as donor sites of fats, allowing the surgeons to create a more holistic improvement.


brazilian buttock lift

This patient has finer fat globules that make it easier to achieve smooth results from Brazilian buttock lift.


Leading Los Angeles plastic surgeon Dr. Tarick Smiley has recently demonstrated the surgery on his Snapchat. The patient shown in the series of videos had flat buttocks, narrow hips, and dents at the lower aspect of the butt cheek, all of which had been improved by the surgery.


Dr. Smiley collected large volume of fat in multiple liposuction sites that included the flanks, lower back, tummy, “bra rolls,” and armpit.


In the video, the celebrity plastic surgeon said the quality and quantify of fat has a large influence on the results of Brazilian buttock lift.


“Some patients have more fibrous fats, while others have smoother, finer fat globules. It is easier to create smooth results when the fat globules are smaller and finer,” he said.


Furthermore, Dr. Smiley said the use of finer fat globules during surgery promotes higher survival rate particularly when they are injected into a highly vascularized area (containing more blood vessels).


“Just like in skin graft, during Brazilian buttock lift when the fat grafts are placed in which there is more contact with the blood supply and are injected into a larger surface area, we can expect high survival rate,” Dr. Smiley further explained.


To collect finer fat globules during liposuction, Dr. Smiley said the use of microcannula is especially critical. This is a hollowed steel tube with an outside diameter of 2 mm or less.


Microcannula not just creates smooth contours of the buttocks and hips; it also prevents surface irregularities on the liposuction sites because it removes fats in smaller bits rather than in bigger chunks.


Aside from the quality of fat, its quantify also affects the final results. Hence, Dr. Smiley said that thin patients in general can only expect subtle to moderate improvements particularly in the amount of projection of their buttocks.


However, Dr. Smiley said that thin patients tend to achieve a more pronounced roundedness especially on the posterior view of their buttocks after surgery.

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Brazilian buttock lift or BBL has revolutionized the way plastic surgeons perform buttock augmentation surgery. In fact, this technique has almost precluded the need for butt implants and other synthetic materials since most people have adequate fat reserves.


During BBL, excess fats are collected from multiple sites, which typically include the lower back, flanks, and anterior abdomen, using liposuction surgery. The fats are then sorted, washed, and transferred to several tubes to be later injected into the buttocks and hips.


large volume bbl


While the term large volume BBL is not clearly or medically defined, most surgeons agree that it involves more than 1,000 cc of fat volume injected into each side, resulting in drastic improvements in the projection and shape of the buttocks.


Leading Inland Empire plastic surgeon Dr. Tarick Smiley explains the factors that allow or warrant large volume BBL.


  • Tall and broad-shouldered patients


Contrary to popular belief, the ideal butt and hip dimension created during BBL is largely influenced by the patient’s upper torso/shoulder dimension, not her legs. The idea is to achieve a more hourglass physique, which is the quintessential feminine shape.


Meanwhile, petite patients (e.g., 5’2 and 118 lbs.) are generally poor candidates for large volume BBL due to disproportionately huge results, which can be a clear sign that a plastic surgery has been performed.


Furthermore, petite/thin patients have not enough fat reserves to allow for large volume BBL. Nonetheless, aesthetic improvements particularly in the shape of their buttocks remain possible in the hands of a skilled surgeon. In fact, due to their small body frame they tend to have a more pronounced roundedness of their backside.


  • Skin that is not too lose nor too tight.


A skin that has a good level of elasticity allows for large volume BBL, while a skin that is markedly tight, which is commonly found in patients with square buttocks, can only take a conservative fat volume.


Dr. Smiley says that tight skin causes too much pressure, which is the “enemy of fat grafts” and thus results in low survival rate; hence, only a conservative volume of fat is administered in patients with this anatomy.

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BBL on small frame generally entails a conservative approach as patients typically have limited amount of fat reserves. Nonetheless, the results on petite women often show a more pronounced roundedness of the buttock particularly on the posterior view.


Leading Beverly Hills plastic surgeon Dr. Tarick Smiley says that average patients typically require at least 800 cc of purified fat on each side to see a noticeable result; however, markedly thin patients may have little excess fat, which could limit the amount of projection and augmentation created by BBL, which is an acronym for Brazilian buttock lift.


bbl on small frame


However, there are ways to compensate for the low fat reserves such as performing liposuction in small volumes over multiple areas, Dr. Smiley says on Snapchat.


“When dealing with petite patients, I will find all the unwanted fats to come up with sufficient amount that is later injected into the buttocks,” he says.


Dr. Smiley says that contrary to popular belief, the legs are not the main consideration when deciding for the “ideal” buttock projection and hips width during surgery.


A few months ago, a thin and tall woman asked for BBL to improve her flat buttocks and near absent hips. While her legs were relatively thin and slender, Dr. Smiley decided to inject more fat volume into the butt and hips to make them look proportionate to her broad shoulder/upper body.


Aside from taking into account the patient’s overall physique, Dr. Smiley says BBL on small frame should also focus on the shape, adding that some patients are more concerned about the contour improvement than the actual amount of augmentation.


Recently, Dr. Smiley had a patient who requested for a conservative BBL (this generally refers to 200-300 cc fat injection on each side) because she only wanted more hips. Meanwhile, the profile or forward projection of her buttocks required little fat injection because it was already adequate prior to surgery.


Dr. Smiley says that BBL on small frame can provide great improvements in the entire physique when 360 degree liposuction is performed, meaning the flanks, lower back, and anterior abdomen are treated as a donor site. By creating a smaller waist, the buttocks and hips are further highlighted.

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