Butt Augmentation

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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BBL surgery, also referred to as Brazilian butt lift or butt augmentation via fat injection, is a two-step body contouring surgery. Doctors first perform liposuction on multiple donor sites (e.g., lower back, flanks, bra rolls, and tummy) to collect large volume of fat, which is then processed and injected into the patient’s buttocks and hips.


While bruising is a normal part of recovery, leading Beverly Hills plastic surgeon Dr. Tarick Smiley says that all efforts are made to minimize this postop symptom to promote high survival rate of fat grafts.


bbl surgery

Dr. Smiley recommends the use of compression garments for at least eight weeks. The idea is to control the swelling in the liposuction sites and to help remodel the tissue in the recipient site or buttocks.


Postop bruising happens when blood from ruptured capillaries or small blood vessels leaks out under the skin, resulting in a red or purplish mark that turns into green or yellow discoloration as the patient moves forward to her recovery.


In a recent Snapchat video, Dr. Smiley says that too much bruising causes “excessive pressure and tension, which is not good for the fat grafts.”


One way to control the amount of postop bruising and swelling, Dr. Smiley says, is to use gentle and correct fat injection technique; this also ensures high survival rate and smooth, natural contours of the buttocks and hips.


“It is important to inject fats in multiple layers of the muscle and subcutaneous tissue, and in a way that separate containers are being created. This technique results in less bruising and allows the buttocks to take more fats. About 70 percent is expected to survive long term, provided that fat injection is done in a highly meticulous manner,” Dr. Smiley says.


Aside from meticulous fat injection, the celebrity plastic surgeon highlights the importance of using medical grade compression garments, which are typically worn for eight weeks. The idea, he says, is to keep the swelling and bruising to a minimum, and ultimately to promote healing and smooth results.


The garments worn around the buttocks are designed to provide minimal compression, as too much pressure may “kill the fats” and lead to less than optimal results; however, the garments for the liposuction sites are usually tauter to control swelling and to prevent edema (fluid formation) beneath the skin.


While compression garments can aid in healing, Dr. Smiley says that most patients can see the final results about six months after surgery, as it takes a while for the skin to fully shrink-wrap to the new contour and the residual swelling from the tumescent fluids to subside completely.

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The success of Brazilian buttock lift surgery largely depends on how meticulous the surgeon is during physical exam and consultation. The goal is to identify the patient’s pre-existing anatomy and ascertain her aesthetic needs, says leading Beverly Hills plastic surgeon Dr. Tarick Smiley.


In Dr. Smiley’s recent Snapchat video post, he demonstrated a patient with noticeable asymmetry between her left and right hips, poorly projecting buttocks, and excess fat along her flanks and lower back that further “concealed” her derriere.


brazilian buttock lift surgery

Prior to surgery the left hip appears flatter compared with the right hip. Furthermore, the patient has pre-existing surface irregularities, which must be addressed at the same time as the surgery.


Dr. Smiley says it is critical to identify any pre-existing asymmetry prior to surgery to customize the procedure and achieve the most balanced results possible. For instance, the patient’s left hip was significantly flatter in comparison to the right side. Furthermore, her oblique and profile view showed that the buttocks were almost at the same level as the lower back.


before bbl

Prior to surgery, the patient’s buttocks are flat that they are about the same level as the lower back.

During physical exam, Dr. Smiley also assessed the patient’s skin quality, particularly its elasticity and shrinkage, an anatomical aspect that would help him determine how much fat volume the buttocks could carry without resulting in sagging appearance or other surgical stigmata.


The pre-existing skin elasticity would also determine how much fat volume that could be harvested from the donor sites without predisposing the patient from surface irregularities and other telltale signs of liposuction.


“The skin of the liposuction or donor sites should be able to retract or shrink nicely. This is possible when the surgeon is able to assess the patient’s skin shrinkage,” says Dr. Smiley.


For the vast majority of patients, Dr. Smiley says the lower back and flanks “carry a large amount of excess fat, which makes them a great donor site,” adding that contouring them creates a more feminine “S” curve and a smoother transition between the back and upper buttocks.


Aside from the lower back and flanks, the celebrity plastic surgeon also collected fat from the patient’s “bra rolls” and tummy, areas that often carry excess fatty tissue as well.


Dr. Smiley allocated about one-third of the fat volume into the outer-lateral side of the buttocks, since the patient requested for curvier hips, while the rest was injected to improve the buttock’s profile.

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During a secondary liposuction surgery of the same area, plastic surgeons deal with more challenges due to the scar tissue created by the previous surgery.


Scar tissue forms within the fatty layer that has been previously suctioned through a liposuction cannula, a slender steel probe attached to a vacuum pump. Hence, during a revision surgery the area is very “tough,” making it more difficult to move the instrument back and forth.


secondary liposuction surgery

A secondary liposuction surgery is performed to correct the unsightly rolls and contour irregularities caused by a previous liposuction. Afterwards, the patient receives BBL surgery.


Leading Beverly Hills plastic surgeon Dr. Tarick Smiley has recently posted a series of videos on Snapchat to demonstrate a female patient who underwent secondary liposuction surgery that was shortly followed by Brazilian butt lift or BBL.


In standard liposuction the fats are discarded, but in BBL they are “re-used” in order to improve the volume and contour of the buttocks and hips, thus obviating the need for synthetic implants.


Dr. Smiley said the patient previously had botched liposuction of the back done by another surgeon, leading to the appearance of rolls and contour irregularities.


The celebrity plastic surgeon corrected the botched results by using liposuction microcannula, which has a narrower diameter compared to the standard design. With this technique, he was able to remove small bits of fat, as opposed to large chunks, leading to smoother results.


The use of microcannula also favored the patient because of the internal scar tissue in her back.


To further ensure smooth and natural results, Dr. Smiley preserved a thin layer of fat beneath the skin.


“Liposuction is not about removing all fats. What is more important is to preserve a smooth skin surface, which is only possible when you leave a carpet of fat beneath the skin,” he said in a previous Snapchat video.


Because the patient also requested for BBL and thus required large volume liposuction, Dr. Smiley also used the axilla (armpit area), bra rolls, anterior abdomen, thighs, and knees as donor sites.


The patient also requested for “wider and curvier hips,” Dr. Smiley said he allocated a large portion of the purified fat into the area.


It should be noted that most patients will need 600-900 cc of purified fat (after removing all the impurities such as the oil and blood inadvertently collected during liposuction) to see a noticeable difference. But for more impressive results, some may even need up to 1,200 cc.

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