Preventing buttock augmentation risks should be the main objective of any prudent surgeon, said leading Beverly Hills plastic surgery expert Dr. Tarick Smiley on his recent Snapchat post.
To demonstrate a poorly done buttock augmentation surgery, Dr. Smiley has posted photos of singer Nikki Minaj clad in a scanty two-piece bikini.
Dr. Smiley said the star’s backside clearly shows buttock implants that are too big for her underlying anatomy, particularly relating to her soft tissue coverage, skin elasticity, and body frame.
The hugely disproportionate buttock implants, he said, are clearly visible beneath the skin that they have also caused the tissue to become thin and over stretched, inevitably causing her “derriere” to droop, a complication medically referred to as ptosis.
Whether buttock augmentation surgery is performed through butt implants or fat transfer, Dr. Smiley said the patient’s anatomy, particularly the “elasticity and resiliency of the skin,” must always be respected to achieve natural-looking results and to avoid most known complications.
“The loss or weakness of the fascia system, which holds the skin and the overall shape of the buttocks, can cause ptosis,” he further explained.
“We should not overdo it. The weight of the implants or the amount of fat injected into the buttocks must always respect the anatomy lest the results will look terrible,” he warned.
To further minimize buttock augmentation risks, Dr. Smiley said he now prefers butt augmentation via fat transfer (or Brazilian buttock lift in layman’s term) to the use of implants, which he only reserves for a very small percentage of patients.
Brazilian buttock lift uses the most natural material—i.e., the patient’s own fat—to reshape and augment not just her backside, but her hips as well, leading to a more proportionate, feminine figure.
Despite the perceived benefits of Brazilian buttock lift, Dr. Smiley said it remains important to avoid over-filling the backside since too much weight can cause ptosis, which can happen right after surgery or years down the road.
To further prevent ptosis, Dr. Smiley said most of the fat volume should go to the hips and the upper half aspect of the buttocks (as opposed to its lower aspect). This fat volume “allocation” results in a heart-shaped backside, especially when the unwanted fats from the lower back and flanks are removed as well.
Liposuction is the surgical technique that allows the surgeon to harvest the “unwanted” fats from two or more donor sites; the fats are then purified and re-injected into the patient’s buttocks, said Dr. Smiley.
Buttock implants under the muscle or at least within this anatomical layer has been known to provide softer, more natural results compared to a placement technique in which the prostheses lie above the muscle.
Placing the buttock implants above the muscle, with only the skin and fat “supporting” their weight, is known to increase the risk of sagging (inadvertent displacement) and palpability.
Leading Inland Empire plastic surgeon Dr. Tarick Smiley warns that the skin’s elasticity means it may stretch over time and lead to implant displacement and other surgical stigmata; hence, he always places buttock implants under the muscle or at least within this layer.
Furthermore, the under the muscle is known to minimize risk of infection especially in the event of poor healing since the muscle itself can serve as a protective barrier.
From the aesthetic point of view, buttock implants under the muscle technique can provide a more natural appearance—i.e., an S-shaped “behind” when viewed from the side.
Nonetheless, achieving natural and proportionate results also entails careful examination of the patient’s buttock dimension. The goal is to use implants that are within the anatomical boundaries, which in turn can also prevent skin thinning, implant malposition, and poor wound healing.
(Note: Patients of average frame are generally advised to stick to buttock implants whose size range is not more than 400 cc to prevent excessive tension on skin. It is important to note that too much tension is closely linked to poor healing and increased palpability.)
All buttock implants are positioned above the “sitting” area and so only the upper half of the butt is actually augmented, while its side (hips) and lower aspect receive no or very little improvement. For this reason, some patients may need a simultaneous fat transfer or fat grafting.
Incorporating fat transfer (which always starts with liposuction to collect fats) also allows the surgeon to “carve out” a more feminine contour by removing the excess fats along the flanks and lower back, says Dr. Smiley.
Liposuction uses a small hollowed tube inserted into tiny round incisions to remove the excess fat adjacent to the buttocks, further improving the contour and profile of the butt cheeks, he adds.
The collected fats from liposuction could be used to reshape the hips and lower aspect of the buttocks for a more proportionate, curvier silhouette, says Dr. Smiley.
Large buttock implants are difficult to “define” because of varying factors such as soft tissue coverage, butt dimension prior to surgery, and body frame. For this reason, a 450 cubic centimeter (cc) might be too big for a petite individual, but for someone taller (and with broader hips) this could be a good size.
Buttock implants come in different sizes, from 190 cc to 690 cc. While custom implants can be ordered larger, they always come at a higher price and a higher risk of complications as well.
Photo Credit: Sientra.com
To avoid a gamut of complications and achieve the most natural results possible, the general rule of thumb is to measure the actual dimensions of the butt cheeks and the soft tissue coverage. According to anecdotal reports provided by Los Angeles plastic surgeons, the most common butt implant size range is 400 cc to 550 cc.
It is important to use implants whose size and shape is within the anatomical boundaries of the buttocks. Failure to adhere to this rudimentary principle can lead to increased risk of wound healing problems, palpability, inadvertent implant malposition, and of course the eventual need for a revision surgery.
Using disproportionately large buttock implants can result in too much tension on the wound, thus increasing the risk of healing problems. Also, it is important that the implants are positioned beneath or at least within the gluteal muscle, which is noted for its strength and thickness.
While the under-the-muscle placement can limit the implant size, many surgeons today still prefer this technique because it lowers the risk of complication and provides a more natural look compared to placing it above the muscle, with only the skin and tissue supporting the implant.
Without the thick gluteal muscle, the skin is exposed to the wear and may eventually lose its elasticity, leading to implant palpability and inadvertent displacement.
On the other hand, placing the implant above the muscle allows for bigger augmentation, which is not really an ideal option for patients who are naturally thin or whose soft tissue coverage is limited.
Aside from the issue of size, the shape is also critical. Butt implants these days come in round, teardrop, oval, and “oval bubble” to deliver the patients’ desired results.
Buttock implants results will vary depending on the underlying anatomies, and the use of simultaneous procedures such as liposuction and/or fat graft, according to the California Surgical Institute website.
Due to the inherent position of the buttock implants—they are positioned above the bone where the patient sits—they can only augment about the upper half portion of the buttocks. The lower and the later aspect (or hips), meanwhile, will experience no improvement.
Despite the “limitations” of buttock implants, they remain the best option for patients with little fat to spare for buttock augmentation via fat transfer, or more commonly referred to as Brazilian butt lift.
To achieve smoother and “sultrier” buttock implants results, they are commonly combined with liposuction, which is particularly helpful in reshaping the flanks and lower back. Its goal is to “curve out” a more feminine silhouette and to further improve the shape and projection of the buttocks.
Liposuction can also eliminate the unwanted fat in the posterior thigh to further achieve proportionate results.
Instead of throwing the collected fats during liposuction, these could be later used to further reshape the “backside,” a technique medically referred to as fat transfer or fat graft. As a stand-alone procedure, this can provide good results provided that the patient has sufficient amount of unwanted fats.
If fat transfer is incorporated into buttock implants, it must be performed separately lest the pressure from the prostheses can lead to low survival rate of the fat grafts. It is important to note that blood vessel ingrowth is critical to achieve long-term results from this procedure.
Since the implants will have very little effect on the lateral aspect of the buttocks (or hips), about a third of the fat volume is ideally injected into the area. The remaining is then used to “thicken” the soft tissue and prevent or at least minimize implant palpability.
Simply put, buttock implants results combined liposuction and/or fat grafting can be impressive provided that the surgical techniques take into account the patient’s underlying anatomies and personal preference.
Most buttock implants complications can be avoided or at least minimized its incidence with proper implant selection, good patient-doctor rapport, and 100 percent patient cooperation.
Experts at the California Surgical Institute explain the basic guidelines on reducing buttock implants complications and ultimately achieve near permanent results.
- Patient selection process
Buttock augmentation, as with any elective surgery, is only reserved for healthy, near normal weight patients. Meanwhile, individuals with serious medical conditions are considered as poor candidates until these are treated or at least controlled through lifestyle change, diet, weight loss, and/or medications.
- Soft tissue evaluation and butt measurement
Careful evaluation of the soft tissue coverage and buttock dimension allows the surgeon to determine the “best” butt implant size in terms of reducing the risk of shifting or malposition, fluid formation, poor healing, and palpability.
In general, butt implants over 400 cubic centimeters can stretch the skin to a great extent and possibly lead to other problems such as palpability (due to fat atrophy or shrinkage), malposition, and wound healing.
- Implant placement deeper into the tissue
Placing the implants within or beneath the gluteal muscle, as opposed to above this anatomical layer—with only the tissue, skin, and small amount of fat covering them—is the most critical step in reducing the risk of migration and palpability.
The “intramuscular” implant placement is also known to lower the risk of infection and fluid formation (seroma) because the muscle acts as a protective barrier between the implant and the incision site should wound healing problem occur.
Any time a synthetic device is introduced into the body, scar capsule always forms around it. For this reason, it is important to give the scar tissue ample time to stabilize before returning to physically demanding activities and prolonged direct sitting.
A good rule of thumb is to limit sitting and physical activities for one month so the scar capsule or pocket heals without any “interruption.”
Simply put, minimizing buttock implants complications also requires the patient’s full commitment especially during the initial healing stage.
Buttock augmentation with implants and fat graft offers unique benefits, particularly to naturally thin patients in which a fat transfer-alone approach cannot deliver the desired results.
While buttock augmentation via fat transfer can mostly deliver good results, the results will largely depend on the donor sites or liposuction sites. For this reason, patients with low body fat percentage (e.g., body-builders and naturally thin people) can benefit more with buttock augmentation with implants and fat graft.
With this combo procedure, most of the augmentation will come from the implants, while the fat grafts will serve just as additional soft tissue coverage to minimize rippling, palpability, and other surgical stigmata. Simply put, the results will appear more natural, smoother, and softer.
Aside from hiding the “signs” of butt implants, simultaneous fat graft can also help reshape the waistline, leading to a more hourglass figure, according to the California Surgical Institute website.
It is important to note that fat graft typically uses the lower back, hip-flank region, and frontal abdomen as the donor or liposuction sites. As a result, the projection and contour of the buttocks are further emphasized.
Furthermore, an implant-alone approach cannot improve the hips. Hence, about one-third of the transferred fat is ideally used in the area to deliver a more feminine figure. The remaining amount is then used to improve the projection of the actual buttocks.
However, most surgeons feel that buttock augmentation with implants and fat graft should not be performed at the same time due to the issue of low survival rate. It is important to note that the transferred fats must form new blood supply for them to persist long term.
If the implants are placed at the same time, the amount of blood flow is greatly diminished and the additional “pressure” can lead to low survival rate of fat grafts.
Leading Beverly Hills plastic surgeon Dr. Tarick Smiley says that with proper handling of fat grafts, about 70 percent of them are expected to last a lifetime. Hence, blood supply ingrowth is a critical issue in buttock augmentation with fat transfer.
Some doctors prefer doing fat graft surgery first to give their patients enough time to decide if buttock implants are warranted, while others do this in reverse.