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.
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.
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.
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.
Fat transfer buttock augmentation has made butt implants a passé due to its more natural results and notable safety, provided that it is performed by a board-certified plastic surgeon with “relevant” experience.
Dr. Tarick Smiley, a Beverly Hills plastic surgeon who conducts an average of three butt augmentations via fat every week, says the “holistic contouring effects of the surgery can be attributed to liposuction” wherein unwanted fats from two or more areas of the body are collected and transferred.
The lower back, flanks, anterior abdomen, and bra rolls are common donor sites, as they typically carry excess fat. Furthermore, carving out the waistline is one of the key elements to improve the female waist to hip ratio, which is perceived to be one of the markers of beauty.
Across all cultures, there is a strong preference for female bodies with WHR of 0.7 or at least close to his proportion. This means that the hip circumference is 30 percent thicker than the waist.
After collecting sufficient amounts of fats, these are washed and sorted; all biomaterials such as the red blood cells and the anesthetic/tumescent fluids are discarded prior to fat injection.
In Dr. Smiley’s recent videos posted on Snapchat, he said that he only uses “good healthy fats rich in stem cells” to achieve permanent results from fat transfer buttock augmentation, which is colloquially called as Brazilian butt lift.
Aside from the quality of fat, the surgeon said the longevity and overall success of the surgery also rely on meticulous injection.
“Fat injection must be must be done in a honeycomb fashion, meaning the fats are injected into a larger surface area,” he explained.
When fats are injected in a way that they resemble tiny compartments within the soft tissue, somewhat resembling a honeycomb, blood vessels can form and bring the much needed oxygen and nutrients. Without this process, the fats eventually die and are resorbed just after a few weeks or months of injection.
Because permanent result is one of the goals of buttock augmentation via fats, all efforts are made to promote blood vessel ingrowth.
The honeycomb injection technique not just ensures long-lasting results, but also softer and better contour because it replicates the natural layered distribution of fats. Furthermore, it prevents fat embolism in which fats enter the blood vessels and interfere with the functions of critical organs like the heart and lungs.
But even with honeycomb injection technique and proper collection and purification of fats, Dr. Smiley said that about 30 percent of the fat volume is resorbed within a year, while 70 percent is expected to persist long term.
When doctors mention 360 degree liposuction, they generally refer to a fat reduction surgery that encompasses the entire waistline—i.e., the four quadrants of the abdomen, flanks, and lower back. The idea is to create a cinching effect that is one of the most coveted features of a feminine physique.
When combined with Brazilian butt lift, the contouring effects of 360 degree liposuction are further enhanced. Instead of discarding the “unwanted” fat, doctors “recycle” them in order to enhance the patient’s backside with the most natural material.
Basically, Brazilian butt lift is buttock augmentation via fat injection. With this technique, patients can avoid the risks they would carry if synthetic implants were used instead.
Leading Beverly Hills plastic surgeon Dr. Tarick Smiley has recently posted a series of snapchat videos and images on Snapchat to demonstrate a patient who have had Brazilian butt lift right after her 360 degree liposuction.
Due to the fibrous fat commonly found along the flanks, around the navel area, and back, Dr. Smiley has used the power-assisted liposuction (PAL) technique.
“PAL cannula [straw-like device attached to a vacuum pump] has a vibrating tip, making it ideal for treating tough areas,” he said in one of the Snapchat videos.
(Note: When doctors use the term fibrous or “tough” fat, they refer to fatty areas with more connective tissue that a thick cannula cannot easily penetrate through. Hence, these areas are best treated by a thin PAL cannula.)
The tiny vibrations released by PAL cannula makes fat extraction gentler and more precise, which in turn results in less surgical trauma and bleeding, and minimal postop swelling and bruising. Thus, the recovery is also perceived to be quicker compared to other liposuction techniques.
After collecting adequate amounts of fat, Dr. Smiley placed them in tubes and allowed the red blood cells to settle to the bottom, thanks to gravity. These were discarded so he could only use the purest “golden” fat, and ultimately promote high survival rate of grafts—about 70 percent or even higher.
It will take about three weeks for the fat grafts to re-establish their blood supply and the extracellular matrix holding them together to achieve its full strength, allowing the grafts to endure the pressure from sitting, squatting, and stretching.
The ideal liposuction sites in patients seeking buttock augmentation via fat injection, or more commonly referred to as Brazilian butt lift, are usually the regions of the trunk because they contain most of the bulk of “unwanted” fats.
Instead of throwing away the fats collected from liposuction surgery, they are purified and injected into the patient’s backside, precluding the need for butt implants. For this reason, Brazilian butt lift is perceived to be safer because no synthetic prostheses are used to contour the body.
Leading Beverly Hills plastic surgeon Dr. Tarick Smiley says he almost always treats the lower back as one of the best liposuction sites because of its propensity to hold on to excess superficial fat (i.e., type of fat right beneath the skin that can be removed with a flexible hollowed tube called cannula).
Furthermore, “carving out” the lower back will allow the buttocks to stick out more, leading to a better shape when viewed laterally and posteriorly, explains the celebrity plastic surgeon.
A many patient can also benefit from liposuction of her flanks to further improve the buttock’s profile and shape.
The liposuction sites may also include the entire circumference of the lower torso, sometimes referred to as 360 degrees liposuction, which is particularly ideal for creating the quintessential hourglass figure. According to studies in which men were asked to rate the attractiveness of female bodies, a hip-to-waist ratio near 0.70 is perceived to be the most attractive.
But as the hip-to-waist ratios climb higher toward 0.80 the feminine curves become less apparent, as suggested by the studies.
Aside from the torso, other viable liposuction sites are the patient’s “areas of concerns.” For instance, women with flabby arms caused by the excess fat can benefit from fat removal surgery in the area.
While the vast majority of patients seeking Brazilian butt lift are women, some men with markedly flat buttocks can also benefit from the procedure, although the “aesthetic guidelines” may slightly differ to achieve a gender appropriate result.
Moreover, many liposuction sites commonly treated in women are rarely considered as viable donor areas in men. This is particularly true for liposuction of the upper arms and hips, which are almost an exclusive procedure for female patients.