Butt Augmentation using fat grafting

Cosmetic plastic surgery video by the Medical Director of The Loudoun Center for Plastic Surgery, Dr Michael J Brown MD. This plastic surgery video expertly shows how fat is used to enhance the buttocks.

Fat Grafting Butt Lift (BBL)

This video demonstrates a liposuction harvest, which involves taking fat out from an area of this patient and then putting this fat back in into her bottom. This is called a buttock augmentation procedure using her natural fat tissues. The cannula that you see going into the tissues right now is actually putting fluid in and now you see a cannula, which has a different type of a tip, which is actually sucking the fat out.

So her harvest site is her flanks, as well as her belly. Depending on the patient, sometimes I can perform the buttock augmentation just on one's position, meaning on her belly. I can get enough fat out of her flanks or her back and then put it into her bottom, so I don't have to turn her over. This particular patient wanted to have a relatively large augmentation and therefore I needed to get the fat out of her belly as well.

One of the nice things about using her flanks and back as the primary areas to suction fat, is I can really improve the contour of her buttock by just taking this tissue out. In essence, your butt will look fuller, but I haven't done anything to it. It's actually a enhancement by subtraction of fuller contours. This particular patient, which could've benefited from that procedure alone, wanted to have a very full butt and asked that I take all the fat I could find essentially and put it into her bottom.

At this point, I have thinned out her fatty tissue plane of the flank, nicely, and I really accentuated a hollow in that area, so that's going to accentuate her buttock contour. I'll do that on both sides and then the fat will be prepared and then it will be put into these syringes. These syringes will then be passed into the buttock tissues and injected into the buttock muscle. I will use small access incisions or use the same incisions that I used to perform the liposuction and actually inject the fat. This is a somewhat slow process where I have to carefully inject the fat as I am withdrawing the syringe.

The problem with this surgery is mostly involved with the technique and the harvesting of the fat. Fat, once you've taken it out of the body and begin to insert it back in, has essentially no blood supply, so it has to be placed deep into the area, so that it's close to the muscle. The muscles in the human body have a lot of blood supply, therefore they carry a lot of oxygen. These fat grafts will have a better chance of surviving then if I just put the fat in right underneath the skin. Putting the fat in right underneath the skin will have a noticeable change very quickly, but will not last for more than a few months. On this particular patient, you're going to see a significant change throughout the procedure. I use various access incisions and I thread the fat in, in a very deliberate fashion trying to raise the contour of her buttock.

The circles that you see were marked on this patient in the standing position, where she wanted to have the most prominence. Her strongest concern was for the middle and upper part of her bottom, so that it really gave her more of a bubble butt look, I think is the way she phrased it. So, I will infuse the fat into the muscle and continually put more and more fat in, in a very systematic and sequential fashion. I will also use massage technique to feel how much fat is in a particular area of the bottom and also to make sure the fat is uniformly positioned. Again, the fat is injected relatively deep to improve the contour and improve the graft's survivability.

In doing this surgery, the patients must be aware that they will have a period of swelling with this surgery that will last anywhere from 10 days to three weeks, and her butt will be even fuller than it will be longterm. After the swelling resolves, she will still have fat that is of questionable viability and may not live. If the fat does not live, she will lose volume in her buttock. The reason why she loses the volume is the fat is actually reabsorbed by the body. It's important that you try and get the fat relatively deep, so that it has a greater chance of survival.

Dr. Brown:
In most buttock augmentations or any type of fat grafting procedure, ideally you'd like to see about anywhere from a 65 to an 85% take. That's a pretty wide window, but that's very realistic. It's not realistic for a patient to wake up after this procedure and say, "Oh my god. I love what you did. My butt's going to be great and it's going to stay this big for the rest of the time." That's just not the case. There will be swelling and there will be some reabsorption of the fat grafts.

What I'm trying to do is make sure that I uniformly fill the bottom up. What you have to kind of imagine that I'm stacking a series of plates and the plates are of different sizes, so there's a very large plate that you have to fill first and then you go to a smaller plate that sits on top of the large plate and then you go to a relatively small plate that sits on top of the medium sized plate. So, at this point, I have filled the two plates with a lot of fat. Because we always have to be concerned about symmetry, what I like to do is go ahead and do the two deepest, broadest areas of fat grafting first, assess how much fat I've placed, and then match it for symmetry, just to make sure that I have enough fat and improve both sides of the bottom.

A mistake would be to fill one side to perfection and then realize halfway through the other side that you don't have enough fat to do it, so you have to really kind of pay attention to how much fat you're putting in the bottom, not only for one side, but to make sure that you have enough for the other side. So, I typically do about 70 to 85% fat grafting correction on one side and then I'll do another 75% to 80% on the other side before I do the final part.

What you're seeing here is the 85% correction from the top of the operating table. I will go ahead and fill her opposite buttock cheek to match the other side for symmetry and then I will go ahead and put the final 15% in both sides. This is a relatively dramatic contour improvement, both from the liposuction of the flanks, as well as the enhancement of the buttock.