Fat Grafting to the Butt (Brazilian Butt Lift) Newport Beach


Dr. Nykiel believes liposuction and fat grafting to the butt (also know as a Brazilian Butt Lift or BBL or Liposuction and Fat Transfer to the Butt) produces excellent results in both increasing the volume of the butt and shaping the buttocks. In my opinion, a BBL is the quintessential procedure to create the hourglass figure. Another way to think of a BBL is: we are moving fat from an area we do not like (tummy, love handles, saddlebags) to an area that we want more volume in (butt, waist, hips…or even breasts)!

I believe that liposuction and fat grafting (also known as fat transfer) is the gold standard in Butt Augmentation. If you have excess fat and want to get rid and are wanting a butt augmentation, we should think about liposuction and fat transfer to the butt and discuss during consultation.

So What is a Brazilian Butt Lift or BBL?

Overview of the Surgery:
A Brazilian Butt Lift is abbreviated as a BBL. It is also known as liposuction and fat transfer (or sometimes referred to as fat grafting) to the Butt. A BBL is an extremely powerful cosmetic surgery procedures that helps to improve a torso toward an hour glass figure by sculpting the torso, i.e. bringing in the waist, decreasing the tummy size, and increasing butt volume and projection.

The liposuction portion of the procedure sculpts the torso with the goals of shaping an hour glass. The liposuction is performed in the abdomen, flanks, and back. Essentially this is the entire torso from the bra line down to the underwear. Then, the fat is utilized to shape the buttocks and the frame of the buttocks (the two main shapes are heart-shaped or round-shaped also known as bubble-shaped). Finally, the remaining fat is utilized to increase the volume of the buttocks.

Amount of Fat Transferred:
The most common question I get is: How much fat can be transferred? Well that depends on the three main issues:

  1. Available fat
  2. The amount of fat the buttocks can “hold”
  3. The size and shape that you want!

We must have fat to remove in order to transfer it. However, even if we have a LOT of fat we still need to make sure that the skin can “hold” or “stretch” to receive the transferred fat. Think about it like a water balloon under a sink faucet. I can leave the faucet on all day and night, but the water balloon will only stretch so much; and likewise, your skin will only stretch so much. Finally, your goals play a role. If you want as much transferred as possible, no problem. If you want a natural amount transferred, no problem. We will attempt to listen to and achieve your goals as best as possible. We believe in self-expression and you are the most important factor!

So How Much Fat Lives?
This is a common questions; and it is one that is up for debate in the medical scientific community. Studies say anywhere from 30-80% lives or “takes” (think about it like a hair grafting/transfer, not every single hair transferred will take root and grow). Therefore, the average that most often gets quoted is 50% fat survival rate. Therefore, we usually “over” graft or transfer fat knowing that there will be some amount that does not survive. Each person is individualized and different so no patient is exactly the same. In saying that, my average fat transfer is 720cc per side or 1,440cc (1.4L) of total fat transferred. Typically, on average, my maximum fat transfer is around 1,000cc (1L) per side or 2,000cc (2L) of total fat transferred.

Again, the important thing to remember is that we listen to your body and do not try to go beyond the natural boundaries that your body allows.

Another issue to keep in mind is that because of the resorption and the soft squishy nature of fat, fat transfer volume is not the same as implant volume. Implants are able to push and expand the tissue significantly while fat is able to plump, fill, and naturally lift the butt.

Different forms and Technologies of Liposuction:

A major portion of a Brazilian Butt Lift (BBL) is the liposuction that is utilized to sculpt the torso toward an hour glass frame. Major advances have taken place with liposuction. There are now multiple different types of liposuction technologies to help aid in the removal fat.

Better Technology Equals Better Results
So why are new technologies required or needed at all? I think there are 3 reason that argue in favor of using new technologies:

  1. Physical Demands on Surgeon
    In traditional liposuction, the surgeon creates the power that helps to remove the fat. The surgeon moves the liposuction cannulas at different speeds to remove the fat. If a significant amount of liposuction is being performed (let us say greater than 2.5L), then this can become tiring on the surgeon. In my opinion, the last thing anyone would want is the surgeon becoming necessarily tired.
  2. Focus on the Sculpting
    In newer technologies, there is less physical demand on the surgeon. In my practice, less physical demand allows the surgeon to have greater focus on the torso contouring from liposuction because the surgeon is not as tired.
  3. Skin Laxity
    One of the major concerns with large volume liposuction (again, let us say greater than 2.5L) is what happens with the excess skin when all of the fat is removed. In my opinion, this is where one of the major advances have come in liposuction technologies. Certain technologies (Ultrasound (also known as “Vaser”) and/or Laser) can significantly tighten the skin. Even in patients with lower volume liposuction (1L or less) skin tightening can significantly help to tighten and shrink the waist. Another common issue with loose skin is/are skin dimple(s). These may also be improved with advanced liposuction technologies.

Classification of Liposuction Types
So what are the major different forms of liposuction technology? The easiest way to discuss the different technologies are to classify the tech based on the energy source:

  1. Traditional
    In traditional liposuction the surgeon provides the power to the cannula moving it back and forth while the liposuction machine creates the vacuum. In this form of the liposuction, the fat is removed. The skin is not tightened. Fluid is injected into the fat to decrease blood loss.
  2. Power
    In Power liposuction either compressed air or electricity is used to move a motor and piston that causes the liposuction cannula to vibrate at extremely high frequencies (Thousands of vibrations per second). This provides power to allow for the liposuction to be performed with greater ease. In addition, some studies discuss less bruising and swelling with this form of liposuction. Fluid is injected into the fat to decrease blood loss. Power liposuction allows for faster rates of fat removal resulting in shorter surgery times. Because of the rapid high frequency vibrations there is mild skin retraction.
  3. Laser
    Laser Liposuction uses light and heat energy to help destroy (liquefy/melt/burn) the fat allowing for faster removal. The light and heat energy also coagulates blood vessels resulting in less blood loss and less bruising. Some studies also show a decrease in post-operative pain. The energy also causes tightening of the skin. However, the destructive energy transfer to the fat cells does not make this a good form of liposuction for fat transfer in my opinion. Laser liposuction has the brand name of SmartLipo®.
  4. Ultrasound
    Ultrasound liposuction is one of the biggest advances in liposuction technology in my opinion. Ultrasound waves are directed at the fat cells causing the body to release the fat cells but not causing the fat cells to permanently rupture. In addition, the ultrasound energy coagulates the blood vessels resulting in less swelling, bruising, and bleeding. Numerous studies have been done showing quicker recovery times, less bruising, less swelling, and less pain after surgery. There are some studies that show as good or greater fat transfer with Ultrasound technology. Ultrasound Liposuction has the brand name of Vaser®.

I would like to make the point that the most important factor in liposuction is the surgeon who is performing the liposuction. Their technical abilities trump any and all technologic advances. However, if all things are equal and in the same hands, I feel the advanced technologies then yield a superior result.

What if I Have Just A Small Amount of Fat:

The “Fit” & “In-Shape” BBL or the Non-XL BBL
Sometimes despite all the hours in the gym working-out and eating healthy there are still areas of stubborn fat in the waist, back, and/or hips that cause the butt to have a square and/or short shape. Other times the the butt can develop indentations on it that simply will not go away. Overall, this creates a shape that does not show all the hard hours you have been putting in working on yourself!
Therefore, there are just small and specific areas that need targeted; but not overall large areas of liposuction or large areas of fat transfer. Typically, in these individuals, only a small amount of fat is available. However, only a small amount of fat is required to improve the overall shape of the butt and balance the hour glass. In these individuals, I recommend a “Non-XL BBL”. Think of it like a “Fit” or “In-Shape” BBL. In this procedure, liposuction is utilized to perfect the sculpting of the hourglass and torso by removing the troubled stubborn areas of fat . Then, the fat is transferred to specific locations that will enhance the shape of the buttocks and balance the hour glass.

Brazilian Butt Lift (BBL) Recovery:

A Brazilian Butt Lift (BBL or Liposuction and Fat Transfer) is an outpatient surgery (you go home after surgery that same day).

A BBL can be performed with you awake (“local only” anesthetic) or sedated (mild, deep, or general anesthesia). What are the differences? Awake liposuction (also known as local only) is a well tolerated procedure when performed correctly and in experienced hands.
Awake liposuction has a faster wake-up period after surgery. What are the negatives? While I think awake liposuction is tolerated well, awake (or local only) fat transfer to the Butt is not tolerated that well. Why? Because in order to get great results in a BBL some fat needs to be placed into areas that I can not anesthetize with local anesthetic. Therefore, I am not able to place fat everywhere I would like because you are awake and you will feel it. Therefore, in my experience, awake fat transfer to the butt gets you an inferior result. Thus, I recommend deep or general sedation with liposuction and fat transfer to the butt.

A BBL has two types of recovery:

  1. Recovery from Liposuction
  2. Recovery from Fat Transfer

Liposuction Recovery:
Bruising, and Swelling are normal after liposuction. The bruising typically takes 1 to 2 weeks to subside. The swelling takes longer and begins to decrease at 3 weeks after surgery. It will typically take at least a total of 6 weeks for the majority of the swelling to resolve. Despite the swelling, you will be able to see a difference the same day after your surgery! You will see these results especially in the waist and these results will only continue to improve as the swelling goes down week by week!

Firmness is also expected after liposuction. The firmness is due to the fat being swollen and from the fat being inflamed from liposuction. Think about when you sprain an ankle, it gets bruised, swollen, and firm. It also take at least 6 weeks to 3 months for the ankle to soften. For some people it takes less time and for others it takes more time. In order to help shorten the recovery time, massage is started at 1 week after surgery to the liposuction areas. The massage softens the skin and tissue. In my opinion, massage is a KEY step to faster recovery and overall better results. I recommend lymphatic tissue massage. This is a type of massage designed to promote the decrease of fluid, swelling, and firmness.

Compressive garments (Medical Grade Spanx) are placed on you immediately after surgery in the operating room. The garments are placed while you are still asleep for your comfort. Therefore, when you wake up the garments will be on and you do not have to fuss with the garment. You will keep the garment on for 48 hours straight after surgery. Then, the garment is worn for 3-6 weeks, at all times, except when showering. The garment helps to decrease the swelling, bruising, and firmness. The garment also helps to shape the torso into the hour glass by helping to ensure that the skin and soft tissues “sticks” and forms in the correct locations. Again, think of it like a sprained ankle: How do we treat it? Rest, Elevation, and wrapping!

Another important factor when thinking about recovery: as we discussed above, different forms of liposuction technology can either increase or decrease your recovery time .

Fat Transfer Recovery
The biggest portion of the recovery is the sitting protocol. I utilize a 4 week sitting protocol. Since we are transferring fat to your butt, in general, the longer you can be off the butt, the better the results.

The Sitting Protocol is:

  • Week 1: No Sitting except for the bathroom. No laying on back or sides.
  • Week 2: Sit as usual with the assistance of a pressure off-loading pillow. If you do not have a pillow then: 15-30 minutes at a time, then standing up to shift your weight. No laying on back or sides.
  • Week 3: Sit as usual with the assistance of a pressure off-loading pillow. If you do not have a pillow then: 30-60 minutes at a time, then standing up to shift your weight. No laying on back or sides.
  • Week 4: Sit as usual with the assistance of a pressure off-loading pillow. If you do not have a pillow then: 1-2 hours at a time, then standing up to shift your weight. No laying on back or sides.
  • Week 5: No Sitting Restrictions. Sit as usual. Unless otherwise directed. Lay on back or sides as desired, unless otherwise directed.

Return to Work:
Most of my patients are back to work in 5 business days. On rare occasions patients will utilize 2 weeks off from work, but this is not the norm.

Return to Activity/Gym:
After 1 week, you can Run/Jog or go to the gym (upper body weights only). I do not want you sitting on your buttocks (no press or rows etc). I also do not want you performing any leg lifts, lifts, squats, lunges, cleans, etc.

Prior to 1 week, I want you walking around as much as possible.

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