#26: Everything You Need To Know About BBL

On this episode of The Natural Plastic Surgeon…

Dr. Barrett: The past 10 years, it's increased in its number of people getting the procedure by 8,000% over the last decade. That is huge, you guys. That's a major change from where we were back 20 years ago when everybody was thinking about breast augmentation. So Sir-Mix-a-Lot had it right when he said, “Baby Got Back.”

You are listening to The Natural Plastic Surgeon Podcast. I'm Dr. Daniel Barrett, Board-Certified Plastic and Reconstructive Surgeon located right here in Beverly Hills. I specialize in cosmetic surgery of the face, nose, breast and body. This podcast is dedicated to those deciding if plastic surgery is right for them and revealing all the latest beauty secrets. Let’s get started.

00:50 DR. BARRETT IS RECOVERING FROM SPARTAN RACE

Dr. Barrett: Everybody, it’s Dr. Barrett and we are on Episode 26 of The Natural Plastic Surgeon Podcast. I am recovering from a Spartan Race this weekend. And in case you don't know, a Spartan race is a, is an obstacle course race. Basically, you show up. You do about a 5k run. And it was raining in Santa Clarita up by Lake Castaic. You run around, you run in the water, and you do a bunch of obstacles. And, and part of the training that I was doing for this was a bunch of box jumps. And I was like, gosh, I hope this, I hope this gets my butt bigger, you know? And I'm thinking about, I’m like, you know, what else can you do besides a million box jumps and a million workouts that you see on Instagram to get your butt bigger?

Well, if you're interested in this, yes, you can do a Spartan Race. And you can work out your glutes. And you can throw a spear and you can dive into water and do all this crazy stuff I did this weekend. Or you can do a combination of that and a fat transfer procedure, known as a Brazilian Butt Lift.

01:43 BBL IS A POPULAR SURGERY

Brazilian Butt Lift is very popular. In fact, it's so popular over the past 10 years, it's increased in its number of people getting the procedure by 8,000% over the last decade. That is huge, you guys. That's a major change from where we were back 20 years ago when everybody was thinking about breast augmentation. So Sir-Mix-a-Lot had it right when he said, “Baby Got Back.”

And you know, maybe he set the trend back then and that's just caught on and it's caught fire. Or maybe the Brazilians caught on and people really started focusing on different parts of the body besides the breasts.

02:20 WHAT IS BBL?

So what is a BBL? What is a Brazilian Butt Lift and who's a good candidate? Well, a Brazilian Butt Lift is basically fat transfer to the buttocks. A way to make the buttocks bigger without an implant using fat from different parts of your body. So you can do liposuction of your abdomen and flanks, inner thighs, arms, wherever. Take that fat and transfer to the buttocks for long-lasting, lifelong, improved shape of the buttocks.

Now it has to be done in the right way. But the, the advantage of this operation is that you don't need an implant. Results last forever and results typically, if done correctly, look extremely natural. And it doesn't look like, there's no major incisions like in buttock augmentation with an implant. What have, we’d have a scar in the buttock crease and you’d have risk for infection and all that stuff. Although there is a risk for fat transfer to the buttocks, it’s not as high and not as problematic as it is with implants.

03:10 SYNERGISTIC EFFECT

Okay, so there's a synergistic effect because when we narrow and we snatch that waist with a liposuction, and then we make the buttocks bigger, you create a more hourglass shape that is way more proportionate for a lot of people and they find that very aesthetically pleasing. And to me, it's awesome because we're using your own body's fat to make this happen. We're not using an implant, we're not using anything that's not natural, to make that happen. So, obviously, who, you know, to go along with that, who's a good candidate to get this procedure, somebody who has fat to take from. So I get some people that are not good candidates because they're too skinny. If you are 105 pounds and six feet tall, you are not going to have enough fat to get this procedure done. Fortunately, most people, most women, and men, have enough fat in various parts of the bodies to make this happen.

04:00 INNER THIGHS ARE A SECRET STASH OF FAT

Sometimes we have to work harder than others to, to get that fat. And women, most of the time, there's a secret stash in the inner thigh. So even if you are really, really skinny, I can almost always get a few hundred cc's from love handles and a few hundred cc's from the inner thigh to make a difference. Now, some people go for overall buttock enhancement.

04:20 HIP DIPS

Some people have hip dips, that's where all of the muscles and everything insert into the joint of the hip and you can see a tiny little hip dip on the side. And it's great for that too. And sometimes it's great for contour irregularities in the buttocks.

04:33 CELLULITE

Cellulite is a common thing that people have in their buttocks and sometimes the actual BBL will help with that. However, it's not really guaranteed. You gotta do a lot of cellulite releasing and fat transfer below it to keep that cellulite bump out. So a really good candidate is someone who's a normal weight, not too skinny, that has fat that we can take from and has volume that, you know, they want to improve in their buttock area.

What happens if you're one of those people?

So these are some questions that we got from our own patients and from people online.

05:00 BUTTOCK IMPLANTS

What happens if you're too skinny to get a BBL and you still want buttock enhancement?

Well, there's implants. I'm not a huge fan of implants because it's a buttock...As opposed to breasts, buttocks you sit on. They’re functional part of your body. They're way more involved in a lot of things. Implants can flip. They can get malpositioned. They can get infected. And there's a scar associated with buttock implants. Have I done it? Yes. Can it look good? Yes. It's just one of those operations that's just not a home run every single time. And I, and I hesitate to do that sometimes. I know if people are really trying to go for it then, then we talk about it.

05:40 SCULPTRA INJECTIONS

But another option is injection of Sculptra. Sculptra is a synthetic filler that's a stimulatory filler that stimulates your own body's collagen production. Problem with Sculptra injection is it takes a lot of Sculptra to make a difference. It's great for the face because it doesn't take very much to make volume differences in the face. But for the buttocks, you need a lot. We're talking, like, 10 vials of Sculptra to make a, kind of a noticeable difference. And even then it's still not as powerful as fat transfer.

So yeah, we can sometimes do fat transfer and do Sculptra on top of it. And sometimes we can do Sculptra with just, with just Sculptra. But it's, it, again, it's not going to be a home run, amazing result. It's really got to be if you're super skinny, you don't have any fat.

06:25 WEIGHT GAIN PRIOR TO SURGERY

So a lot of people ask, should I gain weight prior to getting a BBL? I tell them, it's probably not a good idea. Because if you're gonna gain the weight for the surgery, and then you're going to go back to that normal weight, guess what? You're gonna lose that weight that we transferred. So if you're planning on gaining weight, just because you want to be at that weight, that's fine. But if you plan on gaining the weight, getting the procedure, and then backing off and losing that weight again, I wouldn't, I wouldn't recommend that. Because I, I want to know exactly what we're transferring. I want you to be at your goal weight prior to doing the operation for a more predictable, long-lasting result.

06:55 HOW IS BBL PERFORMED?

How do you perform the BBL procedure?

Well, the BBL procedure--The Brazilian Butt Lift Procedure--is two procedures in one. There’s liposuction, and then there's the fat transfer. Liposuction has to be done very carefully. That act, actually is the biggest risk of the operation is creating a contour irregularity from doing liposuction.

07:13 SAFE LIPOSUCTION

So I do a technique called SafeLipo technique, meaning I break up the fat before I remove it. And I do that by pre-cannulating with basketed cannulas using power-assisted liposuction. I do not use energy, energy-assisted liposuction because it can kill the fat cells. I take the fat out very carefully, and immediately I get it ready to transport right back into the body because the fat, fat is very delicate. It's like this big fluffy piece of popcorn. It's got a tiny little cell wall and it can rupture easily. So a lot, a lot of what we end up transferring is ends up being dead or lost fat cells. So we, we want to get that fat out as gentle and as careful as possible. And then we want to get it back in gently and quickly as possible. It doesn't like to be outside the body and it wants, it wants its home. Okay, so that is the first half.

08:05 FAT TRANSFER

Now when it comes to the fat transfer, again, we, we prepare fat very carefully. We remove the, a significant portion of the lipoaspirate solution on the bottom, and we concentrate the fat. So we get a biggest bang for our buck for the amount of fat that we transfer. We use very small cannulas and place lots of tiny little droplets of fat each in its own little home. So imagine if you're planting a garden, you don't take a bag of seeds and you put it in one spot, you're not going to get very great growth of all those seeds. You want to take one tiny little seed and place it and it's each little, each has, has its own little home. So that way you have the best survival possibility of those fat cells.

08:45 HOW LONG IS THE SURGERY?

How long does the surgery take?

Well, liposuction can take anywhere from an hour for a single area up to three or four hours, depending if it's whole-body lipo. The processing is generally done simultaneously while I'm doing the liposuction. And then the fat reinjection takes about 45 minutes. And a lot of times I like to turn the patient completely prone so that we can focus on any problem areas. Make sure we get good symmetry. Or any release of any cellulite dimples that we encounter. So I would say on average, it's about a three hour procedure, give or take. But totally depends on the person and the goals of the patient.

09:18 HOW OFTEN IS BBL PERFORMED?

How often do I perform BBLs and how many have performed? Pretty sure we're into the thousands by now. But I perform probably, like, two or three a week. I also do a lot of breast fat transfer as well. But two to three a week is, is typically what I'm, what I'm doing for for Brazilian Butt Lifts. And I think that's important. You want somebody who's pretty familiar with how to do this operation, and to understand the risks. So there's been a lot of news lately about the risks of Brazilian Butt Lifts.

09:50 MORTALITY RATE OF BBL

The mortality rate of Brazilian Butt Lift nationwide, it's been one, reported one in 3000. So one in 3000 people getting this operation die. So we're, like, our society, American Society of Plastic Surgery, took a step back and like, what the heck, you know? Tummy Tuck has a one in 10,000 chance of dying. And these are typically people that are just in poor health, that shouldn't be getting an operation in the first place.

But BBL, there's lots of young, healthy people were dying from this. And so there was a taskforce done by our society to investigate this. Like, hey, what's really going on here? Well, there was a lot of non-board-certified plastics, not even plastic surg, non boardified people, board-certified, you know, they weren't even plastic surgeons performing these operations, in strip malls and various places. And they were doing subfascial or intramuscular injection, in addition to subcutaneous.

Now the difference is really important. So you have your skin, you have your subcutaneous tissue below that, that's like the fat, loose connective tissue. And then you have your fascia that's like a, a thick, kind of, layer of, like, imagine canvas, covering the muscle and then you have your muscle. So a lot of times people were, including some board-certified plastic surgeons, were injecting intramuscularly. Now the problem with that is once you go into that fascial plane into those muscles, that fat can now be taken up by blood vessels that go straight to your heart. So if you stay subcutaneously, if you stay above that fascia layer, you are not going to get transfer of those fat cells into the bloodstream.

The problem is if you get fat into the bloodstream, it can travel to your heart and it can travel to your lungs and it could kill you. So that's why we have a big effort by the American Society of Aesthetic Plastic Surgery and board-certified plastic surgeons that we no longer--and I never did this in the first place--but we no longer inject subfascially or intramuscularly because of that risk of fat emboli. And I've never had a patient die; I've never had a patient get a fat embolus because of that reason. And I stay very superficial. I'd rather have a suboptimal result versus trying to go for a real dramatic, ridiculous improvement by injecting into someone's muscle. It’s just, it's just not a smart, it's not a safe thing to do.

So that's, that's, that's what's been in the news lately and I think you have to go to a board-certified plastic surgeon if you're thinking about this procedure. Unfortunately, this is one of those procedures that there is so many chop shops, there's so many hacks out there who think they can do a little bit of liposuction and take the fat and just inject it right into the buttocks. In fact, there's people that, that do this with raw silicone.

12:27 SILICONE INJECTIONS

It’s unbelievable. Raw silicone in the body, for two-thirds of people, is fine, but a third of people, they can get horrible infections and die from it. So 33% mortality rate for that? Not a good idea. If you're going to get a BBL in someone's garage, you definitely want to turn around the other direction and think twice, okay? Do not go to someone's garage, to get buttock augmentation. Okay, you hear about this in the news and so forth. Go to find a board-certified plastic surgeon. Make sure they do a lot of these. Make sure they, they, they only inject in the subcutaneous area and I think you'll be in, in good shape.

13:05 COMBINATION OF SURGERIES

Do patients typically have other surgeries and getting BBL? Yep. I, you know, I make it part of my Grand Slam Mommy Makeover, okay? So breast lift, Tummy Tuck, and then fat transfer to buttocks. Because we are taking fat from, typically from the abdomen when we are doing the Tummy Tuck. And that's our chance. If we've got this fat, are we gonna throw it away, or are we gonna use it? So we can either transfer to the breast or transfer the buttocks. We don't want to throw away this fat. And there's some places that will actually bank your fat and keep it for a later date if you want to use it for something else. It's such a valuable thing. You don't just wanna get rid of it if you are thinking about this procedure at all, in combination with, like, a Mommy Makeover or something else.

13:42 BEST RESULT FOR A PATIENT

What is my idea of a best result for a patient?

Well, I, I try to, kind of, assess what people's expectations are for this procedure. Are you, are you, do you think, you know, what, what are your goals? How much fat do you have? And, and, and believe it or not, the skin of the buttocks don't, it doesn't really expand very much.

So sometimes I've done, like, multiple fat transfers to the buttocks to get better sizing. And, and that's okay. Sometimes it takes more than one go around and let the body and let the buttocks expand to be able to add more. I generally try to keep things very natural looking. So for me, a best result is improvement--more rounder, more fuller buttocks, but not in an unnatural way. So that, I differ from some other people that really try to go for that big, big result and, and I think that people are going to regret that later on. And we want to kind of keep things natural and sane and, and not get too crazy. But I definitely think there's room for improvement for a lot of people. A lot of people have a flat butt and it’s just, they're self-conscious about it. You put a little bit of fat in there? Makes a huge difference.

14:40 RECOVERY PROCESS

How long is recovery for a BBL? Now BBL, the big, the, the most difficult part of it is, is the liposuction because it feels like you hit the gym for the first time, and since never working out in six months. So you feel soreness. So it’s the abdomen and flanks It feels like you did like 100 crunches a day before and you're sore. The buttocks can be sore typically for the first 24 hours but generally that, that, that dissipates really quickly.

The difficult part about recovery is not sitting on the buttocks for two weeks. So we provide our patients with specialized garments, specialized pillows that they can sit on. And there's all kinds of crazy stuff you can buy online that will help you in your recovery to keep pressure off.

15:18 FAT VIABILITY

Why is that?

Well just think about it. We just transferred a bunch of fat cells to the buttocks, we don't want to squish them. We don't want them to get deprived of oxygen or nutrients. So we want to keep that pressure off so the blood flow can go there, okay? So you wanna, you know, keep off the buttocks for two weeks, is my minimum time. And now a lot of other surgeons say it’s six weeks. I think that's a bit excessive and I think most people are not gonna follow that routine. I think the majority of the fat’s going to take, if it is going to take, within the first two weeks and develop its own blood supply.

15:45 GRAFTING RESULTS

What kind of grafting results do we get? So that's really another important consideration. A lot of patients that come out of surgery like whoa, my butt is way too big. And I'm like, don't worry, that's on purpose. We know we're going to lose about 30 to 40% of the fat that we transfer. And how much is that's going to be? We don't know. Fat is a little unpredictable. So we don't know exactly how you're going to look afterwards, we have a pretty good idea. And we, and we kind of roll the dice. Generally, if you're younger, your fat tends to survive, and it's a little more resilient than older patients.

15:15 HOW LONG TO STAY IN TOWN

For out-of-town patients who are getting a BBL, how long should you stay in town for? Well, I would say, stay in town for at least three to four days so that we can see how you're doing, remove any sutures, and make sure that there's no problems that you're having. So it's one of those operations that you can come visit from different places, get done, and go home within a week.

16:35 SURGERY PREPARATION

How long should a patient prepare for a BBL surgery? What product, products will someone need for optimal recovery? Well, we recommend, we have a whole podcast on this, about HealFast and some optimal things to recover after surgery. Again, the main thing for BBL is keeping a good diet right after. Don't starve yourself, because we want those fat cells to have lots of nutrients. Don't sit on the buttock area. I also recommend some red light therapy to help the fat cells survive. Give them, mitochondria, a little bit of boost and help heal with your swelling, in terms of liposuction.

17:05 LIKELIHOOD OF REVISION

What's the likelihood that a patient will need revision? And when is that determined? Well, revision’s pretty rare for BBL. Almost everybody's very happy. Sometimes there's some dimples and things like that, cellulite, that comes back, and we can always go and revisit that and remove some of those dimples again, for a repeat round of fat grafting. Or if the size goals are not really, we didn't really make it, the fat didn't really survive, we can always come back for a second round or even a third round in certain situations.

We talked about, what is the percentage of fat cells survived? I said that's about 30 to 50%. Depends on the person. Depends on how the surgery went. Depends on your recovery.

17:42 WEIGHT GAIN AFTER SURGERY

If the patient gains weight, what are the chances that the patient will gain weight in the same area that the fat cells are removed for BBL? This is, this is more of a question about liposuction, and, and I get this all the time. Will you gain weight in other areas?

The answer is yes and no. So if, if you have a BBL, and we do liposuction of your abdomen and flanks and you eat a bunch of food, you're going to gain weight. You're gonna gain weight more proportionally in different parts of your body than the area that we took the fat from, right? Makes sense. There's no storage. Fat cells are storage cells. So if we take away half your storage cells from your abdomen and flanks, guess what? That's not gonna store as much fat. So you get some growth there. But you'll get even better, bigger growth in other places on your body. My recommendation is, don't gain weight. All right, stay at your goal weight, and then you don't have to worry about it.

18:27 HOW LONG DO RESULTS LAST?

How long will a Brazilian Butt Lift last before it may need a tune up? Is it similar to a breast aug, every 10 years?

Well, kinda, sorta, maybe. So the fat cells that we do transfer, they survive and they'll be there lifelong. However, over the course of our lives, we lose fat in our body. And sometimes we lose fat in our buttocks. So you may want to, after 10 years, take some more fat and transfer it to the buttocks.

At first we thought that fat cells don't regenerate in our body, but turns out that they do and it takes about 10 years for that to happen. So the areas that we did remove the fat from, you could regrow fat cells there. And then we could take from there again, and do the fat transfer.

So that's it, you guys, for our information about Brazilian Butt Lift. I hope you enjoyed that. If you're thinking about this procedure, please check out our website. We've got a whole website on it called BootyByBarrett. Check out our main website, DrDanielBarret.com. We've got lots of before and afters. It is an incredible operation. And if you're thinking about correcting some weird contours of your buttocks, you just want your buttocks a little bit more fuller, definitely check it out. Think about this procedure. It's a great win-win combination. Take fat from where you don't want it and put it where you do want it.  Thanks for tuning in.

Thank you for tuning into our podcast. If you liked today's podcast, don't forget to share, rate, review and subscribe. Also, find out if plastic surgery is right for you by using our virtual consultation at DrDanielBarrett.com/virtual-consultation. See you soon.

Show Notes

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