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Brazilian Butt Lift: A Non- Invasive Resource In Aesthetic Surgery

Brazilian Butt Lift Treatment and surgery in india

What is Brazilian butt lift (BBL)?

An ideal waist to hip ratio is a cardinal objective measurement of aesthetic appraisal amongst women of all ages. In recent years there has been an upsurge in demand for gluteal augmentation. Butt augmentation was initially discussed by Pitanguy in his report in 1964, and has undergone various modifications afterwards. The advent of lipoplasty widened the avenues for the management of buttock ptosis i.e. sagging of buttocks. BBL is a modern medicine technique of gluteoplasty with autologous fat tissue. Buttock sculpting via fat transfer in case of patients with ample donor sites, waves off the risks associated with silicone implants. Fat tissue graft is harvested from the donor site through liposuction and injected into the desirous areas of the buttocks. This procedure accounts for a harmonious way of fat elimination and modification. 

When to consider a Brazilian butt lift (BBL)?

Management of aging skin: Fat mass has been shown to increase in relation with senescence. A wide array of molecular processes and gene expression modification bring about progressive and irreversible age changes in the buttocks. Menopause has been significantly associated with central fat deposition in the body, predominantly the buttocks and thighs. Hormonal changes may bring about an imbalance in lipoprotein metabolism affecting the adiposity that warrants a surgical correction. Consequently certain changes take place in the gluteal region with aging such as the loss of the inward curves at the level of the waist and the absence of inward depth in the mid-line of the lower back with elongation of the infragluteal crease. This makes the buttocks aesthetically unpleasant from the ideal proportions.

Cosmetic enhancement and rejuvenation: Fat grafting involves the harvesting of fat tissue from unwanted areas of the body and utilizing it for fat augmentation with body contouring surgery. Autologous fat grafting plays a pivotal role in gluteal or buttock augmentation and may replace implant - based gluteal augmentation if the patient has enough quantity of aft at the donor sites. Body sculpting by merging the benefits of liposuction and lipofilling can improve the aesthetics of virtually the entire body, providing the desirous hour glass shape.

Body contour improvement: There is some consensus about an aesthetically pleasing buttock area; few characteristics included are a round shape with smooth projecting curves and a short intergluteal crease which reaches the mid-thigh region. Toledo mentioned a waist to hip ration of 0.6 in South Americans and 0.7 in European females. Based on the configuration of buttock and influencing areas, and deformities, four shapes of buttock have been acknowledged; which are triangular, trapezoidal, round and square. Bone remodeling for buttock reshaping is an invasive and complex procedure. Whereas the technique of removal and addition of fat in requisite areas of the body, is a non invasive and patient friendly procedure. A short gluteal crease that does not extend beyond the medial third with no ptosis over this line is the ideal requisite.

Reconstruction of scarred sites: Owing to the regenerative and remodeling properties of lipo-aspirate, it can be successfully injected for painful scars, chronic wounds and burns. Scar depression and adherence to deep planes are seldom associated with unpleasant scarring that hampers esthtics.  Indecorous scarring represent a functional and aesthetic trouble that frequently requires surgical revision. Fat grafts may not only serve as fillers, but also have the additional benefit of improving the quality of aged and scarred skin.

Conditions associated with fat atrophy: Lipodystrophy represents a rare condition of altered subcutaneous fat repartition in a generalized, partial or localized form. The condition can cause one or more depressions in the skin ranging from a few centimeters to greater than twenty centimeters in diameter. There can be partial or total loss of subcutaneous fat with atrophy of overlying skin. Gluteal augmentation is used as a therapeutic approach in such patients. Fat injections are performed in different planes to supplement the buttocks and lateral trochanteric regions of the body.

Buttock ptosis (sagging): The gluteal crease forms a part of the supporting system that maintains soft tissue structures in place in the gluteal and thigh area. This gluteal crease elongates as the buttocks sag, weighed down by the volume gain or laxity leading to the sagging of gluteal tissue over the thigh. As the heavy gluteal tissues continue to sag, it begins to cover the thighs falling over it, which leads to the folds becoming quite conspicucous, and gluteal tissue hanging below the skin folds or infragluteal crease. Buttock ptosis may occur after significant weight gain following weight loss.

Brazilian butt lift (bbl) Procedure:

Preoperative assessment:-

  • Preoperative evaluation and treatment planning is imperative when performing autologous fat transplantation. The patient should be in good health with sufficient fat tissue at the donor sites. Consult your doctor for any medications you are on or any allergies to be considered. As the procedure requires anesthesia, hence any medication that interferes with lidocaine (anesthetic agent) metabolism, is of specific concern and duly noted accordingly. Patient is instructed to stop taking all medicines that hamper the function of platelets approximately two weeks prior to the date of surgery. The medication can be restarted one week after the surgery. 
  • Your doctor may ask you to undergo one or more diagnostic tests or procedures to evaluate conditions that mimic vasculitis or diagnose the condition. Vasculitis is the inflammatory destruction of blood vessels, which can pose a wide range of clinical and pathologic findings among numerous heterogenous conditions. Presence of vasculitis can complicate the procedure of liposuction. Hemoglobin and hematocrit levels are also obtained. Appropriate laboratory reports are obtained approximately a week before the procedure.
  • Patients are required to undergo a Doppler ultrasound imaging as a part of routine surveillance for deep vein thrombosis preoperatively, on the day of surgery as well as a week after surgery. Deep vein thrombosis is a condition wherein a clot develops deep seated in a vein of predominantly the lower legs and the thighs. It may break free and lead to serious cardiopulmonary complications.
  • It is crucial for the doctor and the patient to define and discuss the expectations of the patient. As most of the patients are concerned with size in case of Brazilian butt lift surgery; realistic goals should be set. Buttock enlargement is broadly limited by the volume of fat that can be harvested and injected into the patients’ body, which is multifactorial. If the patients’ expectations are found to be valid and the patient is in pink of health, then your surgeon will proceed with the surgery. 
  • Patient is put on appropriate dose of antibiotics an evening before the surgery or as necessary. The antibiotics are to be continued a week after the surgery. 

Establishment of the donor sites:-

  • Fat rich areas commonly used as donor sites for fat harvest are the abdomen, chest, lateral thorax, waist, hips, back, arms, and/or thighs. Establishment of ideal aesthetics guides the areas for liposuction; which invariably are the lower back region, the sacrum, waist and hips. Fat reduction in these segments leads to a narrow waist with accentuated curves and reduced hip to waist ratio. Donor site selection is largely influenced by the ease of access, preference of the patient and the volume of fat needed. 
  • Next step is the pre-surgical markings of the areas to provide shape, contour and volume to the buttocks. It is performed while the patient is in an upright position. Segments for fat transfer are based on the presence of depressions or deformities in the contour, which are outlined in red. The zones that require liposuction are highlighted in blue.

Harvest of fat tissue:-

  • The site of skin undergoing surgical intervention is prepared in a sterile fashion with chlorhexidine diluted in normal saline, applied via sterile gauge piece. This minimizes bleeding and pain, and facilitates liposuction. 
  • Next the patient is injected with anesthesia. In case of a small operative area, the procedure is carried out under tumescent anesthesia, while in case of larger operative regions, tumescent anesthesia with sedative is given. After the anesthesia exhibits its effects, the patient is placed in the prone position for liposuction as this position enables definition of the buttock contours efficiently. Access incisions are made to make punctures in all planned liposuction sites. Fat is harvested using 3-4 mm liposuction cannulas from the marked zones. The needle of the cannula is pushed through the skin in the middle of the adipose tissue to begin the extraction. Four or five back and forth movements are made in one direction before going to adjacent areas, without taking out the cannula. In thinner patients, multiple areas are used for harvesting; hence the process is repeated until the required volume of fat harvest is accomplished.

Processing of lipoaspirate:-

The harvested fat is processed in order to limit the blood, oil and debris within the lipoaspirate that yields pure fat as a soft tissue filler with enhanced vitality. The lipoaspirate is treated with an antibiotic solution mixed in saline. There are many techniques available for fat processing such as sedimentation by gravity, filtration and centrifugation. Sedimentation or simple decantation is the separation of the layers after sedimentation. It relies on gravity and is time consuming. Centrifugation is the most widely used technique for fat processing, which though more aggressive on adipocytes, yet it separates most of the blood remnants from fat as well as also maintains the highest concentration of stem cells within the processed lipoaspirate. These stem cells are angiogenic growth factors that play a key role in graft survival. The lipoaspirate is centrifuged at 3000 rpm for three minutes, after which three levels are observed in the tube. The lower level is formed by blood, debris and water; the middle layer consists of fat that will be injected; whilst the top layer is composed of the lighter weight oil formed by fatty acid breakdown. Right before the fat is to be injected back into the patient, platelet rich plasma (PRP) from patients’ own blood is mixed with fat.

Anesthesia of recipient site and graft placement:-

Delivery of the lipoaspirate is believed to be the most important step in fat grafting technique. The entry site of the recipient area is injected with local anesthesia. An infiltration cannula with a single hole is used to pump the lipoaspirate back into the patient’s buttocks. Tha fat lipoaspirate is grafted superficially above the muscle and away from the inferior and superior gluteal veins. Inadvertent injury to these veins can lead to fat emboli formation. A pressure controlled injection technique is preferred which cuts off automatically if it senses a higher than normal central venous pressure. 0.1 cc of lipoaspirate is injected with every pass, carried out at an intermittent retrograde pattern. A fan shaped reinjection is done at different levels to obtain a harmonious result while maintaining the normal anatomy of the site. This technique ensures that fat grafts have a maximal contact time with the vascularized tissues in the grafted area, which promotes a better survival of the graft. 

Complications associated with Brazilian butt lift surgery:

Transplantation of fat is a minimally invasive and relatively safe procedure with a low rate of complications. 

  • Absorption: It is the most commonly encountered complication of autologous fat transplantation. There is minimal or no graft retention. The rate of absorption correlates with the technique used for fat harvesting and the areas from where fat is harvested such as the upper abdomen and upper back. The absorption rate may vary from 0 to 50%. To overcome this, it has been proposed to perform an overcorrection acceptable up to 30% or as the case demands.
  • Infections: Studies have reported an infection rate of <1% associated with gluteal augmentation surgery. Yet it should be avoided at all costs. Hence patients are instructed to cleanse their entire body using an antiseptic skin cleanser the night before or on the morning of the day of surgery. All the patients are double prepped prior to surgery as a precautionary measure. Infection may be encountered within the first week of surgery demonstrated as erythema, tenderness and warmth of the buttocks.
  • Fat emboli: It is a rare yet the most catastrophic complication of buttock fat grafting. Fat embolism occurs when fat enters the venous system and travels via the veins entering the cardio-pulmonary system. Theories explain its mechanism propose that the fat embolus may enter the veins via the cannula tip being inserted into the vein, or; an iatrogenic damage to a large vein that creates a pressure gradient in the area which slowly transfers the fat overtime into the damaged vein. Technological advancements in techniques of large volume fat grafting, over the years, have made buttocks lifting safer than before. A closed circuit liposuction system is recommended which stores the sterile fat in an aseptic canister, and reinjected into the patient without being exposed to air.
  • Blood loss and deep vein thrombosis (DVT): Risk factors associated with hematoma formation, anemia and DVT are; aggressive liposuction, patients with BMI>35 and patients getting simultaneous abdominoplasty done. For prevention, routine DVT prophylaxis is done and routine pneumatic foot pumps are used for each patient. Anticoagulants are used on a case by case basis to reduce the risk of hematoma formation.
  • Asymmetry, depression and bulges: Minimal asymmetry can be acceptable if it not obvious except only by the patient. Discernable asymmetry should be avoided by a combined method of liposuction and fat injected till the symmetry is reached. 
  • Cysts and mass formation: Oily cysts can occur following fat injections at any site, predominantly observed in cases with increased fat injection. These cysts can be treated with triamcinolone injections, aspiration of the cystic contents or by compression of the big cysts. Fat necrosis may lead to contour irregularities. Hypertrophy of a part of the injected lipoaspirate can lead to formation of a localized mass or seldom generalized hypertrophy of the entire injected area. In order to avoid this, it is recommended to not over-inject the fat and use appropriateamount and plane of injection. 

Am I a good candidate for Brazilian Butt Lift Surgery (BBL)?

An ideal patient for BBL should be in good health with absence of cardiopulmonary or debilitating chronic diseases. Surgical augmentation of the gluteal region depends primarily on the quantity of fat available that can be harvested with liposuction and fat transfer. It also largely depends on the degree of laxity of the buttock skin. BBL is a preferable method of buttock augmentation in case of women who have excess amount of fat in the region of lower back, waist or abdominal area. Patient who lack projection in the gluteal region and are lean or have an athletic build with minimal or no gluteal ptosis, are advised to undergo aesthetic buttock correction via gluteal implants.

Recovery and after care

Depending on the type of anesthesia used the entire operation may take 1.5 to 2 hours. Patient may have a normal appearance after 3-5 days. The extraction zones may take few weeks to heal completely. Patient is advised to take rest for approximately 10-15 days and avoid any stressful or weight exercise during this period. Patient is advised to rest in the prone position for 7 days post-operatively. During the first 2-3 days avoid sitting for long hours and if sitting is necessary do it by flexing the trunk.

Benefits of BBL(Brazilian Butt Lift surgery):

  • Main advantage is that it uses patients’ own tissue instead of an implant making it superior in biocompatibility and inferior in allergic complications.
  • It’s a minimally invasive technique for aesthetic corrections.
  • It has the additional benefit of fat removal from unwanted areas, enhancing the aesthetics further.
  • Both the procedures of fat removal and buttock augmentation is done on the same day as a two-step single procedure.
  • A substance not native to the body feels foreign on injection. Grafting the patients’ own adipose tissue gives them a natural them.
  • Graft rejection and other foreign body reactions are avoided.
  • It is safe and gives long lasting effects.

Success rate of Brazilian butt lift (BBL) Surgery:

Approximately 80% of the fat cells have been proposed to survive following BBL. Technical advancements have eminently curtailed the complications thus providing a positive outlook towards achieving the realistic expectations from the procedure.

Cost of Brazilian butt lift (BBL) Surgery:

An approximate cost of BBL is around $4096. Cost might vary depending on multiple factors like; qualification and experience of surgeon, type of anesthesia, pre-operative diagnostic procedures, medications required and type of expectation of the patient.

Why choose MedcureIndia?

MedcureIndia is a stalwart of medical tourism. We have a skillful team of highly proficient plastic and aesthetic surgeons well versed in handling cases of varying complexities, with ease. We help you achieve that infallible shape with minimal discomfort as well as provide guidance through the recovery process. 




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