Brazilian Butt Lift

This is Behind the Double Doors with Dr. Bob Basu.

When it comes to a cosmetic procedure, like the one we're discussing today, the BBL or Brazilian Butt Lift, it's our mission to help you sort through the crazy stuff that's out there, especially on social media and get you what you need to know to get both great results and be safe.

(00:26)
And we'll get to the crazy stuff in a moment. But before we do, let me first explain what the BBL is and the goal of the surgery. The BBL is a Brazilian buttock lift. Now the Brazilians get a lot of credit for this, I'm not sure why, perhaps because there's always an aesthetic focused on curves and the buttock in Brazil. But really what a BBL is, is a fat transfer procedure. It's a combination of lipo sculpting. So establishing curves by removing excess fat, when you have excess and also doing some degree of fat transfer either to the buttock and or to the hips.

(01:01)
And the goal of the BBL really is to enhance curves. Enhancing curves can mean an hourglass shape. It can be using the layman's term called a snatched waist, which basically means a very tight, small waist accentuating the waist to hip ratio. It can also mean adding some projection to the buttock. Again, all of these things are designed to enhance curves.

(01:25)
The BBL is popular because we have to recognize the impact of reality TV shows, hip hop artists, Instagram influencers. They're defining the American aesthetic and curves are clearly in, in today's modern aesthetic. To give you an idea, the demand for these procedures, traditionally, mommy makeover procedures used to be restoring the breasts and the tummy to what it was before having kids. Now, I'm seeing a lot of moms coming in saying they want their tummy flattened, but they're looking for a BBL procedure at the same time. In other words, the definition of a mommy maker over is also changing because of the demand for curves. And so we're seeing a lot of moms that are actually not prioritizing the breast, but prioritizing how their waist and their curves and their buttock looks.

(02:14)
So now let's get the crazy part out of the way. We can't talk about the BBL or Brazilian buttock lift without talking about safety. Because you don't have to go far on Google or TikTok or Instagram to find controversy and headlines that are eye catching, that the BBL is a dangerous procedure. So what's this all about?

(02:31)
Well, let's go back. Because of the demand for this procedure, we've seen all these cosmetic surgery clinics are for bargain basement BBLs. And let me be frank, they're cheap prices, right? And unfortunately, people fall for that trap and they head down to these cosmetic surgery clinics that are many times they're not even board certified plastic surgeons. God knows who's doing the surgery. Patients barely even get to meet the surgeon before the surgery. Anyways, the sad part is that healthy moms and women go down to Florida, Texas, or other parts of the country for these cheap BBLs and some of them don't make it out alive. So what's going on here?

(03:09)
It's a phenomenon called fat embolism. Fat embolism is when fat is injected too deep into the muscles and fat gets into the blood supply or your blood vessels and travels up all the way to your heart and it clogs up your heart. It's catastrophic. And that leads to fat embolism, which often leads to death.

(03:29)
Now, any death in elective surgery or elective cosmetic surgery is catastrophic, so we have to study what's going on here. And that's what our community of board certified plastic surgeons did. They a did anatomic studies, they reviewed charts, and they studied what was going on with these mortalities.

(03:46)
They found that when fat is injected way too deep into the muscles or below the muscles, that increases your risk for fat embolism. And they have found that the risk of fat embolism when fat is injected too deep into the muscles can be as high as one in 3000. Now, let me put that into perspective. That's almost 10 to 20 times higher, of a risk of mortality, than any other procedure that we do in plastic surgery. And I'm even including large body transformations that take six, seven hours to do.

(04:17)
To help you understand all this stuff we really got to go back to Anatomy 101. So let's talk about buttock anatomy. When you talk about buttock there's skin, underneath the skin, there's subcutaneous fat or a fatty layer, and then deeper to the skin is a layer called fascia. Fascia is a strength layer of collagen. Think of it as a covering for your muscles. Well below that strength layer or collagen or fascia are your glute muscles. We all know the gluteus maximus muscle or your glute muscles, that's that thick muscle in your buttock. And inside the glute muscle, we have these big blood vessels, arteries and veins, they're called perforators or blood vessels.

(04:55)
The problems occur is when fat is injected too deep into the muscle or below the muscle and fat particles can get inside the blood vessels. That's a big problem because when fat gets in that blood vessel, that little fat particle can travel up your artery and vein. Can travel up and clog up your heart or lungs and that can lead to what's called a fat embolism, and that can be catastrophic. That's where you see healthy patients dying from the procedure.

(05:23)
Now, how do we keep patients safe? We keep patients safe by doing good technique, by performing what's called a safe subcutaneous BBL. What that means is we keep patients safe by transferring that very carefully into the safe subcutaneous zone. That's that layer that we just talked about that's underneath the skin, that's out outside of muscles in that safe fatty layer. It's called a subcutaneous layer. The studies have shown that when we inject fat into the safe subcutaneous layer that keeps our patients safe.

(05:54)
So the good news is there is a way to keep patients safe, but it's really, really important that if you're considering this procedure, wherever you are in this country or in the world, and you're listening, the worst thing that you can do is fall for a cheap deal, race down to one of these cosmetic surgery clinics.

(06:09)
And you're also seeing headlines continuing, unfortunately and sadly, of patients going to non physicians, getting silicone filler into their buttocks. And sadly, in some of these cases, patients pass away. God knows where the silicone's coming from. This is madness, right? You can't have an industrial grade silicone injected in your buttock. Which actually reminds me of a patient that went overseas and got a injectable filler. She didn't know what it was and she came to me because she had a big knot in her buttock and it was causing pain. And what that was, was a granuloma of scar tissue of a foreign body that was injected into your buttocks. On each side, she had a big ball, the size of a tennis ball, maybe even smaller than a softball on each side.

(06:58)
So we developed a plan to excise that. We did it in a staged approach. The first step was to actually excise the mass. We removed it on each side. I sent it to the pathologist and the pathologist looked at it at the hospital and said, "This is a foreign body reaction with some elements of silicone in there." That's all he could tell me.

(07:16)
The good news, the patient did well, but I had told her that when we removed these masses that she was going to have some deformities. So we waited a couple months to let everything settle down and we brought her back for the next stage, which was to perform a BBL procedure, or thankfully she had some excess fat in other areas in her love handles and her waist. And we did, what's called liposuction 360 or liposuction in the anterior waist, posterior waist, love handles in the back. We concentrated that fat and then we strategically transferred that fat into the area where she had those deficits. And we also globally, in the safe subcutaneous zone, we also added some fat in her hips where she was very self conscious that she didn't have the right curves that she wanted. And she did very, very well. Sadly, however, there are cases where foreign bodies being injected and we can't help these patients. So what I would tell you is if you're thinking about these injections done in some clinic or spa or hotel room, please don't. You could be putting your life at risk.

(08:13)
And so let's talk about this procedure. The first thing I want our listeners to know is that the BBL procedure is not just about transferring fat. It's not just about making things bigger. It's about making things better. What do I mean by that? It means at least 50%, if not more, of the BBL effect is targeted and strategic aesthetic lipo sculpting, in other words, liposuction.

(08:41)
I'll give you a perfect example. There are plenty of patients that I treat that don't opt for a BBL procedure. In fact, they're not wanting fat transfer, that's not important to them. But they do come to me for liposuctioning of their waste and flanks. It's called 360 liposuction. Translation, we're lipoing 360 degree around the waist. And when you hollow out the posterior flanks, we're talking about the love handles on your lower back,, if you liposuction that area alone, it makes your buttock look shapely and bigger. And these are in cases that I'm not adding any fat to the buttock, patients don't want that. And their buttock looks more athletic, more shapely, they love their curves. And that proves the point that at least 50, 60% of the power of the BBL comes from really good liposuctioning.

(09:30)
Now, of course, for some patients, they do need some more volume, right? They want to have a little bit more projection than what lip contouring can achieve for them. And so, adding volume does definitely make a difference for sure. So I want everyone to think about a BBL as a combination of liposuctioning or lipo sculpting, same thing, with fat transfer, and we're adding volume in areas where there's volume deficits.

(09:56)
So for instance, for patients that want to accentuate their hip to waist ratio, the marketing term for that is snatched waist, they want a little tiny waist and they want to have nice hourglass curves. Part of the procedure is not only liposuctioning the waist and the flanks again, it's called 360 liposuctioning but it's also adding some volume, fat transfer to the sides or the hip area. Patients call this the hip dips or the hip depressions. And so we're adding to the hips, but we're also taking away from the waist and that's what accentuates the waist to hip ratio.

(10:35)
To be a candidate for a BBL, you have to have enough excess fat to make it worthwhile. We generally want patients to, of course, to be very healthy for elective surgery. I generally keep my requirement for a BBL for patients with a BMI body mass index, which is a ratio of height and weight to be less than 30. And we do plus size procedures, but I generally find that for the BBL procedures to actually get safe and good outcomes, the body mass index really needs to be less than 30.

(11:08)
Now on the opposite end of the spectrum, there're patients that come in who may not have enough fat. So our skinnier patients, candidates, possibly, there's a couple different options for patients that we think that may not have enough fat. Number one, we can consider some of these patients depending on their anatomy for what's called a slim or skinny BBL. What that means is that we're being very, very efficient about where we're harvesting fat from. It might be from multiple different areas. It may be from the waist and flanks. It could be from the arms. It could be from the inner thighs. It could be from the knees. All those little small amounts can add up to something more significant.

(11:47)
But what about for patients that may not have enough fat at all, or they don't want to have any surgical procedure? We do have some nonsurgical options, which is called M sculpt. M sculpt is high frequency, electromagnetic technology that actually stimulates the glute muscles and with a non-invasive procedure, no needles, no down times. With a procedure that takes, again non-invasive procedure, that takes 20, 30 minutes in the office to do, you're essentially getting muscle contractions of about doing 10 to 20,000 crunches in just one setting. We have hand pieces with M sculpt that are applied to your buttock. It can be applied to your tummy. It can be applied to your biceps triceps, or even your calves. So M sculpt is a really great way to build up your gluteal muscles, to accentuate and add some volume to your buttock. And that's a great option for patients that don't have time for surgery, don't want surgery and just wants to look a little bit better in a matter of weeks.

(12:45)
I know there are some practice out there that do the same thing for every single patient and that's not what I'm about. I ask patients to actually bring me one or two wish pics or photos of results that they'd love to emulate. And I like those wish pics, because we can really drill down to what they're trying to accomplish. Where are they trying to go? Because I see plenty of BBL patients that want much more projection on their buttock, but they're actually not look looking to have accentuated hips. In fact, they don't like that look.

(13:18)
I have other patients that are happy with their buttock volume, they just want an hour waist and they want to correct their hip dips. I have other patients that want to correct their hip dips or hip depressions and want to have more accentuated hips and they want to have more projection on their buttocks. And so everyone's different. My job is to communicate to them how we're going to get there. Or possibly we may not be able to get there.

(13:41)
And my team, my patient consultants, encourage patients to come to their initial consult with me with a wish pic so I have an understanding of what they're trying to accomplish, what they like and also what they don't like.

(13:53)
So when we do fat transfer procedures are the results permanent? There's a short answer to that and there's a long answer to that. Long term answer to that is yes, the results are permanent. The short answer to it is, patients go through an evolution of the results. I always tell patients that when they wake up from surgery, the first time they look at their results, they're going to see the transformation. It's a no brainer, especially with all the liposuctioning that we do at the time of a BBL.

(14:19)
But their buttock will be larger than where they want it to be. That has to do with two things. Number one, swelling, right? Everybody swells from liposuctioning and BBL procedures. And number two, it has to do with strategic overcorrection because 100% of the fat that we transfer does not stick around. Regardless of the technique, some of the fat cells are not going to make the journey. They're not going to survive. It'll probably be between 50 to 75%.

(14:51)
Why is there a range? Well, there's a range because everyone's fat is very different. Some people's fat is stronger to make the journey, meaning the transfer, than others. It also has to do with your blood supply because when we transfer fat, ultimately that fat cell sits there, but it needs your own blood supply to build capillaries to feed that fat so it survives for the long run.

(15:14)
The other question that I get is, what happens if I gain or lose weight? If you're going to make a commitment to have this cosmetic procedure done, you're going to make the commitment to go through the recovery to get to heal state, then I encourage patients, make the commitment to lead a healthy lifestyle so you're not gaining 20 pounds or losing 20 pounds. Any significant weight fluctuations, and we're not talking about five pounds of holiday weight, we all deal with that, but we're talking about significant weight gains or significant weight loss, can impact the results of any cosmetic surgery. So make sure you're in a good place in terms of your health status and your weight, that's the perfect time to proceed.

(15:57)
I hear patients say, "Well, should I gain weight before doing a BBL procedure?" And they see other doctors that tell them, "Okay, go gain 20 pounds." I have a problem giving that recommendation to my patients. I'm a physician first and I think it's hard to lead a healthy lifestyle, especially in today's fast paced world. And so I generally do not tell patients, "Go gain 20 pounds," because that can have some health implications. I'd rather explore some other alternatives and options for them.

(16:26)
We generally like to place the incisions for liposuctioning along the bikini line. So when I do my BBLs, I actually have my patients wear a garment and they show us before surgery where they like to wear their undergarment or bikini line. And that's exactly where I might place my little incisions, along that bikini line so they're barely noticeable and they generally fade with time.

(16:51)
So let's talk about recovery. So we get our patients walking within an hour, right after surgery's done. Now there's a lot of stuff online, out there on the internet about, you can't sit on your buttock for two months, three weeks. It's all over the place. And to be frank, there's not much evidence out there about this not sitting for prolonged periods of time and every surgeon as their preferences for post op care. What I like to do is, of course, compression garments are super important. If you're going to opt for a BBL, you need to make the commitment to wear some form of compression garments for at least six to eight weeks, if not longer. Because you're going to swell in the areas where we've done liposuctioning and compression is super important to keep your swelling down so that to your results faster, and you don't develop fluid pockets or scar tissue in the areas that can lead to contour regularities.

(17:41)
I generally recommend no prolonged sitting on your buttock or your hips for about seven to 10 days, approximately about a week. And what does that mean? It means I don't want you sitting in a chair on your buttock. If we've added volume to the central part of your buttock, I don't want you compressing that area for about seven days or so. Now you can sit using special pillows. There are different types of products out there online. You can buy them on Amazon, we have them for you here, essentially creating a donut effect on the area that you've had fat transfer. So you're not crushing that area for the first seven days.

(18:18)
Now, if you'd like to learn a little bit more about this in our show notes, there's a reference to a new segment interview I did about two years ago about this exact topic. So definitely look at our show notes and you'll find the link to the old news clip on safety and BBLs.

(18:34)
The first step to moving towards a consultation is to give us a call at (713) 799-2278, or you can send us a direct message through Instagram. And schedule some time to speak to one of our friendly patient care consultants. Our expert consultants have been with me for a long time. They know exactly what my repertoire is and generally know what I'm going to recommend. But they'll get you all the basic information in terms of how long the surgery takes, the recovery, costs, financing options. And then they'll schedule a time for you to visit with me.

(19:05)
And for patients that are out of town, we do offer virtual consultations that we can review photos ahead of time and walk through some information. Of course, an in person physical exam is needed to give you the best recommendations, but at least a virtual visit gives you some information for you to digest before we meet in person.

(19:23)
So you can find information about pricing. We do publish some ranges on our website. We do offer several financing options that help to break down the total cost down to manageable monthly payments. But the first step is really to contact our office at (713) 799-2278, to learn more about your options. If you have questions about our services, well check out the show notes for links and see our website for hundreds of before/after photos of my private patients.

Basu Aesthetics and Plastic Surgery is located in Northwest Houston in the Towne Lake area of Cypress. If you'd like to be a guest or ask a question for Dr. Basu to answer on the podcast, go to basuplasticsurgery.com/podcast. On Instagram follow Dr. Basu and the team at Basu Plastic Surgery. That's BASU Plastic Surgery.

(20:16)
Behind the Double Doors is a production of The Axis. Theaxis.io.