Someone someday had to set forth the grim reality about Buttocks Augmentation by Fat Injections a.k.a. Fat Grafting a.k.a. Autologous Fat Transplant a.k.a. Brazilian Butt Lift; wow! with such a number of synonyms one might think that this procedure should be very effective but the naked truth is that this is far from being so.

This article will probably not be pleasing to many colleagues but we believe it is essential to start spreading and communicating to the general public what Brazilian Buttock Lift really is, how effective it is and also emphasize the risks of this procedure, which are frequent, contrary to what it is said.

During more than two decades, fat injections have been commercialized worldwide as a panacea for people who were not satisfied with their buttocks volume, despite recurring failures it continues to be widely publicized; evidently when there is money in between, the truth becomes secondary.

Fat transplant operation is very complex. It involves several phases, some very critical, in the end we think that all this discomfort is really not worth it.

But let’s go deeper:

1. Fat Harvesting

The first phase involves a considerable amount of liposuction in order to extract enough quality fat that must have the required consistency to be implanted into the buttocks. Liposuction should be performed the traditional “old fashion” way, i.e. tumescent technique, not Smartlipo by Laser or Vaser Lipo which are lesser aggressive, lesser traumatic systems to have fat removed. This is due to fat cells extreme susceptibility to heat exposure, used in technological fat removal machines.

It is therefore necessary in the first place that patients must have enough donor fat zones and this automatically excludes slim patients which puts in evidence a first flaw.

The fat that has enough consistency to be transplanted is found mainly in thighs, lower back and abdomen; other potentially fat donor sites such as arms and thighs are not adequate because the fat taken from there has little consistency.

If BBL has some positive effect, if any, it is only because  liposuction’s molding and trimming effect enhances overall looks; if surgeon is skilled enough at this procedure, he can create contour in the gluteal area, making it standing out  achieving kind of an augmentation effect when in reality he is only revealing the buttocks that were previously overshadowed perhaps by a waist too voluminous.

2. Fat Purification

Fat collected must be processed and purified because when removed using tumescent liposuction it cannot be transplanted directly into the receptor site as it is mixed with Klein’s solution and serosanguineous fluid which prevents adipocytes from having a chance of surviving.

It is important to say that tumescent liposuction also destroys a conspicuous amount of fat cells which will be reabsorbed by the buttock tissues and quickly disappear.

The purification process goes through a centrifugation process which also produces more mortality to the adipocytes as well as possibilities of infection.

3. Fat Re-injection

Some doctors have coined the fancy term 3d injection which is quite high-pitched and packs a nice punch but the only thing it stands for is that fat is distributed among the various anatomical planes of the buttocks in the hope that graftings will survive and achieve the desired effect of producing an even volume. This phase is quite delicate as it involves the major risks of fat embolism and infections.

Disadvantages oF BBL

Serious scientific studies, not biased by the commercial appeal of BBL, indicate several flaws in this procedure even though, it must be said, the technique has been improved over time, decreasing complications but still quite high as per the safety medical standards accepted nowadays.

First and foremost, it is a fact, which can be checked in the bibliography cited in the footnote that the long-term results of fat grafting are most often disappointing because of unpredictable partial absorption of up to 70% of the volume of the fat graft. Autologous Fat Grafting has unforeseeable success rates, and there is no agreement among physicians as to the ideal method for the harvesting and handling of fat grafts leaving the procedure in a limbo.

In other words, surgeons promote BBL as the perfect solution when they themselves do not even agree on how it should be performed!

Secondly, being that as said before, fat resorption is unpredictable, a great deal of asymmetries are prone to show up requiring subsequent procedures when fat were to be available again next time, the same than the first time. Furthermore, secondary procedures are difficult being that of all the fibrosis caused by the initial liposuction which makes it difficult for the surgeon penetrating the surgical planes as when they were untouched.

Third, fat injections are dangerous. Injecting fat into the buttocks can lead to fat embolism when fat enters the bloodstream blocking a blood vessel while in the brain it can cause a stroke. It is not our purpose to sow panic but in 2018 the Australian Society of Aesthetic Plastic Surgeons stated the rate of death in BBL procedures far higher than any other cosmetic surgery, in other words this is the deadliest cosmetic surgery procedure.

Fourth, we are going to list a series of complications that although they are not directly life-threatening, they represent unpleasant complications

doctors try to underestimate for obvious reasons, but nevertheless patients often report them which lead to the suspicion that the real value could be well above the declared one; namely, bleeding, infections, poor skin healing. Patients can also experience fat necrosis, in which the injected fat cells die, resulting in firm lumps and subsequent infections.

Fifth and finally, the implications of a considerable liposuction done simultaneously with fat injections are not properly explained, since both procedures have antagonistic recovery processes, that is, they are not compatible with one another: while liposuction needs patient to be able to move freely due to the discomfort felt throughout the body due to trauma, fat injections on the other hand, require lying on the abdomen only, avoiding sitting altogether during two months, since fat needs blood irrigation in order to survive fat transplant.

In conclusion, is it really worth going through all this odyssey to finally discover that within a year all traces of the supposed improvement in the appearance of buttocks have disappeared due to fat resorption?

We leave the answer to the reader.

Bibliographic references:

Author:
Dr. A. Urrego.
Bioplasty Specialist at Bioplasty International Center Colombia