There are four effective procedures to improve buttock shape. They all own unique advantages and disadvantages. And for some people, not all of the options exist. An individual may be a poor candidate for a number of reasons. Below are the three main options that exist for buttock enhancement and the things a prospective patient should know when researching these options.
Buttock Implants (gluteal augmentation)
Buttock augmentation, like breast augmentation, is a surgical procedure that utilizes an implant to provide increased volume and projection of tissue. Buttock implants are composed of silicone. Unlike breast implants, there are no saline alternatives. And, the implants for the buttock tend to be more firm than buttock implants.
While a buttock implants do not technically lift the buttock, the added projection and volume does create the illusion of a perkier backside.
The main advantages of gluteal augmentations is their predictability, potential, and aesthetic outcome. The volume chosen reflects the true enhancement, unlike fat transfer and Sculptra® injections where unpredictability is more common. The implants, when placed properly, can create very natural looking results. In cases where men and women want a more provocative or curvy shape (and sometimes unnatural look), buttock implants can rise to the occasion and meet just about any desire. This of course contrasts to fat transfer (BBL) since one is limited to the amount of volume based on one’s preexisting fat deposits.
Disadvantages include the need for an incision, risk of infection, seroma, extrusion, and malposition. The incision for buttock implants are typically larger than incisions for breast implants and certainly much larger than those required to transfer autologous fat. While the incisions generally heal well and remain rather camouflaged, there exists a higher implant infection rate with buttock implants than breast implants. This becomes a problem when the infection cannot be cleared by antibiotics. In such cases, the implant must be removed to prevent tissue injury or sepsis.
A seroma is a collection of fluid that builds up around the implant. Again, the rate of seroma formation is higher for buttock implants than breast implants, autologous fat transfer, and Sculptra injections. Seromas often need to be drained in the office. With each aspiration of a seroma, the risk of bacterial infection rises. Thus, not uncommonly, a persistent seroma will result in an implant infection.
Because the buttock is a big pad for seats, the tissues surrounding the implant receive some considerable wear and tear. Malposition describers the change in location of the implant from an area where it should be to an area where it shouldn’t be. If this occurs, surgery is required to reposition the implant. If the tissues break down or the implant develops an indolent infection, the implant may extrude from the body and necessitate removal.
BBL (Brazilian Butt Lift)
BBL refers to the use of autologous fat to enhance the buttock. One must use their own fat, and generally a lot of it, to appreciate a significant difference in shape. Thus, the limitations to this procedure should be obvious. If one is too thin, they are not a candidate for the BBL surgery. In such cases, the next best options, absent of sever skin laxity, are gluteal augmentation with buttock implants or Sculptra® injections. It should be noted here that there are no other feasible (and safe) products to inject into the buttock for enhancement other than one’s own fat at Sculptra®. While other injectable products do exist, they are neither safe nor effective for this use. Be wary if you are told otherwise. Improper product injection can cause terrible permanent deformities and chronic, painful infections. And death.
The main advantage to the BBL procedure is that it uses one’s own fat. While there is always a risk of infection in any surgical procedure, there is no risk of rejection. The other advantage should be clear. One improves their shape with liposuction. In fact, the art of BBL surgery incorporates sculpting with both addition and subtraction. Fat is removed aggressively in the lower back (and other areas as necessary to improve body contour) and injected into the buttock to add volume and projection. Depending on one’s desire, the fat can be transferred to also widen the buttock and hips to enhance curves.
The main disadvantage to this procedure is that one must have enough fat to provide adequate volume to the buttock. The other disadvantages are the unpredictable nature of fat transfer and risk of fat emboli.
Not all of the fat injected will survive. In good hands, the survival of fat is anywhere between 60 and 80 percent. However, it is exceptionally difficult to clinically determine the exact percentage of fat retention after the surgery. Thankfully, the fat survival between both left and right buttocks tends to be very similar. That is, it is almost never the case that one buttock retains far more or less than the other, except for cases where infection plays a role in fat loss. The amount of fat injected into each buttock and hip ranges from 80 cc to over 500 cc.
Fat emboli refers to the condition where fat enters the venous system and lands in the lung. Recent literature collected demonstrated an alarming one out of five thousand deaths from BBL surgery. The report did not differentiate between complications related to qualified, Board Certified Plastic Surgeons, from poorly trained (or in some cases un-trained) cosmetic surgeons. No doubt, the numbers reflect the alarming trend of physicians performing procedures they ought not to be performing. These may include skin doctors such as dermatologists, emergency medicine doctors, gynecologists, internists, pediatricians, and general surgeons.
In all cases of fat emboli, deep vessels were injured which demonstrated intra-muscular injections – a place where one should not inject. The BBL surgeon must be equipped with proper technique and knowledge. While one can never reduce complications to zero, experience and proper training go a long way in keeping patients out of harm’s way.
Sculptra ® BBL (poly-L-lactic acid)
Sculptra® BBL refers to the use of the injectable product Sculptra ® to add volume to the buttock. Sculptra® is composed of poly-L-lactic acid. The product is mixed with water and injected with a cannula or syringe into the buttock to enhance the body’s own collagen production. Thus, results are never immediate. And often, more than one session is required to achieve the desired result.
Generally, ten syringes of Sculptra® are required per buttock cheek to gain visible differences. A second treatment is often repeated three to six months later. The main advantages of a Sculptra® BBL is that one doesn’t require surgery. There is no incision (unless a cannula is used in which case the incision is 2-3mm), no stitches, no anesthesia, and very little down time. The disadvantage is that one requires a lot of product (which isn’t cheap) and often more than one session. The other disadvantage is that it is unrealistic to expect the same volume enhancement with Sculptra® as one can achieve with large fat transfers or buttock implants. However, for the man or woman who desires a very safe and subtle enhancement, Sculptra® BBL may be a wonderful option.