The Truth Behind Brazilian Butt Lift (BBL)

Let’s talk about Buttocks Augmentation by Fat Injections a.k.a. Fat Grafting a.k.a. Autologous Fat Transplant a.k.a. Brazilian Butt Lift, a very popular procedure that has attracted the attention of all those people who have thought that their own fat is the most effective solution to give volume to their derriere.  Up to this point, everything seems to be favorable and perfectly logical; it is only a matter of undergoing a liposuction, generally these are people who have scarce adipose tissues accumulation. Beyond their excitement and enthusiasm, they overlook analyzing the procedure in depth: quality and quantity of the fatty tissues to be transplanted, buttocks projection to be obtained by it and procedure lifespan are for example important aspects to be found out beforehand.

BBL has been offered as an elixir for people who were not satisfied with the volume of their buttocks, yet there are drawbacks that are lightly weighed; fat grafting involves several phases, some of them critical that are not explained in depth to the patient becoming very frustrating later on. 

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.

2. Fat Purification

Collected fat 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 resorbed by the gluteal tissues and quickly disappear.

The purification phase goes through centrifugation 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 figure 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 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 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.

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