Brazilian Buttock Lift Revision

Brazilian buttock lift (BBL) revision is intended for patients who have failed on their first attempt at a Brazilian buttock lift. This makes Brazilian buttock lift revisions more technical than the first round of buttock surgery. The most important consideration is to define why the first BBL was not satisfactory. As a BBL revision specialist, we are referred disgruntled BBL patients each week. The most common complaint is that the volume of the buttock did not last. Patients on Realself, the online Q and A platform, routinely post that they lost 40% of their buttock volume at 6 months. The second complaint that I hear is that the surgeon did not give them the buttock shape that they were desiring. This complaint typically involves having grafted too aggressively to the upper lateral aspect of the buttock creating a shelf like a deformity, or not having adequately filled in the lateral hip region located in the upper lateral thigh and the mid-buttock level. The final complaint is the appearance of residual dimples over the lower buttock and upper posterior thighs often described by the cellulite appearance.

Brazilian buttock revision is complicated by several factors including the fact that the body has already been liposuctioned and become scarred throughout. Attempts at removing more fat from this area using traditional liposuction techniques are fraught with the inevitable mistake of injuring the removed fat cells that are laden amongst the scar tissue. This is because the extra force is required to pierce through the scar tissue when attempting to scrape out the fat with traditional cannulas. It is imperative that an inventory of all areas previously liposuction is completed so that any virgin areas of the body are first liposuctioned to remove non-traumatized fat. If this is not enough fat volume to achieve the desired BBL revision goals, only then is the fat from prior liposuctioned areas used for fat transfer. This is not to say that all areas are going to be liposuctioned in order to smoothen out and optimize the entire body! Regardless, the use of ultrasound-assisted liposuction is critical to harvest both virgin fat and fat from scarred areas.

Ultrasound-assisted liposuction harvesting of your fat provides several advantages. First, ultrasound-assisted liposuction is the definitive liposuction technique allowing for 40% more fat removal than traditional techniques. This is important because often, most of the fat has been removed on the first BBL attempt. So Brazilian buttock lift revision is often performed on patients with limited fat reserves. The second advantage is that ultrasound-assisted liposuction is gentler on the fat cells and provides a higher 90% fat viability and survivability following the transfer. This is a significant improvement over the 60% survivability observed with traditional liposuction techniques. This is even more critical for fat that is laden with scar tissue from prior areas of harvest. In fact, the only modality that can correct contour irregularities created from the first BBL especially in areas of generous scarring is ultrasound-assisted liposuction.

The second critical component of Brazilian Buttock Lift revision is to confirm the exact size and shape of the buttock that is desired by a disgruntled first time BBL patient. This is a very important consideration because a majority of patients that I have consulted for a BBL revision complain that they didn’t feel that they communicated with their surgeon the buttock that they wanted. As such, we have created the Brazilian Buttock Lift Assessment Tool that allows patients to convey the exact buttock size and shape that they are desiring.

Buttock width sizes are described by the ratio of maximum buttock width to the waistline as a ratio spanning from 0.5 to 0.8. In addition, buttock projection sizes are depicted as a ratio of buttock projection to the waistline. Finally, the position of both maximum width and projection are altered from the upper pole to middle pole and finally lower pole to gauge the exact buttock shape patients are desiring. The Brazilian Buttock Assessment Tool is not only used for BBL revision patients but also for those first time BBL desiring patients.

The final reason for disgruntled BBL patients is the appearance of residual buttock contour irregularities resulting from redundant skin. These irregularities are often observed as dimples localized to the lower mid-buttock cheek or the posterior thighs and are related to skin redundancy. We utilize three separate techniques to eliminate skin redundancy for our BBL revision patients. The first is to graft directly into the dimples using fine, smaller gauge cannulas. The second is to use Renuvion subdermal coagulation to tighten the skin in areas laden with cellulite lesions. This technique is novel and utilizes the fusion of two energies including Helium activated plasma and radiofrequency in order to allow for skin contraction by virtue of shortening collagen tissue in the deep layer of the skin. The advantage of Renuvion subdermal technology is that it avoids any incision lines except for the porthole used to liposuction and/or transfer fat. The final consideration for eliminating sagging and skin redundancy is the use of a lateral thigh and buttock tuck which allows for the lifting of the entire buttock complex as well as the lateral thighs and posterior thighs. The lateral thigh and buttock tuck is combined with fat transfer as well and intended to dramatically improve the appearance of moderate to severe buttock sagging and extensive cellulite.

Brazilian buttock lift revision should only be performed by BBL specialists who have experience with buttock shaping and augmentation. BBL revision requires attention to detail, an artistic eye, and expertise in removing, processing, and transferring fat cells. All attempts must be made to optimize all steps involved in the fat transfer that may have potentially failed in the first BBL attempt. We utilize a closed-loop system that provides several advantages to our BBL revision patients. The first includes the elimination of any contamination and/or subsequent infection of fat cells by virtue of avoiding exposure of the fat cells to any outside environment. The second is to hasten the out of body time of the fat cells. This is important because when the fat cell is removed from the body it, in essence, starts dying just like a fish out of water. Using the closed-loop system we are able to minimize out of body times for fat cells to under 30 minutes. We also utilize fat cell cooling during this period in order to lower metabolic demands for fat cells while they are not back in the body.

If you are unhappy with your first attempt at a Brazilian butt lift, I recommend that you consider a complimentary virtual or in-house consultation so that we can identify the reason for your failed BBL. Then Our Surgical Teami can customize a surgical plan to correct not only any contour irregularities created over your body as well as to design your fat transfer needs to give you the ideal buttock contour. Brazilian buttock lift revision is very technical and requires attention to detail and a strategically sound operative plan for success.