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Brazilian Butt Lift (BBL)

At Hill Country Plastic Surgery, we perform the Brazilian Butt Lift (BBL) to enhance the shape, size, or fullness of the buttocks using fat grafting. In this procedure, liposuction is performed on other areas of the body and the fat is processed and then injected into the buttocks in the desired areas. The effects of the BBL are two-fold. First, the abdominal and flank liposuction performed is done to enhance the waist and contour the back and thighs. This contouring helps enhance the look of the buttocks. Secondly, fat is injected into key areas to enhance the contour of the buttocks. The areas that are typically troublesome to patients are the lateral buttocks or the top of the buttocks so fat can be transferred to this area.

Am I a good candidate for this procedure?

This procedure is best for patients who are healthy and are at or close to their goal weight so maximal results from the contour definition can be seen. If you have realistic expectations of the results, want to improve the general shape or roundness of the buttocks or make your buttocks more symmetrical, you may be a good candidate for the procedure. During your consultation, we will discuss your options and expected results based on your current buttock size and shape, the amount of fat you have available, your goals and activity level, and your skin quality.

How is the procedure performed?

The procedure is typically done under general anesthesia but for some, it can be done awake with minimal sedation.  Liposuction is performed in areas determined by you and your surgeon. The areas done are usually the abdomen, flanks, back, and thighs.  The fat is collected and then purified and separated prior to reinjection.  The purified fat is injected into the layer of fat under the skin to help correct any contour defects of the buttocks. This procedure can take anywhere from 2-4 hours depending on the complexity.

What is the recovery after fat transfer buttock augmentation (BBL)?

You will be in compression garments with special buttock panels after surgery.  You will need to wear a compression garment at all times except when showering for at least 6 weeks.  It will take months for the full results of your surgery to be seen so it is recommended that you wear the garment for 3 months. Swelling and bruising can be present for several weeks. You should sleep on your stomach or side for at least 2 weeks to avoid pressure on the newly grafted areas. Most patients return to work within one to two weeks, and are comfortable with returning to social engagements after a couple of weeks. Patients are allowed to resume their normal exercise regimen 6 weeks after the procedure once the wounds have sufficiently healed and swelling has decreased. This allows the fat that is transferred to have the best chance of survival. Additionally, most patients should buy a special pillow to offload pressure from the buttocks while sitting.

How big can you make my buttocks?

Your final outcome depends on multiple factors, but the way we perform the procedure is to improve the shape and increase the size in a safe manner. We do not perform high-volume buttock fat transfer due to concerns about safety and final outcomes.

Does the fat go away?

Of the fat that is injected during the procedure, 60-80% of the fat remains. The fat that remains, stays around and does not go away.

Is BBL (fat transfer to the buttocks) safe?

Fat transfer to the buttocks is safe when performed correctly but it has been linked to fat embolism leading to respiratory distress and even death. It is important that the procedure be performed by a board-certified plastic surgeon who has training in the procedure. Our surgeons have extensive knowledge of the anatomy of the buttocks through their experience of multiple types of buttock surgery, including flap surgery. High-volume fat transfers and injection into the muscles have been associated with higher risk of fat embolism and death.

Do you do buttock lift with auto-augmentation?

Yes, we do! This procedure is usually done after massive weight loss and there is excess skin present that needs to be surgically removed.  Your own skin and tissue are used as a flap to increase the size of the buttocks. Please see the body contouring section of our site for more information.

We emphasize safety while performing the fat transfer butt lift procedures. We do not do high-volume fat transfers which have been associated with increased risk of fat embolism and death.

What are some potential risks of BBL?

In addition to the standard risks associated with any surgical procedure such as complications of liposuction, anesthesia, bleeding, and infection patients should be aware that there can be: bruising, stretch marks, blood clots, excessive blood loss, cardiac and pulmonary complications, deep vein thrombosis, fat embolism (fat is injected into the bloodstream and travels to the lungs), or necrosis of fat or surrounding tissue.

Why Should You Choose the Surgeons at Hill Country Plastic Surgery?

Both Dr. Farber and Dr. Shah were fellowship-trained at the most prestigious institutions and their techniques for delivering patient results and satisfaction set the standard for plastic surgeons in the field. They use the most advanced techniques and consistently achieve superior results. Their warm demeanor, genuine care, and dedication to their patients are second to none. Ultimately however, patients choose Dr. Farber and Dr. Shah for the results. Their patients look and feel their best, and so can you. Discover the difference here in San Antonio!

What to Expect During Your Consultation Visit

During the initial consultation with your surgeon at Hill Country Plastic Surgery, we will discuss your concerns and goals before recommending treatment options that are tailored specifically to your needs. Prior to your consultation, we recommend that you review the procedure on our website so you are familiar with the terms we will be using during our discussion.

Once we identify your concerns and surgical goals, we will discuss all the treatment options that are available to you. Every patient is unique and we will develop a tailored surgical plan that addresses your specific goals. In addition, we will thoroughly review your medical history, surgical history, medications, allergies, family medical history, and other important details. It is very important that we obtain accurate information in all these areas as it may impact the outcome of your surgery.

While discussing different treatment options, we will perform a physical exam and take measurements that are necessary for planning for your surgery. We will measure and do an analysis of your skin elasticity and body fat to ensure that you are a good candidate for the procedure.Pre-operative (before surgery) photos will be taken either at your initial consultation, or during your pre-operative visit.

After your consultation, you will receive access to your notes on the patient portal in addition to information about your specific surgery. If you have not activated your patient portal, this can be done at your appointment by asking any of our staff to assist you. If you have questions after your appointment, you can contact our office or message us through the patient portal. Some patients will require medical clearance from their primary care physician or a specialist or additional tests before undergoing surgery.

Once you have determined that you would like to have surgery and have completed any clearances and tests that were requested, contact our office at (210) 658-3555 to schedule a pre-operative appointment with one of our surgeons.

Pre-operative Appointment

On the day of your pre-operative appointment, we will review your procedure in detail and go over the surgical plan with you. We will also address any questions and concerns you may have. Please read over the procedure consent prior to this appointment and have any questions ready so we can discuss them.

During your pre-operative visit, we will provide you with all of the after-care instructions as well as necessary medication prescriptions. You will also be provided with a post-operative appointment for follow up after your surgery.

Before the Day of Surgery

Please do not smoke (cigarettes, vape, or pipe) or use any nicotine products 4 weeks prior to and after your surgery. Smoking and nicotine greatly impair healing, which can cause increased risk for infection and complications, such as delayed incisional healing or wound opening which lead to worse scarring. Please stay away from second hand smoke as well, as this can also cause wound healing problems. If you use nicotine products, you will need to stop 4 weeks prior to surgery and then you will need to undergo a cotinine test prior to surgery to ensure that the nicotine is out of your system.

Please do not drink alcohol before or after your surgery (until cleared by your surgeon). In addition, please do not drink alcohol while taking pain medication, as this can have serious, and life threatening side effects.

Please leave all valuables at home. If you have body piercings, kindly remove them prior to surgery.

Please have someone available to drive you home. Due to the lasting effects of the general anesthesia, you will be unable to operate a car after surgery. A taxi or car service is not adequate either. You will need a family member or friend who can assist you.

You may have been asked to obtain pre-operative tests at a lab facility or your primary care physician. Your pre-operative tests (labs, X-rays, EKG, etc) need to be completed at least three days before your surgery. If you have them done at your doctor’s office, the results will need to be faxed to (210) 362-1582.

The surgery facility will call you the day before your surgery to let you know what time and where you should arrive.

Shower the morning of or the night before your surgery with your normal soap and water. Do not use deodorant, lotion, cream, perfume, aftershave, oils, or makeup after bathing.

Do not take Advil, Aleve, Naproxen, Fish Oil, Garlic, CoQ10, Omega 3,6, Motrin, Excedrin, Ibuprofen, Aspirin, medications for arthritis or any medication that contains these medications for ten days prior to your surgery and two weeks after.

Do not eat or drink anything after midnight the night before your surgery.

Please call our office if you have an infection of any kind prior to your surgery.

Day of Surgery

On the day of surgery do not take the following blood pressure medications before your surgery:

Medications with generic names that end in “-pril”, “-sartan”. If you are on metformin, you will be asked to not take it on the day of surgery.

On the day of surgery, your plastic surgeon will meet you in the pre-operative area to go over any last minute questions or concerns you may have. Your plastic surgeon will make some preoperative markings and will perform extensive checks with careful attention to detail, ensuring high quality care and safety. You will meet the anesthesiologist and their team, as well as the members of our plastic surgery operative team.

During the plastic surgery procedure, our plastic surgeons pay meticulous attention to detail and work as a highly experienced team to ensure a great result. Your family will be updated of your status periodically and will be able to talk with the plastic surgeon in person after the procedure is completed. The incisions will be placed in a dressing or a compression bandage. Instructions for care on these will be given to you in your preoperative paperwork.

Aftercare

In order to make your recovery faster and more comfortable, we recommend that you prepare before your surgery. Things you can do are:

  • Prepare a sleeping area that is easy to get to. For example, set up a couch downstairs instead having to walk up to an upstairs bedroom. Keep your toiletries close by and prepare food ahead of time. Arrange for someone to be with you the first night after surgery.
  • You may receive your post-operative medications at your pre-operative appointment.  You should pick up these medications prior to your surgery.
  • If you’re having an outpatient same-day procedure you will be released to go home the same day and will need someone to drive you home.
  • Review your post-surgery instructions given to you at your pre-operative appointment
  • Most patients should buy a special pillow to offload pressure from the buttocks while sitting.

If you have a history of nausea or vomiting after anesthesia, please let us and your anesthesia provider know. We can prescribe anti-nausea medications and take extra steps to prevent nausea and vomiting after surgery.

When undergoing general anesthesia, you will need to have someone drive you home.  You will not be allowed to undergo surgery if there is no confirmed designated driver.

Medications:

After surgery you will have discomfort and the goal of pain medications is to reduce pain, but it will not completely remove all pain. A good measure for if you need more pain control is that you should be able to take a deep breath without severe pain. Do not wait until your pain is unbearable to take the next dose of pain medication because it will take longer to get your pain under control again.

You may resume your home medications after surgery except blood thinners and as determined by your surgeon.  We will give you a prescription for a pain medication.  If you are prescribed medications that contain acetaminophen (tylenol) it is important that you not exceed 3500 milligrams of acetaminophen (tylenol) per day..  Do not drive, operate heavy machinery or make important decisions while taking narcotic pain medications.

Narcotic medications may cause constipation. Ensure you have adequate (>25 grams/day) of fiber in your diet and drink at least 64 oz. of water daily. You may also wish to take an over the counter stool softener such as Miralax or Colace once or twice daily.

You can alternate your narcotic medication with Ibuprofen 600mg every 6 hours and/or Gabapentin 300mg three times a day.  Take ibuprofen with food to protect your stomach from irritation.

If you have a history of nausea or vomiting after anesthesia, you may be prescribed an anti-nausea medication (Ondansetron) which can be taken as needed.

Before prescribing any narcotic medications, we are required to check the Texas controlled substance history database (Texas Prescription Monitoring Program).  If you currently have a pain medication contract with another physician or are currently on narcotic medications, we will have to coordinate your medications with that physician.

We will prescribe pain medications for recovery after surgery, but do not prescribe long-term pain medications and do not do more than one refill for any pain medications. If you have pain that is beyond what is usually anticipated for your surgery and there is no surgical reason that can be found, we will help by referring you to one of the many pain management specialists that we work with.

Surgical Site Care:

You may shower 48 hours after your surgery. Do not scrub the incisions, just let the water run over them and gently dab them dry afterwards. Apply gauze or ointment over the surgical site daily as needed for light drainage. Do not immerse your incisions in baths or hot tubs until at least 2 weeks after surgery. More specific instructions will be provided during your pre-operative visit.

Please Call Immediately if:

Please call if you have the following signs/symptoms:

  • temperature greater than 100.5 F
  • bleeding or pus draining from the wound site. If you have bleeding, apply direct pressure to the area for 20 minutes
  • increasing pain that is not controlled on oral pain medications
  • increasing redness or size at the surgical site
  • if your incisions come apart
  • Any other concerns

For non-emergency questions:

During business hours (8 AM – 430 PM): call (210) 658-3555.

After hours and on weekends/holidays: call (210) 658-3555 and you will be forwarded to the on call surgeon.

If you are having any serious problems or symptoms such as difficulty breathing or chest pain, call 911 or proceed to your nearest emergency room.

Activity restrictions:

No vigorous activity: no pushing, pulling, bouncing, housecleaning, yoga, running, heavy lifting greater than 5 lbs until your follow up appointment.  Avoid activities that raise your blood pressure or heart rate. You are encouraged to walk around and you can climb stairs after surgery. You should not lay in bed and not move.

Clinic appointment:

Your clinic appointment will be scheduled at your pre-operative appointment before surgery.  If you need to change your appointment time or date, please contact our clinic at (210) 658-3555.

Brazilian Butt Lift (BBL) FAQs

Interested?

Are you interested in learning more about this procedure? To schedule a consultation, please fill out the form on this page or call us today. Hill Country Plastic Surgery is the premier plastic surgery center in the San Antonio and Austin area, and our friendly team members are here to help you and will reach out promptly.

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