The famous Brazilian butt lift is in surgical terms a fat transfer procedure to the buttocks. Although I have not been able to determine where the actual term Brazilian butt lift originated from, I would like to emphasize what the surgical meaning of this procedure implies. Brazilian women are famous for their nice round behind and curvy figure. Let us be honest. Most women would like to have a nicer behind. A nicer buttock makes the female figure look sexier and more attractive. The Brazilian butt lift is equivalent to butt shaping with fat transfer. In this procedure, areas with excess fat like the abdomen, flanks, thighs, arms, lower and upper back are sculpted. The fat that is removed is processed and re-injected or grafted into the buttock area. This procedure is a total body sculpting procedure through which, not only the shape of the buttock is made nicer, but the actual proportion of the hip to waist ratio is improved. This transformation creates, not only a nicer looking butt, but also a sexier figure. Although by augmenting the buttock the butt is actually lifted to some extent, the “butt lift” is an actual misnomer because long incisions are not done.
When we think about lifting an area of the body, we immediately think about long scars to reposition the butt to make it look more youthful. In this procedure, small incisions are done, not only to remove the fat with liposuction, but also to re-inject the fat into the buttock area. The butt is actually lifted to some extent by increasing its volume with fat injections. Think about the butt like a deflated balloon. When you inject air, it gets bigger and firmer and its overall shape is “lifted.”
Not everybody is a good candidate for this procedure though. There are many factors that are taken into consideration before doing a Brazilian butt lift and age is not one of them. It is well known that age by itself is not a contraindication for cosmetic surgery. The following is part of the criteria that I use to determine if a patient is a good candidate for butt sculpting:
- Amount of fat: You need to be at least 20–30 lbs above your ideal weight. We need fat and the bigger the desired butt, the more fat you will need. If you would also like to have relatively larger hips, then, you need to have more fat.
- Location of the fat. The fat needs to be accessible.
- Health: You cannot have any significant medical problems.
- Shape of your body before your surgery. Not only the amount of fat will determine if you will have good results but also your hip to waist ratio, your bony/hip frame, the preoperative shape of your buttocks, and the length and width of your buttocks.
- Quality of your skin: If your buttock skin is very saggy, then, you will not be a good candidate for just butt augmentation. You might need to have excision of the excess skin, which is a more traditional butt lift.
- Realistic expectations: This procedure can do wonders to your body and can even transform you life, but you will need to be realistic on what to expect in terms of your goals and what the surgeon can provide. The results depend on a combination of multiple factors: your skin tone, shape of your body before surgery, and the surgeon’s experience.
Overall, the main factor that determines if you are going to be a good candidate for the Brazilian butt lift will be your weight and the location of the fat in your body. Typically, I remove between 6-7 litters of fat and fluid during this procedure. Out of this amount, approximately 1.5 – 2.0 liters of fat is usable. In other words, the ideal candidate is a female that is size 6 or above in clothing. In addition, the fat needs to be accessible, which means that it should be extra-abdominal fat, not intra-abdominal fat. Intra-abdominal fat is the fat around the liver and guts. This fat cannot be harvested. Only the fat that you can grab with your hand can be used for the procedure itself.
What if you do not have enough fat? Then, you will need to gain weight. In general, a patient that does not have enough fat needs to gain approximately 15 – 20 lbs. before surgery.
In order to do liposuction and harvest fat for any butt shaping procedure, small incisions (5 mm) are strategically placed in different areas. As part of the Brazilian butt lift, I routinely perform liposuction of the abdomen, flanks, thighs (if the patient wants this area to be liposuctioned) and upper and lower back. In general, these are the amounts of incisions I use and their specific locations by area:
1. Abdomen/flanks: 4 incisions located at the bikini line
2. Medial thighs (inside of the thighs): one incision on each side
3. Upper back: one incision
4. Lower back: 2-4 incisions
Remember: All of them are very small incisions that measure about 4-5 mm. There is nothing to worry about. These incisions heal very well and you can barely see them later. The location and amount of incisions are based on surgical judgment, the surgeon’s preference, and the desired quantity of fat removal.
I follow strict surgical guidelines for better results and outcome. My approach for fat transfer is not only based on surgical experience but also in peer reviewed scientific conclusions.
There are many fat grafting and preparation techniques that might have some effect on adiposities graft survival. In other words, the fat grafting technique does not determine where the fat comes from but the survival of the fat once harvested and transplanted. Some of the factors that have been shown to play a role in fat survival include the harvesting technique and the fat preparation techniques. Some physicians advocate for different types of techniques, pressure setting during the fat removal with liposuction, and preparation techniques. Many of the recommendations are based on logic rather than real science. There is no question that minimizing trauma to the fat will improve its survival.
Studies have demonstrated conclusive recommendations based on scientific data. There are two main ways of removing fat either with syringe liposuction (manually applying pressure with a syringe to harvest the fat) versus routine liposuction with a liposuction machine. It has been demonstrated that the fat survival was similar using either techniques to remove the fat. Moreover, minimal preparatory techniques meaning not washing the fat with any product to remove the blood, oil, tumescent solution (epinephrine and lidocaine) have a better survival outcome than when the fat is washed with saline or centrifuge (spinning in a machine to remove non fatty tissue) to remove all the “non fat tissue”.
I use the following guidelines for longer lasting results which are like the Ten Commandments:
- Use small cannulas to inject the fat. A cannula should not have more than 3 mm diameter.
- Inject the fat in multiple passes.
- Inject the fat in different layers. The muscle layer has a better blood supply so the chances of fat survival will be higher.
- Avoid excessive blood in the fat.
- Do not irrigate the fat with saline or any product. It has been shown that minimal handling of the fat gives better results than the “cleaning and washing approach.”
- Avoid the fat from being exposed to air for a long period of time.
- Mix the fat with platelet gel. This is basically your own growth factors mixed with fat. It will improve angiogenesis (growth of vessels).
- Avoid pressure on the buttocks that can damage the fat by not sitting for 10 – 14 days.
- Do not smoke.
- Use low power suction during liposuction and a liposuction machine that does not injure the fat. I typically use the power-assisted liposuction under low settings. This liposuction technique allows the surgeon to remove most of the fat and improve its survival. The ultrasonic liposuction machine, the VASER or laser liposuction, is not recommended.
Always ask your surgeon to show you before and after pictures of the long-term results at least for 6 months after surgery. Anybody can make a butt look good the first three months after surgery due to swelling. If the procedure is not done right, the fat can be reabsorbed and, consequently, you will have suboptimal results. Experience has shown me that the main factor to determine if you are going to have good results is the surgeon’s experience, intuition, and techniques.