BBL Revision of a Brazilian Butt Lift | SurgiSculpt™

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Reviewer: Arian Mowlavi, MD FACS
Author: Babak Moein, MD FACSBoard-certified, Fellowship trained in
Cosmetic Surgery

BBL Revision: Brazilian Buttock Lift Revision

Brazilian buttock lift (BBL) revision is intended for patients who have failed on their first attempt at a Brazilian butt lift. This makes Brazilian buttocks lift revisions more technical than the first round of buttock surgery. The most important consideration is determining why the first BBL was unsatisfactory. As BBL revision specialists, we are referred disgruntled BBL patients every week. The most common complaint is that the volume of the buttock augmentation did not last even though they had gone to a prominent plastic surgeon for their BBL. Patients on Realself, the online Q and A platform for surgical procedures, routinely post that they lost 40% of their buttock volume as early as six months following their BBL. The second complaint we hear is that the cosmetic surgeon did not give them the buttock shape and size they desired. The list of complaints is extensive and includes the following:

  • Overgrafting to the upper lateral buttock resulting in a shelf-like deformity
  • Not having filled in the lateral hip dips
  • The buttock cheeks are just too large
  • The buttocks cheeks are not large enough
  • The buttocks projection is inadequate
  • The buttock looks droopy, i.e., the diaper butt
  • Too much lower thigh fullness
  • Persisting dimples, especially over the lower buttock cheeks
  • Firm areas of the buttocks cheek resulting from fat necrosis
  • Areas of bulging and redness result from a lake of necrosed fat, called Blow Out
  • Buttock cheek asymmetry

BBL Revision Considerations

BBL revision surgery is complicated by several factors, including the fact that the body has already been liposuctioned and is thus full of scar tissue. Removing more fat from these areas using traditional liposuction techniques is extremely difficult because the scarred areas are difficult to traverse with the liposuction cannula. Second, the force required to retrieve the fat makes the patient prone to vital structure injuries. Perhaps, the most constraining repercussion is that the fat retrieved may have been injured and thus not ideal for fat transfer. Since the transplantation process places additional stress on fat that is already compromised, graft take can be compromised.  As such, it is imperative that an inventory of all areas previously liposuction be completed in order to identify any virgin areas of the body that possess non-traumatized fat cells. This virgin fat should be transferred to your buttocks first. If this is not enough fat volume to achieve the desired BBL revision goals, then fat from previously liposuctioned areas should be used for transfer. This is not to understate that all areas of concern require revision liposuction to smoothen out and optimize the overall body contour! As a result of the above concerns, the implementation of VASER ultrasound-assisted liposuction is critical to successful BBL revision surgery.

Advantages of VASER liposuction for your BBL Revision

Expert surgeons employ ultrasound-assisted liposuction harvesting of your fat benefitting from several advantages over traditional liposuction. First, ultrasound-assisted liposuction is the definitive liposuction technique allowing 40% more fat removal than traditional techniques. This is important because most of the fat is often 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 following transfer. This significantly improved over the 60% survivability observed with traditional liposuction techniques. This is even more critical for fat laden with scar tissue from prior harvest areas. The only modality that can correct contour irregularities created from the first BBL, especially in areas of generous scarring, is ultrasound-assisted liposuction.

Communicating your desired Buttock Shape

The next critical component of the Brazilian Buttock Lift revision is to confirm the exact size and shape of the buttock you desire. This is a very important consideration because a majority of patients that consult for a BBL revision complain of not having received the buttock shape and size that they desire. They universally expressed that they didn't feel they had communicated the buttock size and shape they wanted with their surgeon. As such, we have created the Brazilian Buttock Lift Assessment Tool, allowing patients to convey their desired buttock size and shape.

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

BBL Butt Ratios

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, i.e., cellulite, 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 small gauged 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, to allow skin contraction by shortening collagen molecules in the deep layer of the skin. The advantage of Renuvion subdermal technology is that it avoids lengthy incision lines except for the port sites used for liposuction and/or fat transfer. The final consideration for eliminating sagging buttock fullness and skin redundancy is using a lateral thigh and buttock tuck, which allows the lifting of the entire buttock complex, the lateral thighs, and the posterior thighs. The lateral thigh and buttock tuck is combined with fat transfer and intended to dramatically improve the appearance of moderate to severe buttock sagging and extensive cellulite.

 

Expertise required for BBL Revision Surgery

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 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 starts dying like a fish out of water. Using the closed-loop system, we can minimize out-of-body times for fat cells to under 30 minutes. We also utilize fat cell cooling during this period to lower metabolic demands for fat cells while they are not back in the body.

What’s the next step if you are unhappy with your Brazilian Butt Lift Surgery

If you are unhappy with your first attempt at a Brazilian butt lift surgery,  you will require consultation by a revision Brazilian Buttock Lift specialist. During your consultation, we will identify the reason for your failed BBL. Then, the SurgiSculpt team will customize a surgical plan to correct any contour irregularities created over your body and design a fat transfer plan 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.

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