Butt, I’m Fabulous

Mariel Chow on the bottom line of bums

Dr Marco Faria Correa - March 29, 09:20 PM

Despite all of them denying the use of plastic surgery, let’s not kid ourselves – the Kardashian/Jenners possess one of the planet's most coveted bodies. Whether naysayers like it or not, many do look to them for inspiration. Mrs Kardashian-West (The Klan’s Kueen) affirms she hasn’t had work done, but how did she go from quintessential Middle Eastern dame to one of the world's greatest beauties? Kylie Jenner – or shall I say the next Kim – is vying for her sister’s crown, quickly becoming the most favoured Kardashian/Jenner. Don’t believe me? Take a gander at her Instagram page. She turned from ugly duckling to swan within two years, gaining 100 million followers who covet her thick lips and guitar-like waist and hips. To be honest, it’s no wonder why plastic surgeons acquiesce she’s been nipped and stuffed. Even if she refutes it. Yes, this lot of ladies are trendsetters. We mirror their style and even purchase expensive merchandise, just to sample that KarJenner life.  For those wanting to kick it up a notch, fans in pursuit of Kylie-like perfection are even undergoing butt augmentations. So much so, gluteal surgeries increased a whopping 26 percent in 2016 alone! 
So, what are cosmetic gluteal surgeries and the differences between augmentations and enhancements? According to Plastic and Reconstructive Surgeons and Fat Transfer experts – Dr. Marco Faria Correa and Dr. Lee Kim Siea – gluteal augmentations are those which utilise implants. Enhancements with fat transfers are combinations of liposculpturing and adipose tissue grafting to enhance a patient’s waist, hips and thighs whilst accentuating the butt’s shape and fullness. We consult with Dr. Lee and Dr. Marco as they give us the low-down on how butt enhancements work, whom they’re appropriate for, and why patient selection including moderate surgical expectations are important. 
What are butt enhancements and Brazilian Butt Lifts?
Many believe butt enhancements are similar to gluteal augmentations but this isn't true, says Dr. Marco. He confirms, “What we should be calling the procedure is butt enhancement surgery or Brazilian Butt Lifts (BBL) because we do so much more than insert silicone bags under muscle.” He adds, “Through gluteal enhancements, cosmetic surgeons can amalgamate artistry and surgery by reshaping and resculpturing the body and hips to accentuate a lifted, perkier behind.”  Although patients always have augmentation options utilising big, heavy implants, it won’t include liposuction of the surrounding areas. What surgeons try to accomplish are not ‘big butts’ but contoured silhouettes that compliment a patient’s fitness and smooth figure, Dr. Marco maintains. This preferred result can only be achieved through liposuction of the love handles, thighs and flanks. Ultimately, once patients have small waists and shapelier thighs, bums will automatically look firmer, lifted and more pronounced, without seeming overly large. To further improve results, doctors may inject fat from donor areas into bums to enhance shapes, contours and volume. 
In Dr. Lee’s view, BBLs are implant surgeries which excessively raise the butt's upper pole. Fat grafting however, is transferring fats without the use of implants. He explains, “Many international doctors – including those on Snapchat and Instagram – maintain that BBLs are liposuction plus fat transfer, but my personal opinion of such a term connotes lifting the bum and making it bigger through extreme inflations of its curves.” He continues, “Whatever way doctors provide that service is subjective, but to me, fat grafts aren't able to offer such effects.” When patients expecting exaggerated curves consult Dr. Lee, he recommends implants instead, as East Asians don't typically have enough fat to transfer when expecting amplified outcomes. Conversely, if larger patients already possess decent sized butts and want BBLs through fat grafting, it is certainly possible as there are good amounts of fat to extract and inject. Thinner patients of smaller statures however, may attain good enhancements with improved contours but cannot expect Brazilian swimwear model outcomes since they don’t normally have enough fats to transfer and graft.
Before and After
Surgical Types
Every butt is unique. Some have fuller upper poles, others have plumper lower poles. Some women have huge, shapely bums with good all-round volume while others have flat behinds. Although every shape is unique and normal, Dr. Marco suggests the most desired shapes are those which are lifted and firm, with full upper and lower poles. Furthermore, the infra-gluteal fold (transition between the butt and thighs) shouldn’t protrude but instead, appear curved and contoured to pronounce healthy and fit bodies. The Kardashians are noted to popularise butt enhancements but according to Brazilian-born Dr. Marco, beautiful backsides have always trumped large breasts in Brazil, and this is how the BBL came to be. “The Brazilian butt lift or Brazilian Bum Bum is a procedure that gives impressions of a lifted backside," Dr. Marco explains. Although there's no procedure which physically lifts the butt, liposculpturing of the love handles, waist and outer thighs create curvatures which give the illusion of lifted and fitter butts and bodies that neither looks square or boxy. Plus, fats from donor sites can be injected into the bum to improve shapes and volumes. “If patients opt for augmentation with implants alone, they may end up with overly large butts. BBLs however, don’t necessarily create amplified volumes, but instead construct toned and elevated silhouettes due to combinations of body contouring and fat injection,” Dr. Marco states. 
While Dr. Marco and Dr. Lee have different opinions on the term ‘BBL’, surgical techniques in both practices are similar. According to Dr. Lee, suitable patients are those desiring improved contours rather than increased volumes. He divulges, “Many of my East Asian patients normally complain of flat bums with zero shape, these are the procedure's best candidates." They shouldn’t be too skinny either, he advises. Although Dr. Lee is able to graft some fat and improve current appearances, he cannot meet unrealistic expectations especially if exaggerated sizes, lifts and projections are expected. Larger patients have more possibilities because they typically possess enough fatty tissues to spare. Nonetheless, with the many options available, patients can either choose implants or added grafting procedures when desiring greater results. “We normally remove adipose tissues from the buttock region in order to accentuate areas we want to enhance,” Dr. Lee articulates. To do this, he will typically harvest fat from the flanks, upper, medial and lateral thighs and waist to reduce lateral bulkiness. “When enhancing the butt, I need to inject at least 500CCs or more per bum and hence will harvest over 2000CCs of adipose tissue because fat only yields 50 percent of the harvested value,” Dr. Lee reveals. He adds, “I also mainly graft fat into the bum’s upper pole as over-injecting the lower pole causes droopiness.” Due to fat’s propensity to dissipate over time, Dr. Lee may recommend a supplementary stem cell procedure called Stromal Vascular Fraction (SVF). SVF is a complementary procedure with abilities of drastically improving fat uptake levels while reducing chances of complications. Despite its advantages, be reminded that additional stem cells treatments cost more and require added surgical time and fat extraction due to necessary adipose tissue incubation and processing. 
In Dr. Marco’s practice, the choice between augmentations and BBLs depend on physical indications and patient desires.
In Dr. Marco’s practice, the choice between augmentations and BBLs depend on physical indications and patient desires. Based on his preferences, if patients aren't muscular, and skinny with minimal donor areas, the best option would be gaining weight or building more muscle tone. If patients cannot build muscle, the second option is to ascertain how much fats patients have, in which region the fat lies and if that amount produces satisfying results. Dr. Marco illustrates, “If we can manage to harvest fats from the tummy, arms, thighs or wherever fat can be spared, and mange to achieve 600CCs of fat, favourable outcomes can still be attained because we didn't only sculpt the body but also inject at least some fat in the bum.” Conversely, if patients don't want liposuction and fat grafting because they’re either too skinny or prefer to avoid liposuction-related pain, Dr. Marco may recommend implants. Still, there are limitations to the implant's volumes according to a patient's natural size. Average patients can normally accommodate 300 to 400CC implants, but when patients are petite, there aren't enough tissue envelopes to fit such capacities. Therefore, Dr. Marco may recommend 200CC implants and amalgamate liposculpturing and fat transfer for improved results. In cases where patients are adamant on zero liposuction, Dr. Marco may advocate body fillers or Macrolane for enhanced volumes. “For me, combination procedures are best applied to smaller or thinner patients while larger patients may achieve optimal results through two sessions of liposculpture and fat transfer of up to 300 to 400CCs of fat per session.”
Implants Pitfalls
Gluteal implants are a foreign body. Although medical literature claims gluteal implants cause less contractures because of increased massage and movement, complications are still a possibility. Like breast implants, infections are a potential complication. Although rare, ruptures can occur too. Dr. Marco recommends, “If patients have opportunities of achieving desired outcomes with liposculpture and fat transfers in one or two sessions while avoiding any form of foreign body application, that would be best, as complications are heavily reduced. However, if certain patients show zero signs for effective BBL with minimal risks, then gluteal augmentations can be an option.”
Dr. Lee agrees. He believes implants to be inferior to fat transfer because implant migration and displacement are commonplace from constant sitting, sleeping and motion. Moreover, and as Dr. Marco revealed, infection is a possibility due to the implant’s proximity to the anus. Dr. Lee maintains, “Although fat transfers posses rare chances of infection, the commonest complication patients experience is poor fat uptake where grafted volumes dissipate by up to 50 percent.” He continues, “Should this situation arise, patients can always return for follow-up procedures, providing they have enough fat to graft.”
Expectations after surgery
Liposculpture and fat grafting patients will experience swelling, bruising and pain immediately after surgery. Bruising subsides after one to two weeks. Swelling reduces within the month, continually diminishing in the coming months. Pain normally lasts between three to six months. Besides possible pressure garment application, patients are reminded to sit on their posterior thighs – 90-degree positions – and sleep on their tummies or sides. Normal work activity can be resumed after a few days, but strenuous exercise should be avoided for at least three months. If patients have undergone butt implants, massaging the augmented region and light compressions may be recommended for better healing and reduced bleeding.
Important details
It’s imperative patients research specific procedures before deciding anything. “Prospective patients must investigate how surgeries are performed and maybe have a chat with their surgeon about how many of the same procedure he or she has done,” Dr. Lee advises. Patients should also undergo multiple consultations and seek second opinions, if they prefer. Finally, ensure that doctors are qualified and credentialed plastic surgeons who practice in safe and sterile environments. If you’re unsure or skeptical of a doctor’s experience, speak to his or her previous patients to guarantee you’re in good hands. 
Perkier butts connote how fit and healthy you are, Dr. Marco concludes. However, whether one has undergone surgery or not, perfection isn't attainable without diet and exercise. “You must remember that the butt isn’t a single entity, but part of your body. If patients want butt-iful results, they’ll need to pair it with a fit body that’s beautifully sculpted,” Dr. Marco reminds. He further notifies, “You cannot assume surgeons can work miracles when patients don't do their part.” Although doctors possess the skills and hands to provide gorgeous backsides, waists and thighs, it’s still mandatory for patients to maintain a perfect balance between muscle and fat – even after surgery – as rocking bods aren’t only telltale signs of beauty, but of all round health and fitness as well. 

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