Brazilian but lifts have become extremely popular with patients. This term usually refers to augmentation of the buttocks with fat. The ideal shape varies in different cultures.
Most want a heart-shaped butt with good projection and lift. Some want a little more roundness in their outer thighs and more curves laterally. Most patients want a nicely shaped behind that looks good in jeans and tight dresses. In order to achieve this one needs to do liposuction along with fat grafting to the buttocks.
Most patient need liposuction in their lower back,. waist and hip areas to enhance the appearance of the buttocks. Many also have a sacral fat pad that can also be removed. This is a common anatomic area that gets reduced in order to try to create the ideal waist to hip ratio of 0.7. This will create an hour-glass figure that most patients desire.
Vaser liposuction of those areas gives a better result that with traditional liposuction. The vaser probe is larger than most laser cables and it is more efficient at heating large surface areas and hence providing fat lipolysis quickly. The fat comes out in about half the time of other methods. It is also very good at disrupting areas where there is a lot of fibrous tissue such as the upper abdomen and back. Patients that have had prior liposuction also have more fibrous tissue and this makes it harder to perform liposuction without the Vaser. Studies have shown that there is about a 70-80% survival rate when it is harvested using the Vaser. Collecting methods have improved over the years. Now we used a closed collection system that can easily collect most of the fat that is removed by liposuction. The fluid can be easily decanted and most of these systems can collect 2-3 liters of fat which is more than enough to transfer in one session. There are systems that can mechanically deliver the fat back. These have safety pressure levels that will turn off when a certain pressure is reached.
When the fat is grafted into the buttocks, it is usually grafting in multiple planes using small aliquots to allow for survival of the fat. The volume that is grafting has changed over the years. Most patients now get between 500-1000 of cc of fat grafted per buttock. Studies have shown this to be safe if this is injected into a larger surface area and in multiple planes.
Studies have shown that 80% or more of the fat that is grafted can survive. If a patient maintains their weight then results can be long term. MRI scans and 3D surfacing imaging have been done to document fat survival.
A task force recently examined the safety of fat grafting to the buttocks. They sent a survey to 4800 surgeons and 692 responded. They were looking at mortality rates from gluteal fat grafting procedures. These were caused by fat embolization into the gluteal vessel. They analyzed over 199,000 cases and made the following recommendations. In order to avoid injection into the gluteal vessels they recommended avoidance of injection into the deep gluteal muscle. The cannula also should not be angled downward and injection should occur when the cannula is in motion.
Other complications reported include seroma, infection, under correction and pain or sciatalgia which occurs in less than 1.7%.
Some patients that have under correction might need a second transfer. These patients have small buttocks with little projection to begin with. I have written a blog on this topic and there are photos that document the sequential improvement. The ones that have a second transfer will have a significant improvement in terms of volume and projection with much less fat having to be transferred the second time.
In conclusion, gluteal fat grafting or Brazilian Butt Lifts are very popular porcedures that have been shown to be safe and with a high patient satisfaction rate. This need to be done with stategic liposuction to reduce key areas to try to achieve the ideal waist to hip ratio of 0.7