The Brazilian butt lift remains a popular procedure, yet there’s an emerging trend towards a more subdued and safer alternative for buttock enhancement. “BBLs were very popular in my practice a couple of years ago, but we’ve seen a little bit [of a] downtick in our patients seeking BBLs,” says Dr. Mansher Singh, a plastic surgeon in New York City. This adjustment in patient choices highlights a trend towards more natural-looking enhancements, emphasizing the rising interest in nonsurgical alternatives for buttock augmentation.
For the uninitiated, a BBL is a surgical procedure that uses fat transfer to make your butt higher, rounder, and fuller without implants. During the procedure, a surgeon performs liposuction to harvest your own fat from other areas before reinjecting it into the buttocks to create an enhanced shape. “BBLs have amazing transformative properties,” says Dr. Johnny Franco, a board-certified plastic surgeon in Austin, Texas. “Patients can be transformed from having a square figure to an hourglass shape.”
But even in the best hands, a BBL is risky. When fat is injected into the muscle, whether intentionally (a technique that’s increasingly come under scrutiny but still favored by some doctors for the longevity of results) or accidentally (the distance between the subcutaneous space under the skin and the muscle is mere millimeters), the risk increases that the doctor can nick an artery and fat will enter the bloodstream and block blood flow—a very serious and life-threatening consequence called a fat embolism. BBLs are often quoted as having a 1 in 3,000 mortality rate, the highest for any cosmetic surgery procedure—though a 2020 survey published in the Aesthetic Surgery Journal found that the mortality rate has dropped to 1 in 14,952, but that’s only when the procedure is performed by a board-certified plastic surgeon.For the risk-averse, a BBL may be off the table. Ditto for those who are too thin and don’t have enough fat to be a good candidate, which usually means having a body mass index (BMI) below 22. If buttock augmentation is something you definitely want to do, there are other ways to go about it. Here’s the scoop on four treatments, including two that don’t require stepping into an operating room.
1) Liposuction: take out surrounding fat to emphasize the behind
It’s logical to think that to get a bigger butt, something has to be physically added to increase its size. A BBL alternative, however, is to remove fat via liposuction in a circumferential fashion around the entire perimeter of the waist (meaning the flanks and abdomen as well as the triangle above the buttocks) in order to create far more prominent buttocks. “Some patients already have a generous amount of buttocks, but it’s not well-defined because of the muffin top above it,” says Baltimore board-certified plastic surgeon Dr. Ricardo Rodriguez. He’s dubbed the procedure the B’more butt lift, but this type of circumferential liposuction is also called lipo 360, 360 Lipo and 360-degree liposuction.
If your desired result looks like Kim or Cardi, liposuction alone may be too subtle. But it might be an appealing option for those after a more natural hourglass figure: a butt that’s rounder and curvier but not necessarily much bigger. “Some patients may want a more defined, perky, and attractive backside but not necessarily a significant increase—so for them, this procedure is ideal,” says Dr. Rodriguez, pointing out results from his before and after photos.
In some cases, it’s the lipo of the lower back that really makes the difference, says Dr. Singh, “If you do the lipo [there], the lower back curves very nicely, providing a nice transition between the lower back and your buttock area, it can be just as transformative as adding volume.” For many people today, the goal is to get a naturally rounder buttocks silhouette, rather than substantially larger enhancements. By refining this area, the focus is on improving body contours and prioritizing the harmonious proportions you’re born with rather than enhancing them, says Dr. Singh.
In addition to being less risky than a BBL, liposuction can be less expensive (40% so, in Dr. Rodriguez’s practice) and has a much easier recovery. For instance, you don’t have to commit to not sitting for at least two weeks (some doctors keep patients off their backside for six weeks), as you have to with a BBL—pressure from sitting can cause the injected fat cells to die or relocate to other areas, compromising your results. In fact, according to Dr. Rodriguez, you’re able to sit on your butt immediately following the procedure. While BBL requires three to four weeks of downtime, with circumferential lipo you can return to work after a week and resume normal activities after two to three weeks.
The final benefit has to do with something called fat redistribution. Once you remove fat cells from the areas where your body likes to store fat, such as the waist and hips, the body has to select new areas to store the fat, Dr. Rodriguez explains. If you do want to augment your booty, this can work to your advantage. “If we remove most of the fat cells in the waist and hips but leave the butt intact, it will continue to accumulate fat,” he says. “If you lose weight, your figure will be maintained—but if you gain weight [as many women do after liposuction], the weight is redistributed to the butt.”
Related: Deceptive Before & After Photos Are Everywhere. Here’s How to Spot the Red Flags.
2) Butt implants: create bigger contours
Butt implants aren’t a particularly popular option for adding oomph to your posterior, but if you’re looking for a one-and-done permanent solution, implants—which reliably create better projection and roundness than a BBL—meet the criteria. “Of the approximately 20 new buttock implant consultations I see per week, at the very least four to five are because the results of their BBL melted away within 10 to 16 months after surgery,” says Dr. Ryan Stanton, a board-certified plastic surgeon in Beverly Hills, California.
Unlike breast implants, which are made of silicone gel, butt implants are made of a semisolid silicone—so there’s no worry of leaking or rupture. They’re considered permanent, unless you change your mind and opt to change the size of the implants.
One of the knocks on butt implants is that they have a high rate of complications. Though an oft-cited statistic is 38%, a 2016 review of 44 articles reported a substantially lower overall complication rate of 22%, which is still high. The most common complications with butt implants are poor wound healing, seroma, infection, and transient sciatica, which can cause tingling or pricking (“pins and needles”) down the back of the leg and sometimes onto the foot, due to pressure on the nerves.
Most complications can be avoided by choosing an experienced surgeon—ideally, someone who has consistently done at least three to five procedures a month for at least five years. “If you don’t know how to do butt implants, there is a high rate of complications,” says Dr. Stanton, who has a less than 1% wound-healing complication rate and 0.5% infection rate.
Size really matters with butt implants. “With implants, you have to fight the urge [toward] ‘butt greed,’” Dr. Franco advises. “People get excited, and they want these huge Instagram-look butts.” The majority, however, just want to improve their shape and look good in clothes. “They want to look more athletic, sexy, somewhat proportional, and more realistic and believable,” says Dr. Stanton.
These before and after photos show butt implant results.
Too-large implants are associated with a host of problems, including poor healing because the additional pressure creates more tension on the incision. They’re also more likely to be visible. “The implants look great when you’re standing straight, but the moment you bend over in yoga pants or when you’re being intimate, you’ll see the outline of the implant if it’s too big for your body,” says Dr. Franco. Sometimes, in a very thin patient, even an appropriately sized implant may show, so surgeons may add fat to buffer the implant, softening the feel and appearance.
The surgeon’s insertion technique is also critical: One sign they may be inexperienced is that they insert the implants through a single incision in the crease of the butt, a technique that creates a 30–50% chance of wound-healing complications; distributing the tension between two wounds cuts it in half.
Placement of the implant within the muscle is also important, to prevent complications and have stable long-term results. For instance, if placed on top of the muscle, the implants can end up touching in the middle (the “uniboob” implant look, aka symmastia). But intramuscular placement is more difficult to perform than placing the implant above the muscle, so be sure your surgeon is experienced doing it.
Butt implant surgery requires at least two weeks of downtime, and you’ll want to prepare for a difficult recovery—many surgeons report that butt implants are one of the most painful procedures they do. A lot of nerves run through the butt muscles, so you feel an extreme tightness and pressure until the muscles relax and the nerves settle down. “The first two weeks are misery, and you have to plan on that,” says Dr. Stanton. “After two weeks, life gets better because you’re able to sit down.”
It may also take a while before your implants really feel like they’re a part of you. The more muscle and fat you have, the more natural things feel. “Implants do make your butt feel slightly firmer, but most of my patients want to firm up their butt a little,” says Dr. Franco. Occasionally, someone can’t get used to the implants and asks to have them removed. But that’s unusual. “Even the rare patient who says the implants feel hard as a rock don’t want to have them removed,” says Dr. Stanton. “They’re like, ‘No way. I’m not giving them up for that.’”
3) Sculptra butt lift: fill ’er up with injections
Sculptra is best known as an injectable dermal filler that reduces lines and wrinkles by stimulating your skin to regrow its own natural collagen over time. But in a case of what’s good for the face is good for the fanny, Sculptra is also being injected into the butt cheeks, to create lift and fullness.
Sculptra itself doesn’t provide the filling action. It contains microparticles of poly-L-lactic acid (PLLA), a material that’s been safely used medically for many years in dissolvable stitches and implants. Sculptra is injected deep into the skin, and as the PLLA microparticles are absorbed, they cause a reaction that stimulates collagen production to create more volume.
A major downside of Sculptra is that a lot has to be injected to see even a modest—or measly, as some doctors call it—result, and the filler isn’t cheap. “The amount of collagen stimulation is directly proportionate to the amount of Sculptra you added,” says Dr. Franco. How much of a result can you expect with 20 vials? Results are not the same for everyone, explains Dr. Anna Avaliani, a board-certified physician based in New York City and known for her noninvasive techniques. “It’s not one to two vials, it’s a [much] different amount in the face versus the butt,” she says. While Dr. Avaliani was cautious about specifying the exact number of vials needed due to an individual’s variability, on average, patients need anywhere from 10 to 20 vials per treatment depending on their desired outcome.
The so-called “Radiesse butt lift” is also gaining traction in nonsurgical buttock enhancement. It utilizes Radiesse, a distinct bio-stimulating filler made of calcium hydroxyapatite. “Radiesse gives an instant result, while Sculptra’s volume takes one to three months to show,” says Dr. Avaliani. Despite Radiesse’s immediate effect and similar pricing to Sculptra, she prefers Sculptra for its natural appearance and reduced nodule issues. Sculptra also tends to last longer, typically three to five years, compared to Radiesse’s two-year duration.
Part of the reason BBL patients look so good is that “we’re adding and subtracting, not just adding,” says Dr. Franco. “With just fillers, we don’t have the benefit of trying to subtract those love handles to make patients a figure.”
Still, Dr. Kimberly Butterwick, a dermatologic surgeon in San Diego, says that “Sculptra can definitely create a cute profile and shape to flatter buttocks.”
These before and after photos show results on one patient after 10 vials of Sculptra from two treatments, spaced one month apart.
Depending on your doctor’s Sculptra pricing (it can run anywhere from $400 to $1,000 a vial), it can end up costing exponentially more than a BBL, which RealSelf members say averages $7,596.
Another drawback is that any enhancement from a nonsurgical butt lift may last for only up to two years. “There is some thought that you build permanent collagen, but we don’t really know to what extent,” says Dr. Franco. Reflecting on the longevity of Sculptra, Dr. Avaliani notes, “Once we get to the result that the patient is happy with, we recommend maintenance once a year. So, if the result was about 20 vials, they will need about four vials maintenance per year.”
Though likely cost-prohibitive for all but the 1% when injected in large amounts, Sculptra is more widely used to spot treat—for instance, by filling in small divets, such as hip dips, or contouring deformities, say, where fat on a BBL didn’t take. “It’s also great at camouflaging butt implants,” especially in very thin patients, where you can see a little bit of the implant—something that specifically looks really fake. “You can inject Sculptra around the lateral areas of the implant and create a nice, smooth transition,” says Dr. Franco.
It’s important to know that the immediate plumping you get with a Sculptra butt lift, which results from the material being diluted with saline, disappears pretty quickly. “The initial volume from Sculptra comes from water, and then it takes one to three months for you to notice the real results as it stimulates collagen,” says Dr. Avaliani. Then it builds back up over the next month. While that can be frustrating for people, there is an upside to the reversal. “It requires a couple of sessions and it’s a nice, natural build-up,” says Dr. Avaliani. This is an additional boon for patients seeking enhancements without obvious signs of cosmetic intervention.
Related: 7 Unexpected Areas Where Filler Injections Can Have a Big Impact
4) Emsculpt: tone your glutes to sculpt your backside
If you’re looking for a needle- and scalpel-free way to define your derriere, Emsculpt—a nonsurgical procedure that creates muscle definition in your butt—might fill the bill.
The “em” in Emsculpt stands for the technology behind the treatment, which uses electromagnetic energy that’s applied via a paddle-like applicator to get the muscles to contract in the treated area. One 30-minute session produces nearly 20,000 muscle contractions, an amount equal to doing 20,000 squats. Contracting repeatedly without rest stresses the muscles, triggering rapid changes at the cellular level that make them grow bigger and stronger. A group of four sessions delivers a 16% increase in muscle mass.
Emsculpt enhances gluteal muscle tone and strength, focusing on muscular definition rather than adding volume. This makes it suitable for subtle improvements in projection. Dr. Avaliani notes, “Emsculpt is great for toning [within reason], but if it’s someone who works out four hours a day, seven days a week, they already have a really nice projected muscle.” This underscores the importance of setting realistic expectations for Emsculpt results.
Check out these before and after photos.
What Emsculpt doesn’t do is add volume. “You have to be realistic in what you expect to get out of it. You cannot compare a BBL result to getting multiple sessions with Emsculpt. They are going to be nowhere close,” says Dr. Singh. Because of the anatomy of the gluteus maximus muscle, Emsculpt won’t create a very rounded look either.
Adding a filler like Sculptra can help create that rounded shape. The filler pairs well with Emsculpt because Sculptra needs to be massaged in. “We [regularly] combine Emsculpt together with Sculptra. The best result is obtained by having healthy muscle. And then on top of the muscle layering in some volume [with Sculptra],” says Dr. Avaliani.
There are two protocols for treatment with Emsculpt. While the protocol used on the abdominal area burns fat (19% in studies) and builds muscle, the protocol used for the buttocks (which has a shorter pulse sequence) doesn’t burn fat—a plus, since many people don’t want to lose volume in this area.
Four treatment sessions of Emsculpt, typically spaced a few days apart over a two-week period, are recommended. The treatment has different intensity levels, and the stronger the intensity, the better the results. Even at the strongest intensity, the treatment isn’t painful. “It feels like a muscle spasm,” says Dr. Franco. “Most people tolerate it really well.” Afterward, you may have some soreness, but the treatment flushes out lactic acid that builds up in the muscles. “It’s almost like having a workout and then a massage,” says Dr. Franco. There’s also no recovery time.
However, treatment results will diminish over time if they’re not maintained, so Emsculpt is considered an ideal way to jump-start an exercise routine.
