This isn’t a story about Brazilian butt lift safety. Truly, it’s not. But we can’t discuss the finer points of the BBL—a plastic surgery famous for combining liposuction and fat grafting to sculptural effect—without first addressing the well-publicized risks. In short, “the butt is a danger zone,” says Dr. Ran Y. Stark, a board-certified plastic surgeon in Bryn Mawr, Pennsylvania. “If injected incorrectly, devastating consequences—namely death—can occur.” While leading experts have, over the past several years, studied the dangers involved and devised ways to minimize them, this is still not a body contouring procedure for the strip-mall surgeon.
“There is a high degree of technical expertise and nuance involved in getting it right,” Dr. Amaka Nwubah, a board-certified plastic surgeon in Nashville, Tennessee, tells us. “It’s not a cosmetic procedure that can be learned in a weekend course.” Our doctors insist that it’s imperative to seek out a board-certified plastic surgeon who performs butt lift procedures routinely and in accordance with the latest safety guidelines.
Once you find a vigilant surgeon who meets these benchmarks, you will, of course, want to peruse their patient testimonials and their before-and-after photo gallery. But what exactly are you looking for? Real, relatable photos, for starters—plus several other subtle signs of remarkable results. Here, the six things that matter most in BBL B&As, according to top plastic surgeons.
1. Before pics that align with your body type
When reviewing before-and-afters, it’s natural to focus on the after—eye on the prize, and all that—but surgeons say that BBL before photos deserve equal attention. “Always be sure to look at the patient’s shape in their before photos, to see if [their end result] is something that is achievable for you,” advises Dr. Nwubah. “If you start off square but all the before photos you’re looking at are round, those results may be unrealistic.”
A lack of variety in “before” bodies may also be a red flag. “You want to know that the surgeon can handle the procedure in different types of patients, because everyone comes with a unique canvas that is their starting shape,” she adds.
To help set reasonable expectations, Miami board-certified plastic surgeon Dr. Pat Pazmiño relies on digital imaging. “I sit down with every patient and keep changing their picture, little by little, until they see, on their own body, the shape that they want,” he says. In his experience, this is the best way to ensure everyone is on the same page and to get an accurate idea of what an individual’s results will be. Because again, you may covet a certain tush you see online—be it a celeb’s or a perfect stranger’s—but if that person’s pre-op pic doesn’t resemble yours, you cannot count on an identical outcome. “Wish pics are wonderful,” says Dr. Pazmiño—“but wish pics are fantasy.”
2. Authentic, long-term after photos
We all love immediate gratification—and plastic surgeons are no exception. Which may explain the abundance of on-the-table BBL posts in our social media feeds. These images are taken in the OR, directly following the buttock augmentation procedure, when bums are (temporarily) at peak plumpness post-fat transfer. “On-the-table results are essentially a marketing tool,” Dr. Nwubah explains. “Most surgeons take after videos on the table, with patients in what we call the ‘jackknife’ position—they’re basically bent over, lying down, which makes the hips and buttocks look rounder and more accentuated.”
Beyond being borderline deceptive, on-the-table snaps are also fairly useless in forecasting actual outcomes, says Dr. Pazmiño, since “BBL results can change for up to 10–12 months after the procedure.” He prepares patients for two separate stages of shrinkage: the first occurs by two weeks post-op, when the saline that was injected during surgery gets absorbed, and the second happens around three months, when roughly half of the grafted fat gets absorbed. “Typically, anywhere from 50% to, if a patient is lucky, 70% of the fat that’s moved from one part to the other will stick around,” he says. Anticipating some degree of loss, surgeons generally fill the butt to capacity, being careful to stay in a safe plane and to not overstuff the tissues.
For a more reliable predictor of BBL results, look at after photos that are taken at least three to six months out, when swelling has subsided some and true dimensions are better established.
3. Flawless lipo results
The BBL is a two-part cosmetic surgery procedure, remember, so while the butt may be the star of the after shot, liposuctioned zones should be carefully analyzed as well. “It’s not just about the butt—it’s about having great 360 lipo, because we’re harvesting fat from everywhere,” says Dr. Stark. Look for smooth transitions; a lack of lumps and irregularities; and natural contours across the abdomen, upper and lower back, and any other areas that were treated. (Something you don’t want to see in the afters: liposuction scars. More on that in a sec.)
Here again, it’s important to consider the before photos. “Look very closely at the patient’s skin quality,” says Dr. Pazmiño. Those with no stretch marks or scars generally shrink back very well after lipo, he explains. But if your midsection bears more signs of laxity, your skin likely won’t contract the same way, so getting comparable results may require your surgeon to take a different tack—either by liposuctioning other areas or combining the BBL with a tummy tuck (or mini tummy tuck), perhaps as part of a mommy makeover—for ideal skin tightening.
4. Smooth curves
A well-shaped booty typically possesses two key curves. When viewing the buttocks in profile, “you want to see that there’s a smooth transition from the lower back to the buttocks—not a shelf-like appearance,” Dr. Nwubah tells us. The secret to creating that swoop, she says, is not oversuctioning the area right above the buttocks and the hips, which is what typically leads to that dreaded ledge. From the top of the butt, that line should continue around the apex, or fullest point of the bottom, and sweep down onto the back of the thighs. Ideally, “projection should fall in the center of the buttocks,” adds Dr. Stark. “The patient should be injected proportionately, not overfilled at the top or bottom of the butt.”
The second crucial curve can be seen when viewing the patient from behind. Along the sides of the body, “you want to establish a curve that goes from the flanks to the most projected part of the hips and down the legs,” Dr. Stark says. “You’re looking for smooth transitions and beautiful contours.” Some of the worst B&As he’s seen feature bums that are large but ultimately shapeless—as if size were the only goal. In Dr. Stark’s experience, “most patients don’t necessarily want a huge butt—they just want nice curves.”
5. Proportionality
A butt should never look as if it was created in a vacuum, with no regard for its owner’s overall physique. Rather, for the most natural look, “the buttocks and hips should match the patient’s frame,” says Dr. Nwubah. Overfilling for dramatic effect is never a good idea. Not only can it make someone look odd and disproportionate, but it can potentially tear the connective-tissue septae of the buttock, says Dr. Stark, causing lasting irregularities. Moreover, he points out, butts, like breasts, are affected by gravity and can become ptotic, or droopy, with age. “But if you fill the butt proportionately and don’t overdo it, your results will stand the test of time,” he says.
6. Hidden incisions
“One thing I don’t see talked about enough is incisions: Can you see the lipo or BBL incisions?” says Dr. Nwubah. Ideally, the answer is no—cannula entry points should be expertly hidden. On the upper back, Dr. Nwubah conceals lipo incisions in the patient’s bra line. “The lower back has one incision, and this one I place in the upper portion of the butt crack, so you can’t even see it when naked,” she says. On the front of the abdomen, she hides scars under the hood of the belly button and within the pubic area. While each incision is generally less than one centimeter long, obvious cannula marks show a complete lack of care, our doctors agree. “If you see bad scars in visible areas from liposuction,” summarizes Dr. Stark, “find a different surgeon.”
Related: 5 Things to Look for in Breast Implant Before and After Photos, According to Top Plastic Surgeons
