2 years postop - Was my BBL botched? (photos)

Question

I've never spoken about this, as the outcome was so terrible and embarrassing. Post-op, it was glaringly obvious that my results were not the same as what I had seen in several before/after photos from various mediums after researching for 2 years. I had seen botched BBL's also, but mine seemed. Because my surgeon has left the country, and at this time I don't have the means to pay for correction, I will would just be so grateful to receive opinions from some PS's. Are these results botched?

Alan Gonzalez, MD, FACS · Answer

Hello @Michelleybelle, thank you for your question. A consultation is essential to develop a surgical plan that meets your needs, fulfills your expectations, and takes into account what can actually be achieved. During your consultation, your surgeon will be able to assess your unique needs and develop a treatment plan that is tailored to your needs. Best wishes! Alan Gonzalez MD, FACS. International Federation for Adipose Therapeutics and Science” Member (IFATS), American Society of Plastic Surgery Member (ASPS), Colombian Society of Plastic Surgery member (SCCP)

Ryan A. Stanton, MD · Answer

You are in good company with many others who had high hopes for BBL but instead received disappointing results (lumpiness, unevenness, lack of projection in the central and/or lower buttock, post-deflation sagging, etc.) as most of the fat melts away. It is not quite as much the quality of the doctor nor liposuction technique but rather the quality of the procedure that is a large part of the problem.  Thus, going back for additional rounds of BBL most often produces the same disappointing results but at another financial loss.

Buttock implants, however, provide a more reliable, predictable, relatively safe, and permanent result, especially for adding projection to the buttock and often smoothing out lumpiness. Occasionally a lower buttock tuck may be advantageous for lower buttock fold asymmetries and/or sagging.  When considering buttock implants make sure that the surgeon is going to be placing the implants within gluteus muscles , (a.k.a. “intramuscular pocket”), and that they are using anatomically correct, oval-shaped implants, such as Stanton Anatomic ®️ implants. 
Please keep in mind that an extremely few number of board-certified plastic surgeons specialize in these buttock implants so be sure to consult with one that is reputable and experienced. Unfortunately you may have to travel long and far away from home to find this particular surgeon. Glad to help.

Daniel Barrett, MD · Answer

Dear Michelleybelle,I understand your concern. However, without a proper assessment, it would be difficult to determine what went wrong. It is best that you visit your plastic surgeon for further assessment or ask for a second opinion. Only after a thorough examination, you can get proper recommendations and advice.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

George Marosan, MD · Answer

Thank you for your question and photos. Based on these photos, you started out with a "square" buttock shape and ended up with a "V" shaped buttock shape. This shape is the hardest to correct. Unfortunately, it seems that you went to a surgeon who had no idea of muscle and/or bony anatomy, did not understand the "beautiful normal female shape" and does not understand body proportions. To have a lump of fat placed into the wrong areas of the buttock and not sculpt the torso leads to poor results. This is analogous to breast reconstruction using a flap. It is not enough to place a large lump of tissue on the chest and call it a breast. A breast, just like a buttock has three dimensionality and shape to be considered beautiful. BTW, to reshape your buttocks, it is not a revision or correction. You need a whole new operation by a surgeon experienced in body sculpting techniques. Save up for the surgery, do not go into this "half assed", no pun indented, because the third surgery will be more expensive and less positive return.
See a board certified plastic surgeon experienced in advanced body sculpting techniques for an in person consultation/evaluation. Good luck.

Cengizhan Ekizceli, MD · Answer

Thank you so much for your question! Based on your pictures you are suitable for the BBL revision surgery. Hope it helps!

Camille Cash, MD · Answer

There are some contour irregularities that are present, which is a risk of this procedure.  It does appear that you would benefit from some revision to help smooth out your results.  You can consider Aveli treatments to address the cellulite.  See a board certified plastic surgeon near you to learn more.

Darryl J. Blinski, MD · Answer

Thanks for the question and posting your photos. I would not classify you as a "botched" case! Your result demonstrates if using a clinic setting the artistic ability on the surgeon was poor. Now you need a round 2 redo BBL to correct the shaping of the buttock to coccyx/flanks ratios. Best to virtual consult with.....

Douglas Taranow, DO, FACOS · Answer

Michelle,
I agree that your BBL did not come out the way you expected.  There are several areas that the fat was placed very superficially causing an 'outpouching' of fat or they released bands to the skin and the fat migrates to the looser areas of skin.   While it is very difficult to fix, it is definitely "improvable".  
I feel further liposuction to fix the upper buttocks/hips with some more fat place to the hip dips and around the high areas of the buttocks to better camouflage them.
Best wishes,
Dr. Taranow

Mats Hagstrom, MD (license on probation) · Answer

Delivering consistent quality in Liposuction, and fat transfer results is more difficult than most people believe.
In the end, there are generally only two variables determine someone’s cosmetic surgery results. The first is the patient’s candidacy for the procedure itself, and the second is the skill of the surgeon.
Patients should get a clear assessment of their own candidacy for any procedure they may be interested in. I recommend patients do this the same way they go about finding the best provider. Do this by having multiple in person consultations. Let each plastic surgeon examine you and explain to you in their own words why, or why not you are a candidate are not a candidate for a certain procedure. The great majority of patients seeking a BBL are average candidates. This means that the best they can hope for our average results. Out of every 10 people seeking consultation, two or three will be excellent candidates two or three will be poor candidates, or non-candidates, and the rest will be average candidates. Candidacy, for Liposuction and or fat transfer generally means that the single only variable keeping someone from looking their best is a less than ideal distribution of subcutaneous fat. If other variables are contributing with the problem is not directly related to subcutaneous fat only then candidacy usually is less.
In your case, you appear to have modest skin, laxity and cellulite, both which diminish your candidacy for the procedure. To make a more accurate assessment, we need a complete set of pictures, but you were not an ideal candidate to start with. Cellulite is not treated by fat transfer and fat transfer can make cellulite worse. Patients who have cellulite should therefore realize that a BBL may not be in their favor, or should consider having a successful cellulite treatment, either in conjunction or prior to the procedure. Individuals with severe cellulite should probably consider not having fat transfer to those areas.Your procedure could’ve been done better. There’s no question that your provider was not one of the few plastic surgeons who mastered this procedure. Delivering consistent quality liposuction and fat transfer results requires mastering the procedure.
Doing this procedure well requires years of experience with a total commitment to mastering the procedure. Unfortunately all too often Liposuction is viewed as a simplistic procedure both my patients and providers.
Liposuction results has the greatest variability and outcome based on who does the procedure of any plastic surgery operation I’ve ever seen. It is astonishing how different the results can be among board-certified plastic surgeons whom patients assume know how to do the procedure.
Being board-certified in plastic surgery, with years of experience, and an overall good reputation, does not mean somebody has mastered. Liposuction, is even good at Liposuction or enjoys doing it. I’ve met a substantial number of plastic surgeons who really don’t like doing the procedure. When that’s the case, it is unlikely they will ever get to the point of delivering consistent quality results. To become one of the few plastic surgeons actually mastered this procedure requires a total dedication to excellence, being critical of urine results, and performing thousands of cases. 
The learning curve for both Liposuction and fat transfer are long and steep.
Technically, the procedures are simple enough, but getting quality results is a whole other story.
Revision procedures, especially for Liposuction and fat transfer, generally limit what can be done in comparison to primary procedures. It is much more difficult to improve on a poor outcome than it is to create great results never had surgery before.
Revision surgery has its own set of candidacies. The patient will have the best potential for improvement from a revision procedure are the ones who were under treated during the first procedure. Patient who had aggressive and uneven treatments during the first procedure have a little left to work with in these cases are almost impossible to give great improvements to.
I understand that revision work may not be appropriate for you at the moment. When the time comes, I recommend following the same basic principles that I recommend for patients seeking primary procedures. Defined the best provider and get an accurate assessment. I recommend patient start by having at least five in person consultations. Whenever possible I encourage people to avoid virtual consultations, and I also generally recommend avoiding traveling long distances for elective surgical procedures. Patients should take an active approach during consultations. It is your job and your responsibility to get the information you need to make an informed decision. You are after all hiring somebody to do a service for you. As an employer consultation, you need to get confirmation of the competence of the person that you are about to hire. 
I recommend patients do this by asking each provider to open up their portfolio and show you their entire collection on before, and after pictures of the previous patients who had similar body characteristics to your own. Providers may be reluctant to do this and will prefer to show you pre-selected images, representing the best results of their career. This is, however, insufficient to get a clear understanding of what average results look like in the hands of each provider or how much experience they actually have they had the ball should always be to get a clear understanding of what average results look like on patients who had your candidacy for the procedure. it is also very important to get a clear understanding of your candidacy. The choice of providers should be based on having a clear understanding of what the underlying problem is. The abdomen for example has for valuables to determine what it looks like. Somebody may want to have Liposuction and Liposuction may not be the correct procedure. The four variables to determine what someone’s abdomen looks like are abdominal skin Laxity, excess subcutaneous fat, muscle separation from previous pregnancies and excess of visceral for intra-abdominal fat. Each of these variables has a different way of being treated and understanding which variables are contributing, should help direct what procedure someone chooses. Plastic surgeons should be able to differentiate different tissue variables, and thereby understand and explain why certain procedures are more likely to work than others, as well as what inherent advantages and limitations of each procedure are going to be. Skin Laxcity is probably the number one reason the patient’s failed to be excellent candidates for Liposuction. Skin laxity contributed significantly to body, contour, and people often confuse skin laxity for being fat distribution related issues.
An experienced plastic surgeon should have hundreds or even thousands of sets of before and after pictures to choose from. It is reasonable to expect an experienced plastic surgeon to be able to show you at least 50 sets before and after pictures of commonly performed procedures like the BBL.
Make careful notes during each consultation, especially regarding the quantity and quality of before and after pictures. Get a clear understanding of what quality results should look like. They are reviewing lots of before and after pictures before having consultations. When doing that, look very carefully to make sure you are selecting images of patients who have similar body characteristics to around in the before pictures.
Your long-term result images show there is clear room for improvement, especially reducing your love, handles, waste and back. You will still have skin Laxity but an improved fat distribution could make a substantial improvement. when making an assessment, we need to see your whole body. Looking at body parts without having a reference to the rest of the body is insufficient. Crop pictures so they show your body from your neck to just below your knees. Take accurate pictures, showing your backside, side and front, standing in a neutral position with your arms down.
In your case, there is room for optimism because your results have the potential to be greatly improved. Your surgeon lacked sufficient scale to deliver quality results. At the same time your candidacy for the procedure was at least in part limited.
Best,
Mats Hagstrom, MD

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