Can my Brazilian Butt Lift be fixed? 6 months post op, concerned about indentions. (photos)

Question

I had a BBL/inner thigh lipo on April 28th, 22. I told my surgeon that my #1 priority was to fill my hip dips. I wanted an hourglass shape but ended up with a pear shape. I also feel like it looks like 2 balls versus having a smooth transition. My concern is the indented areas on the upper sides that look like they are over-lipo’d. My surgeon said it was from my garment which is impossible as it wasn’t tight there. It matches his felt marks from the video I took one day after my surgery.

Stan M. Valnicek, MD · Answer

Irregularity after Lipo can be due to over or under-resection of zones as well as uneven pressure from garments and foam inserts. The garments are designed to smoothly apply pressure over the suctioned areas but this assumes a perfect fit between the patient and the garment. If you get folds in the garment (especially in the first few weeks), the increased pressure from the overlap can create an indentation. Diligence in smoothing out any folds in the garment regularly as well as use of foam under the garment can help avoid this. Patients also have natural variation in the shape of their musculoskeletal structure which can cause pressure issues since garments are build for a specific idealized shape and proportions. In some cases significant weight gain or loss can lead to some distortion of the intended results - generally speaking. There are also variations in garment type with some leaving the buttock open, some applying partial compression and some full compression. The open buttock garments could possibly create more demarcation at the transition between compression zones (not my experience to date and just speculating here).
At 6 months in your case, the shape you see is likely not going to change too much. Scar tissue in the treated areas will soften for up to 2 years. I would return to your surgeon and discuss your concerns regarding the transition from the buttock to the hips. In a general sense these type of contour issues can often be improved with some liposuction and/or fat grafting. You can see the sharp transition and indentation in the earliest post op photos at the boundary between the bruised areas (less compression) and the unbruised hip (more compression).

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, persistent hip dips, 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 round 2 BBL most often produces the same disappointing results but at another financial loss.   Buttock implants and/or cosmetic hip implants indeed provide a more reliable, predictable, relatively safe, and permanent result, especially for adding projection to the buttock/hips and often smoothing out lumpiness.  Also in your case, some revision liposuction of the waistline may also be in order. Please keep in mind that an extremely few number of board-certified plastic surgeons specialize in buttock/hips 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.

Ajaya Kashyap, MD · Answer

Thankyou for your query! Based on your photographs you  have a good result from your procedure. While further improvement of contours can be  achieved by gentle mobilisation and grafting  of fat, I would recommend that  you wait for a full year before seeking any further improvement. Meanwhile follow all your surgeon’s directions including massage etc. all the best!

Zoran Potparic, MD · Answer

It takes good 8-12 months for result of fat grafting and liposuction to set and mature. Making any conslusions about your result before that time (12 m.) may not be real. Once result is stable, it should be evaluated with your plastic surgeon and, if needed, small corrections may be done by means of additional liposuction and fat grafting. Unfortunately, nobody can predict how much of fat grafts will take in certain area(s), considering that only around 50-60% of the fat injected in the time of surgery, will survive. Patience. Hope this helps.

Daniel Barrett, MD · Answer

Dear Imaginative946934,
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, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Adolfo Sesto, MD · Answer

Hello. I can see what you mean. Unfortunately you must wait for a year for any revision, since you are still with edema. It was not the compression garment but the places fat was transfered and the donor areas used for lipo. Those indenttions can be filled if we can find fat to harvest and trasnfer to those areas.

Darryl J. Blinski, MD · Answer

Great posted series photos. YES! I can revise your poorly done BBL, with a "COMPOSITE BBL". Doing more lipo in area you showed and any other areas for fat to use, redo hip dip BBL, add Radiesse injections (10 vials @$4,000), specialized taping. Fee $10,000. Best to virtual consult with....

Douglas Taranow, DO, FACOS · Answer

It appears that your surgeon sculpted out a sharp demarcation between the upper buttock and your hip/back.  The only cure for this is to place some fat in the depression and even possibly taking a little away from the upper border of the buttocks.
Best wishes.
Dr. Taranow

Mats Hagstrom, MD (license on probation) · Answer

You’ve included a substantial number of pictures to show your concerns. What we really need is formal standard before and after pictures.
If you followed up with your provider then your provider should have standardized before and after pictures. If you don’t have copies of those then ask your provider to forward the pictures they took. use those pictures.
Delivering consistent quality liposuction and fat transfer results is not as easy as people believe it. Plastic surgeons also have different views on what looks good and how to create an ideal feminine figure.
Compression garments do not change liposuction or fat transfer results.
Plastic surgeons are a notorious bunch for coming up with vividly creative reasons other than taking ownership of their own work.
The most common excuse is that patients are still swollen and it takes a year before results are final just kicking the can down the road telling people that it’ll get better with time.
The proper vetting of plastic surgeons is best done before you have surgery.
I recommend patients do that by having multiple in person consultations exclusively.
During each consultation while meeting in person asked each provider to open up their portfolio and show you their entire collection of before and after pictures.
Bring pictures of your old torso with you for comparison.
Ask the provider to find as many pictures as possible of patients who have similar body characteristics to your own and compare. Patients should be familiar with quality work and have a grading system in place while vetting plastic surgeons in regards to skill, experience and overall competency for delivering quality results.
Ask the surgeons to show you examples of excellent outcomes, average outcomes and less than outcomes. We all have them and it’s fair game for patients to ask to see if a different variety of outcomes.
By reviewing lots of before and after pictures you’ll get an idea of what surgeons consistency is as well as their overall style and what you should expect.
An experienced surgeon should have no difficulty showing you at least 50 sets of before and after pictures. Highly experienced I just wanna have 100 or even thousands of before and after pictures for commonly performed procedures like the BBL.
This is also a good time to talk to each surgeon about the revision rates and what the revision policy is. you may want to ask to see examples of patients who had revisions previously.
All this work should be done well in advance of having surgery.
There are many variables and characteristics that differentiate quality work when it comes to this procedure.
One of them is the transition zone that differentiates the line at which above the line the body is being reduced with Liposuction and below is being augmented with grafting fat.
Ultimately your surgeon is responsible for the outcome of your procedure and you are responsible for choosing that surgeon.
Revision may be indicated but considering that revision work is many times more difficult than primary body contouring you should ask yourself if your surgeon is the right person to do your revision.
I’ve seen better and I’ve seen worse.
In the end you’ll have to decide if your current provider is the one to work with and convince him to offer you a revision.
If not you’ll need to have a proper second opinion consultations which should all be scheduled as in person consultations.
For a proper second opinion consultation patient should come prepared to bringing with them all before and after pictures and a copy of your operative report.
These are all available from your surgeons office if you request them. They are part of your medical records
Best,
Mats Hagstrom MD

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