Did my surgeon place the fat incorrectly/lack skill (tombstone BBL result)? (Photos)

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.). It is not quite as much the quality of the doctor 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 indeed 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. Please keep in mind that an extremely few number of board-certified plastic surgeons specialize in 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.

There is no doubt that your result is less than optimal and expected. Part of that is in underlying anatomy (squareness of your buttock/hips to start with), tight skin envelope which can change only to a certain degree with injection of fat grafts (not always in a way patient and surgeon want), unpredictable nature of fat grafts take-survival and, in significant part, suboptimal execution of the procedure. However, this can be corrected with combination of liposuction of upper, square buttocks, and secondary grafting- enlargement of hips and upper lateral thighs. This will give you more acceptable, elongated buttocks/hips. In person consultation and discussion about possible outcome with a true expert in this procedure, is recommended. Good luck.

Dear Fantastic9284,
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

I fix many bad BBLs Yours is easy fix btw. You need redistribution of fat with specialized upper buttock taping. Please connect see messages. Sorry for your poor outcome.

There are several things going on here. First, your buttocks had a natural upper pole fullness. The operative photo shows nice roundness, however I’m sure a good amount of the transplanted fat was absorbed. There’s nothing wrong with the way that the procedure was done, however, your upper outer buttocks/hips are fuller than they should be. If this area bothers you, you may simply liposuction it. Best wishes.
Dr. Taranow

To make it simple, there are 3 things that determine your shape long-term: the natural shape and tissues of your body, the surgical procedure, and the recovery/fat take. Some patients with very narrow hips/prominent hip dips just may not be able to get their desired result in 1 session - this is something we usually talk about during the initial consult, depending on how much of a change the patient would like. The fat take has some variability to it as well - and the areas you want to expand the most are usually the ones that are able to accept the least fat graft (ie there’s not a lot of room there for the graft). However, you can see some upper buttock fullness in the on-table photo, and that’s unfortunately a very common issue in patients that have come to see me for revisions. We have moved to drawing on the preop photos or doing photo manipulation to simulate the result to make sure the patient and I are on the same page to avoid this issue. Fortunately, this is usually correctable and you can still get a good result - doing some lipo on the overly full upper portion and transferring that to the hip dips can be usually be done awake as an in office procedure to help save costs and can make a significant difference in the appearance.