My doctor says no garment is needed for BBL, and sitting and laying on back is ok. Should I worry?

Question

I am getting a extended tummy tuck and bbl. My doctor told me no garment is needed after surgery other than the binder. He also told me i can sit and lay down on my back and that it does not affect the bbl. Should i worry?

Steven H. Williams, MD · Answer

Thanks for your question -We perform this procedure about twice a week.  It is a procedure that requires experience and technique to get good results.Our post-op protocol includes a compression garment.  Compression garments have very clearly been shown to improve liposuction results over a certain volume.  They help minimize swelling and may play a role in aiding in some skin tightening.Regarding pressure (sitting or lying) the concept of avoiding pressure makes sense.  Fat transfer is essentially a tissue transfer.  Until the fat transfer establishes a new blood supply the fat is vulnerable to stresses including pressure.We advise our patients to avoid sitting for more than 15 minutes at a time.Laying down actually is less harmful as your body weight is spread over a larger area minimizing direct pressure on your buttocks.I hope this helps.  Make sure you evaluate long term results of your plastic surgeon (over one year post-op) to really see what your doctor should be able to achieve.

Jeffrey LaGrasso, MD · Answer

Research is  everything before surgery, I'm  glad you asked this question its best to get multiple medical opinions •When performing a BBL procedure, I recommend to my patients to lay on their stomach for the first month while sleeping to keep pressure off of the gluteal area.  You cannot sit for the first 10 days post operatively for the same reason.  When you transfer fat from one area of the body to another, the fat needs the blood supply from the surrounding area to grow into it for it to survive.  Typically, you will keep 70-80% of the fat which is placed into the gluteal area.  If you sit or lay on your buttocks you will be compressing the area and in addition to all the swelling which is there post-operatively, there will be a decreased amount of fat which will survive.  This is also the reason why I do not combine tummy tucks and breast procedures with BBL's as you need to lay on your back post-op for these.  To get the best result you need to follow a specific post-op instruction to allow the fat to survive.

Jose M. Soler-Baillo, MD, MS · Answer

Thank you for your question.  Each surgeon will offer his or her own opinion regarding post-op care.  It is best that you follow the instruction given to you.  If it is negatively affecting your recovery, please voice your concern with the surgeon.All the best,Dr. ResultsMiami, FL

Kenneth Hughes, MD · Answer

I recommend avoiding sitting or placing pressure on the buttocks for 6 
weeks after the Brazilian buttlift.  Most patients get an immense 
benefit with maximal 
liposuction of the 
abdomen, sides, and back to obtain the smallest waist possible and then 
maximal fat transfer to the buttocks and hips.  Kenneth Hughes, MDLos Angeles, CA

Kyle Song, MD · Answer

Getting a nice result with a BBL means that a good majority of the fat transferred to your buttocks has survived.  Fat can only survive if it finds a permanent blood supply in the grafted area, and is not injured during the first 6-8 weeks.  This is the critical period where the fat is susceptible to damage, injury and fat cell death.  The single most preventable thing you can do to protect the fat is to keep pressure off your buttock for minimum 6 weeks.  This means sitting on a pillow balanced under your thighs so your buttocks are "floating".  Also, you should sleep on your stomach.  Hope this helps.

Tania Medina de Garcia, MD · Answer

Hello dear!!
Thanks for the question and provided information as well.
Every doctor has their preferences in regards to compression garments. I suggest my patients use a full body compression garment (that closes with clips), 24/7 for the first 3 months, and after that, for 12 hours a day for 3 more months, to get the best results.
It is important for the compression garment to be very tight, for it to help with the swelling, after surgery, and to use it with a cotton t-shirt underneath to avoid garment burns. 
Please, follow up close with your plastic surgeon.
Good luck :)

Ron Hazani, MD, FACS · Answer

I recommend a compression garment for the liposuctioned areas. The transferred fat needs to revascularize soon compression is necessary. Please follow up with your doctor as these issues require the attention of a plastic surgeon.

Mark A. Jabor, MD · Answer

This is a good question and one that I get asked frequently by patients. I have performed this procedure for over 13 years now and have acquired substantial experience with this procedure. In theory, it would make sense not to have the patient sit on the buttocks or lie on their back after a BBL for 6 weeks or more. However, in a mobile patient who will go back to work in 1 to 2 weeks after the procedure this is not practical, unrealistic, and virtually impossible. Furthermore, I have never seen a peer reviewed article in any of the major plastic surgery journals comparing patients who did not "sit" on their buttocks after a BBL VS those that did. In short, I do not have any restrictions for my patients sitting on their buttocks after a BBL and to my knowledge it has not adversely effected my results. Keep in mind, that in most patients it is painful for them to sit on their buttocks after a BBL and in a way this will restrict sitting.

James S. McAdoo, DO, FACOS (account suspended) · Answer

I am so proud of you for looking ahead and considering your post op care and optimizing your outcome to best possible result. Many patients do not realize their result could be far better if they stay off the fat grafts after surgery for up to 2 months or more. This is one of the most common questions in the office. PREVENT DVT:Tummy tuck with muscle tightening is one of the most cosmetic procedures associated with increased risk of DVT formation and PE. Abdominoplasty with muscle repair will raise the pressure inside your abdomen and reduce the rate of blood flow from your thighs. Adding a garment can increase the effect and for that reason some surgeons do not use it. Also, if the garment is too tight it can limit the oxygen to the incision and cause openings in the incision with infection and drainage. But if the garment is fitted properly, it can limit the amount of inflammation and swelling after surgery and allow the drain to come out earlier. So with the increased intra-abdominal pressure form the tummy tuck muscle tightening, some surgeons try to match the pressure in the thighs with waist high compression stocking (10-20 lb.). This allows the pressure to be constant form toes to rib cage and keep blood moving uniformly. Use for approximately 2 months.  Some surgeons consider using daily Lovenox 40mg subcutaneous injections after surgery for the first 3 days at minimum to reduce blood ability to form clots.Always remember to be mobile in walking or do calf raises will standing still to reduce the risk for DVT as much as possible. Remember the suggestions below may increase your risk of DVT due to compression the posterior thighs, so stand up and lay on your abdomen as much as possible.FAT GRAFT SURVIVAL:Experience with facial fat grafts and BBL fat grafts in practice and current literature supports the thought that the low oxygen state of the fat grafts send signals to stem cells for new cell growth and new blood vessel growth into the low oxygen area. Anything that would decrease oxygen supply to the area would delay growth and cause more reabsorption on the fat grafts. A few of the research supported factors that would delay oxygen supply to the grafts include:Decrease blood circulation due to blood pressure changes: body weight compression ( Sitting and lying) greater than systolic blood pressure (main cause of nursing home bed soars)decreased blood supply form generalized hypotension

Vasoconstrictive agents which decrease the rate of oxygen flowing to the fat grafts:nicotine ( one inhalation of puff of a cigarette will constrict vessels for 16 hours) caffeine (watch your tea, 5 hour energy, decaf, chocolate)

Reduced angiogenesis:A diet rich in green vegetables has been proven to reduce the ability for new blood vessel branches to grow into the low oxygen area

SITTING:Many patients have given me feedback over the years with tips and tricks to stay off their buttocks and have a normal life style during recovery. The most recent and economical way I have seen to stay off the buttocks in the sitting position would be to use of two bath towels rolled up like a cinnamon roll and wraped with a little tape to hold their shape.  Before sitting, place the towel bolster you just madeunder thighs just below your buttocks. The towel rolled bolster will touch the front edge of the seat and cause your buttocks to hover off the seat. Adjust the thickness of the towel roll mat as necessary so there is no contact of your buttocks with the seat. An additional rolled mat can be used behind the lower back just above your buttocks. The position of the back towel roll mat can be maintained with the carrying strap over the back or head rest of the seat.Full support of the thigh from back of knee to lower buttock crease with the foam mat will be the most comfortable position per patient feedback. LYING IN BED:Many patients have given me feedback over the years with tips and tricks to stay off their buttocks and have a normal life style during recovery. Past patients have had success in sleeping on their sides and back without their buttocks touching the mattress. They describe the easiest way is to elevate your back and legs on coach cushions placed over your original mattress.  There should be no pressure on the buttocks when lying on back or sides. If there is still contact with buttocks, consider adding more thickness to coach cushions for more lift.Great question! Wish you well on your journey toward your tight abdomen and full buttocks.James McAdoo DO FACOSAOA dual board certified general and plastic reconstructive surgeon Microsurgery fellowship trained 20 years experience 33,000 operative cases10,000 BBL

My doctor says no garment is needed for BBL, and sitting and laying on back is ok. Should I worry?

Answers (9)

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