My girlfriend had implants removed to have BBL, but PS says she must have implants to fill the pocket. Is this right?

Although i am generally a staunch advocate of buttock implants (only if placed under the muscle however), there is no need in your case to have them replaced if you are sure all you want this time is BBL. Please read on for more general details on buttock augmentation:I perform about 5 - 6 buttock implant surgeries per week and this is what I have learned. Regarding buttock augmentation, let me start off by saying that I currently see at least 2 - 3 patients per week that failed "brazilian buttock lift" (i.e. the fat melted away after 10 - 12 months) and are now seeking a more reliable and permanent option (i.e. buttock implants). Allow me to share with you some information that you may not hear elsewhere. There are only two proven safe and relatively effective methods for Buttock Augmentation and Hip Augmentation: 1) Autologous Fat Transfer (using your own fat, transferring from one area of the body to the other) and 2) Buttock/Hip Implants (semi-solid silicone rubber implants that cannot rupture &/or leak). Both are options but what it comes down to, like any surgery, is proper patient selection.Indeed because at least 50+ % of the fat transferred will melt away within a year, most patients are not good candidates because they lack an adequate amount of fat to harvest. Another tip is that if you purposely gain weight (i.e. fat) for the procedure, the fat you lose first as you get back to your baseline weight is that very same fat that was transferred into your buttock...so don't fall victim to this recommendation. Although using your own fat is relatively safe, the one serious complication that can rarely (< 1%) happen is "fat embolism" in which some of the fat gets into the blood stream and travels up into the lungs, heart, and/or brain causing serious problems. This complication is more likely to happen with the larger amount of fat being transferred. This is even more likely to happen when using fillers like PMMA and hyaluronic acids. Also fillers, when injected in large quantities, have a relatively high tendency to migrate away from the original area they were placed and tend to stimulate a lot of inflammation and a subsequent disastrous amount of scar tissue/hardening.Thus buttock/hip implants become a very good, safe, and long term reliable option for most patients seeking buttock augmentation (at least in my practice). I prefer to insert the buttock implants through a 1 1/2 inch long incision along the inner curve of each upper buttock cheek at the level of the tailbone, similar to two opposing parentheses ")(" (concealed within the crevice between the buttock cheeks) and the hip implants through a ~ 1 inch incision just below the beltline above the hip region. The buttock implant should always be placed under or within the gluteus maximus muscle. In this position, the implant is less palpable, less visible, and does not sag or shift/migrate over time unlike implants placed on top of the muscle. Therefore it is extremely important to seek consultation with a board certified plastic surgeon who specializes in this procedure (in fact both implants and fat transfer so that s/he is not bias). And in this case too, at least in my surgical practice, the infection rate is minimized to <2% (much lower than and contrary to popular belief by many other surgeons not experienced in buttock implants).Depending upon the amount of your current fat reserves and their distribution, you may or may not be a reasonable candidate for fat transfer. If you are wanting to utilize the fat to further augment your buttock in addition to implants, then I caution you against this. The reason being that the fat needs to be placed into the buttock muscles for optimal survival, however, this is exactly where the implant needs to reside and thus risks infection and/or death of the fat. Because of this risk, I frequently avoid fat grafting into a buttock that has an implant. Bottom line, I recommend consulting with a board certified plastic surgeon specialist in buttock augmentation (BOTH implants and fat transfer) to determine what option is best for you. Glad to help.

Hi… by don't really see a reason why she needs to have BBL. The only the reason I could see the need for implants is if she does not have enough fat or a successful BBL. It is critically important that you find and follow the advice of a board-certified plastic surgeon who has extensive experience in BBL, buttock implants and their revision. I wish you best! Dr. Gabbay.

Hello, Thanks for your question. This question is pretty hard to answer without a proper personal consultation or at least photographic documentation. I do understand your concern, because dealing with the trauma of another surgery is not an easy scenario. I would agree that if she's aiming for a similar volume, butt implants should be placed again, unless she has enough fat to achieve such fullness. I am personally against the placement of butt implants subfacially. The facia is a very thin structure and we're talking about an area that receives constant pressure (when sleeping and sitting). I would advice to use an intramuscular plane to achieve a much better implant coverage and to ensure its placement (meaning, not having the possibility of coming out). Again, there is not much a surgeon can tell you without a proper physical evaluation. Hope this resolves well for your girlfriend, Dr. Fernandez Goico

If after the removal of the buttock implants, all wounds are healed and the capsule has adhered and no space is left. Then fat transfer can be performed