Can you prevent uneven fat necrosis in a bbl?

Fat necrosis is dead fat that occurs usually secondary to the lack of blood supply. Without the blood supply, the fat dies and becomes calcified and hard. This necrotic fat then may be painful or create an unpleasing appearance. Fat necrosis typically occurs as a result of trauma or secondary to transfer of fat during a surgical procedure. The most serious complication of cigarette smoke to the plastic surgery itself is the death of tissues, known as tissue necrosis or flap necrosis.

Dear Nice4671,
I instruct my patients not to sit for 2 solid weeks. We provide them a specialized pillow that our patients can sit on during that time. They can sleep on their stomachs or sides. Fat viability depends a lot of surgeon technique. The fat has to be placed back into the buttocks as soon as possible so that it has a greater chance of survival. It has to be placed carefully so that not too much fat is placed in only one area.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

It is impossible to perform surgery without ever having complications. Good surgical technique and even distribution of the fat is imperative in having the least amount of post op asymmetry or lumpiness.

Uneven results or problems with healing are almost entirely related to technical skill or the lack there of.
There are in the end only two variables that matter for the outcome of this procedure.
The first is the individual patient’s candidate sea for the BBL in the first place in the second is choosing the most talented and experienced provider.
Not everyone is a good candidate for the BBL and candidacy needs to be explored during in person consultations and will vary to some degree based on what each surgeon believes. For example, having a lot of cellulite make somebody a lesser candidate because cellulite is often made worse from fat grafting.
For example, having a lot of cellulite make somebody a lesser candidate because cellulite is often made worse from fat grafting. Typically there’s not a lot patients can do to change their candidacy for the procedure so focus on what you do have control over. There is a dramatic difference in outcome depending on who does this operation.
The Aesthetic approach is drastically different among providers and delivering consistent quality results is more difficult than most people believe. This includes patients and plastic surgeons.
There is a trend of distorting the natural desirable S-curve for the sake of having a large bottom with plastic surgeons purposely doing liposuction on the outer thigh to make the bottom look larger. I called this the lollipop look and it is a gross distortion and deviation from natural feminine human attractiveness and should be avoided at all cost.
Defined the best provider requires a substantial amount of effort.
I suggest patients have multiple in person consultations and continue doing that until they feel quite certain they found the most experienced and talented provider in their community.
During in person consultations ask each provider to show their entire collection of before and after pictures for the procedure you’re interested in.
When it comes to fat grafting a.k.a. fat transfer it is imperative that patient confirm that after pictures are always taken at least three months from the date of surgery.
Early postoperative results can look very impressive but do not in anyway represent final results for this procedure. Any provider showing after pictures taken in the operating room or with patients who still have surgical markings on them should be dismissed entirely and crossed off the list of potential providers.
Simply being shown a selection of sample results which most likely represent the best results of the providers career is insufficient to get a clear understanding of what average results look like in the hands of each provider.
This is why patients need to ask providers to open up their portfolio and show their entire collection of before and after pictures or at least as many as they’re willing to.
Specifically ask the provider to show as many pictures as possible of patients who have similar body characteristics to your own. this should not be difficult to do for anyone who has enough experience.
Highly experienced surgeons will have hundreds or even thousands of before and after pictures to choose from. I would say anyone who cannot present you with a minimum of 50 sets of before and after pictures is either not demonstrating sufficient experience or doesn’t have the results to be a worthy contender.
Since the BBL is two procedures done at the same time patients need to be assessed both in regards to Liposuction and the fat transfer procedure. Likewise when reviewing before and after pictures patients need to look carefully at the Liposuction aspect and the fat transfer part of the procedure since both of them have major implications, are permanent and in many ways irreversible.
When reviewing liposuction results ask the provider to share with you exactly what areas were included and what areas were not treated so you can see where the transition zones are between treated and on treated areas. you should look carefully for any evidence of contour irregularities such as devots, streaks lumps and bumps or any other evidence of poor technique when it comes to Liposuction. The transition from treated to untreated should be smooth and natural. The majority of patients will have Liposuction of their torso which for most providers means the abdomen waist and love handles. Personally I view the torso as a single anatomic unit and typically recommend patient Street the entire tour so if they’re going to have Liposuction. This means including the full back and under arm areas in addition to upper abdomen, lower abdomen, love handles and waist. Send individuals may need to have the pubic area and lower back treated as well. The key is to leave patients with a natural thin fat distribution that’s consistent throughout the entire torso to not have unnatural transition zones of treated to untreated areas which are a dead giveaway of having had poor quality Liposuction.
The fat transfer should create smooth harmonious curves and should be viewed from the knees to the armpits and should create smooth ass curbs along the back and side.
Finally I recommend patients read all reviews and various physician review websites avoiding providers for any significant number of justified negative reviews.
The absence of justified negative reviews is more important and more telling than having an abundance of positive reviews.
Continue having consultations until you feel you found the most experienced and talented provider. simply being board-certified in plastic surgery with a good reputation is insufficient to ensure that a provider is talented and has sufficient experience with this difficult procedure.
When done correctly in BBL can leave stunning results but unfortunately all too often patience do not make sufficient effort to properly vet their providers and end up with the results quite different than what they had anticipated.
Best,
Mats Hagstrom MD