What procedure would be best for me for unevenness after bbl? Cellulite or fat? (Photos)

Question

I had a bbl two years ago and most of my fat didn't make it. I can't tell if the uneven area on one cheek is cellulite or fat transfer. I do not want to go back to my doctor as I didn't have a good experience/ aftercare. Is this fat or cellulite? What procedure could help smooth the area? I have very little fat left and am hoping to find the least invasive option if possible. Thank you very much!

Robert M. Lowen, MD · Answer

This is just ordinary cellulite. Some fat resorption can make it look worse, but the overall shape of the buttocks is good regardless of whether you feel the volume is as much as you would have liked.
I use Cellulaze for cellulite and am happy with the results, but not many doctors seem to have this technology and there are others that are less effective that are used.  You might find some plastic surgeons with good before and after pictures for cellulite and get an opinion in person.  Evaluating skin surfaces and texture is really hard in pictures and is best done in person.

Ryan A. Stanton, MD · Answer

Allow me to answer your question as best i can based upon your photos. However, please keep in mind that an in-person, or at least a virtual, consultation with physical exam is first necessary before any legitimate evaluation or final surgical recommendations can be made.

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, fatty necrotic cyst or scar tissue, 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 additional rounds of BBL most often produces the same disappointing results but at another financial loss.   Beware, if a surgeon asks you to purposely gain weight (i.e. fat) before BBL, know that the fat you lose first as you get back to your baseline weight after surgery is that very same fat that was transferred into your buttock, hence your new buttock shrinks first, the fastest, and the most...so please do not fall victim to this recommendation.

Fillers, such as Sculptra and hyaluronic acids,  for augmentation of the buttock/hips are a rip-off, period! Also, minimally/non-invasive skin tightening treatments are not likely to help much in your case.

Buttock implants, however, 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.  When considering buttock implants make sure that the surgeon is going to be placing the implants within gluteus muscles , (a.k.a. “intramuscular pocket”), and that they are using anatomically correct, oval-shaped implants, such as Stanton Anatomic ®️ implants. 
Please keep in mind that an extremely few number of board-certified plastic surgeons specialize in these 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.

Daniel Barrett, MD · Answer

Dear Beautyresearch,
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, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Zoran Potparic, MD · Answer

It is sometimes very difficult to find out what is a real cause of dimples after fat transfer. Unpredictability of fat graft take, resorption, deep scars, areas of fat necrosis may all be involved in final outcome. It may be difficult to completely correct this but it is possible that selective fat grafting may improve current situation. Hope this helps.

Mats Hagstrom, MD (license on probation) · Answer

To make an assessment on the outcome of a plastic surgery procedure we generally need to see proper before and after pictures. If you don’t have before, and after pictures and contact your previous provider and ask them to forward the entire set of before and after pictures. You should probably get a copy of your entire medical record, especially the operative report as well. From your posting, it’s not clear exactly what your concern is. Try taking some close-up pictures or point out exactly where the area of concern is and try to describe the problem a little better. Without before and after pictures we can’t really see what the impact of the procedure was.
Best,
Mats Hagstrom, MD

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