High volume HA for butt enhancement or has everyone gone strictly to biostimulators?

Question

I asked whether there was anyone in NC or even in the tri-state area that is utilizing PRP for butt enhancement but only received one reply and wasn't in the area I was inquiring about. Given that, I'm reaching out again with another question--are any providers in this area administering high volume HA fillers for gluteal enhancement or has it everyone gone strictly to biostimulators? There has to be a more cost effective method of gluteal enhancement than fat transfer and biostimulators.

Anna Chacon, MD, FAAD · Answer

High-volume hyaluronic acid (HA) fillers and biostimulators are both used for gluteal enhancement, but their popularity and usage can vary by region and provider preference.

### Hyaluronic Acid (HA) Fillers for Gluteal Enhancement

HA fillers, such as those specifically designed for body contouring (e.g., Macrolane), can be used for buttock augmentation. They offer the advantage of immediate results and are less invasive than surgical options like fat transfer. However, HA fillers can be quite expensive, especially when large volumes are needed for significant enhancement, and they are temporary, requiring maintenance treatments.

### Biostimulators for Gluteal Enhancement

Biostimulators like Sculptra (poly-L-lactic acid) and Radiesse (calcium hydroxylapatite) have gained popularity for gluteal enhancement. These products work by stimulating the body’s own collagen production, leading to gradual volume increase and longer-lasting results compared to HA fillers. However, they also tend to be costly and require multiple sessions to achieve desired outcomes.

### Regional Practices

In North Carolina and the tri-state area (typically referring to New York, New Jersey, and Connecticut), the availability of specific treatments can vary:

1. **North Carolina**: While there might be fewer providers offering high-volume HA fillers for gluteal enhancement, some practices do exist. It's worth contacting larger aesthetic clinics or plastic surgery centers in major cities like Raleigh, Charlotte, and Durham to inquire about their offerings.

2. **Tri-State Area**: This region generally has a higher concentration of aesthetic practices and plastic surgeons, so you may find more options for both HA fillers and biostimulators. In cities like New York City, advanced aesthetic treatments are more readily available.

### Cost-Effective Alternatives

If cost is a primary concern, consider the following:

- **Combination Treatments**: Some providers may offer combination treatments using both HA fillers and biostimulators to optimize results and manage costs.
- **Payment Plans**: Many aesthetic practices offer financing options or payment plans to make treatments more affordable.
- **Non-Surgical Butt Lifts**: Some clinics offer non-surgical butt lift options using radiofrequency or ultrasound technologies, which can be less expensive than fillers or fat transfer.

### Recommendations

1. **Consult Multiple Providers**: Schedule consultations with several providers in your area to compare options, costs, and outcomes. This will give you a better understanding of what's available and help you find a provider who meets your needs.
   
2. **Research Online**: Use online platforms like RealSelf, Yelp, or Google Reviews to find highly-rated providers and read about patient experiences.

3. **Professional Associations**: Check with professional organizations like the American Society for Aesthetic Plastic Surgery (ASAPS) or the American Board of Cosmetic Surgery (ABCS) for certified providers in your area.

Ultimately, the choice between HA fillers and biostimulators will depend on your specific goals, budget, and the expertise of the providers you consult.

Falguni Patel, MD, FACOG · Answer

The reason most providers prefer biostimulators like Radiesse and Sculptra for non-surgical BBL is that they serve more long-term benefits and are generally safer to inject into the glutes. They provide immediate volume and also help to build collagen and elastin in the tissues. This will give you more long-term results and help maintain shape and projection over time. HA fillers would be just as expensive if not more expensive in most practices and your results won't last as long.

Zoran Potparic, MD · Answer

In order to achieve desired augmentation it would require significant amount of filler in the range of 250-350 ml per buttock. This would be extremely expensive and would last for a limited time. There is no better buttock augmentation than with fat grafts and, in same cases,  buttock implants. Both of these are by far cheaper than fillers. Hope this helps.

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.

There are currently only two FDA approved surgical options for augmenting the buttock/hip area:  1) Buttock and cosmetic Hip Implants (which are soft semi-solid silicone rubber implants that cannot rupture &/or leak) and 2)Brazilian Butt Lift (aka BBL) - which utilizes the patients own fat from liposuction then transfers this fat into the buttock. On the other hand, BBL using Sculptra is a dangerous, guaranteed waste of money, and is NOT FDA approved. So what it comes down to, like any surgery, is proper patient selection and long-term results. Implants provide the only guarantee for a sustained permanent result and tend to be ideal for perking up not only lean or deflated buttocks but also providing substantial projection to any butt, which is what every single patient wants. Typically a combination of sculpting the waistline with liposuction and augmenting the buttock with implants +/- the hips with implants provides the best chance for a long lasting and desirable "hour-glass" figure.  Based upon your photos, a Stanton Anatomic®️ shape buttock implant may serve you best.

Unfortunately, fat typically melts away leaving disappointing results after 12 months, often sooner.  Unless your BBL surgeon is injecting only 200 to 300 ccs of fat into each buttock cheek, a large percentage of that fat is going to die.  Dead fat leads to dents and dimpling like cellulite, unevenness, loss of projection, and fatty necrotic oil cysts which are hard marbles and can be very tender 
Unfortunately, because ~70+ % of the fat transferred will melt away within a year or two, most patients are not good candidates for BBL because they lack an adequate amount of fat to harvest. 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. Even those patients that had adequate amounts of fat pre-operatively, still end up seeking buttock implants after a year or so because most of the fat transferred melted away leaving them with minimal result.  Fillers such as Sculptra are cost prohibitive, provided enough volume is injected (i.e. at least 400 cc of active ingredient costing over $300,000) and last only 12 - 18 months.  Frankly, “biostimulators” for buttock enhancement is just a joke, and any board certified plastic surgeon promoting such should not be trusted. So, if you're looking for a reliable, predictable, and long-term permanent option that also provides projection in the central buttock, buttock and hip implants are your solution. Please note that an extremely few number of board certified plastic surgeons specialize in buttock or hip implants, so you may need to travel far and away from home to find this particular surgeon.  Glad to help.

Mathew A. Plant, MD, FRCSC · Answer

Great question! While I can’t speak for any providers in your specific area we are doing a lot of high-volume HA for buttock enhancement in patients who can’t have or don’t want a BBL. It is not inexpensive but it definitely costs less and gives a lot more volume than biostimulators which do nothing more than irritate and slightly thicken the skin. High volume HA is the only way to actually add volume in a non-surgical buttock augmentation, hopefully you can find someone near you who can do the procedure for you.

High volume HA for butt enhancement or has everyone gone strictly to biostimulators?

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