Would I suit a second BBL or implants? (Photo)

Question

Hi, a year and a half ago I had a bbl with 360 lipo. Within the first 6 months the fat had almost totally been reabsorbed and I went back to looking the same as before surgery. Now I dont know if I have enough fat for a second bbl (i do not want my thighs or arms liposuctioning) and only have some fat remaining on upper back and some round the midsection). I'm worried it will fail again or if I have implants, they will look and feel unnatural. I am 44, weight 63kg and 5ft6 and train regularly.

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, insignificant hip augmentation, 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!

Buttock/hip implants, however, provide a more reliable, predictable, relatively safe, and permanent result, especially for adding projection to the hips and central buttock, and often help 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 Sociable469874,
it is hard to tell for sure without an examination. BBL revision will probably be a better option. If you are considering surgery, I would suggest you consult a board-certified plastic surgeon. Only after a thorough examination, you will get more information and recommendations.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

John L. Burns Jr., MD · Answer

In my opinion, you have a very nice shape, and I think you would be disappointed by a second procedure, I don’t think you have enough fat for another BBL. Butt implants Have a high degree of failure, and honestly the shape is less anatomic than what implant's Have a high degree of failure, and honestly the shape is less anatomic than what  you have now.

Mats Hagstrom, MD (license on probation) · Answer

To make an assessment for any plastic surgery procedure we need to see a complete set of proper before and after pictures. If you don’t have before and after pictures, then ask your surgeon to forward the pictures they took. Delivering consistent quality, liposuction and fat transfer results is more difficult than most people realize. The number of plastic surgeons of truly mastered this procedure are in a small minority. Simply being board-certified in plastic surgery with years of experience does not mean somebody has mastered any one single procedure especially not Liposuction and fat transfer. Without seeing before and after pictures, we can address your outcome. I don’t think it would be all that difficult to harvest sufficient amount of fat for a second BBL. The following are some general recommendations for finding the right provider. 
To find the best provider, I suggest patient schedule multiple in person consultations with experienced plastic surgeons in their community. During each consultation, ask each provider to open up their portfolio and show you their entire collection of before and after pictures of previous patients who have similar body or facial characteristics to your own. An experienced plastic surgeon should have no difficulty showing you the before and after pictures of at least 50 previous patients. An experienced provider should in fact have hundreds or preferably thousands of before and after pictures to choose from for commonly performed procedures. 
Being shown a handful of preselected images, representing the best results of a provider’s career is insufficient to get a clear understanding of what average results will look like in the hands of each provider.
There is no correct number of consultations needed to find the best provider. The more consultations you scheduled the more likely you are to find the best provider for your needs. 
Take careful notes during each consultation, especially regarding the quantity and quality of before and after pictures. It’s not a bad idea to bring pictures of your own body/face to use as reference when reviewing before and after pictures. 
The biggest mistake patients make is scheduling only one consultation without properly vetting or comparing providers before scheduling surgery.
Best,
Mats Hagstrom, MD

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