Do I have enough fat for another revision bbl? (photos)

Question

I had a tummy tuck and bbl done in Jan 2019. Had revision July 2019. I gained 10lbs as recommended by my surgeon because he said I didn't have a lot of fat to lipo. My waist is bigger after the revision which leads me to think he never lipo'd my abdomen. not happy with my results. Does it look like I have enough fat for another revision? He says no and that it's mostly extra skin especially on my back? Covered my tattoos in the pix to remain unidentifiable. Im so insecure now :( I paid 20k

Ryan A. Stanton, MD · Answer

The good news is, your surgeon has been forthright with you by saying that you do not have enough fat, especially if you had to gain weight for the last time around. Hence, doing the same exact same thing again (i.e. round 2 or 3? BBL) will likely not produce different results. The only relatively safe, reliable, and permanent option would be buttock implants.  Because an extremely few number of board-certified plastic surgeons perform this procedure, make sure to find one that specializes in this procedure and only places the implants within the gluteus  muscle (i.e. intramuscular) NOT on top or subfascial. Glad to help

Dhaval M. Patel, MD · Answer

Thank you for your question and photo! I suggest seeking a board certified plastic surgeon and consulting for 360 lipo with secondary fat transfer.  Best of luck!Dhaval Patel
Double Board Certified 
Plastic Surgeon
Chicago 
Hoffman Estates
Oakbrook
Orland Park

Luis A. Mejia, MD · Answer

Hello dear!Thanks for the question and provided information as well.
Based on your pictures, you are a candidate for liposuction with BBL revision, and I think you'll get very good results. 
Liposuction allows your plastic surgeon to transform your entire shape. You can improve your abdomen, hips, back and flanks, and of course your buttock, to give you a nice heart shape.In this regard, I recommend you waist and back Liposculpture, getting better curves especially in the waist, improving your body contour.
Finally, I suggested take the fat we get and transfer to the buttocks and hips, to mold them and get better volume, contour and butt projection
In general, you need to be physically healthy and at a stable weight, have realistic expectations, be a non-smoker and your BMI needs to be 30 or less.
l recommend you to make an appointment with another Dr, preferably with a board certified plastic surgeon to talk about your goals and anything you need to know.
Good luck :)Dr. Luis Mejia.

Kenneth Hughes, MD · Answer

The thinner patient requires an expert at liposuction to remove as 
much fat as possible while leaving the skin smooth.  
You have to consider not only which areas will have perhaps the best 
fat, but also you have to consider which donor sites will have the 
fewest problems afterward with the liposuction.  In general, the abdomen
 and thighs are preferred, but, if those sites are not available, other 
areas can be used. 
Having the BBL done a third time is an option as long as you have enough fat to be transferred. The revision implies that there is less fat than the first time, and scar tissue will make the surgery much more difficult on the surgeon. The percentage of fat survival in the third BBL should be about the same as the first and second. The volume loss occurs over the first 6 weeks or so.  After that period of time the volume remains stable assuming weight is maintained. Wait six months to a year to evaluate results before scheduling a BBL revision.

Daniel Barrett, MD · Answer

Dear Dn992,
based on your photos, you look like a good candidate for a BBL. Liposuction of your abdomen, back and flanks should give you more curves and hourglass shape and fat transfer to buttocks should give you more projection. I would suggest you to consult a board-certified plastic surgeon because only after a thorough examination you will get more information and recommendations.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Raja Mohan, MD · Answer

A Brazilian butt lift (BBL) is a cosmetic surgery procedure that enhances the shape and size of the buttocks by transferring fat from other areas of the body: Brazilian butt lift (BBL)ProcedureFat is removed from other areas of the body, such as the thighs, hips, lower back, or belly, and injected into the buttocksGoalTo improve the shape and volume of the buttocks, and sometimes to create an hourglass figureResultsMore rounded and fuller buttocks, and sometimes a smaller-looking waistRisksExpensive, can be dangerous, and there are no guaranteed resultsRecoveryPain is usually minimal, and full recovery takes about six monthsMaintenanceResults should last for many years, but it's important to maintain a stable weightA BBL is different from a traditional "lift" procedure, like a breast lift or facelift, because it doesn't improve sagging or excess skin. A BBL is also different from other butt lift techniques because it doesn't use implants. Candidates for a BBL should have good skin tone in their buttocks and hips, be in good health, and not have medical conditions that would impair healing.

Erika Sato, MD, FACS · Answer

When a patient considers a 3rd BBL, you do not want to mess around. You need to go for in person consultations. I need to do an exam to feel how much fat you actually have. I would also say to include your thighs in the harvest. I would want to see before photos (before each surgery). I also need to know your weight before each surgery and your current weight. You don't want to spend any more money if you can't get the result you desire.

Jonathan Kaplan, MD, MPH · Answer

It appears that you could have fat taken from the inner thighs to help with your next round of liposuction, followed by fat injections to the hips to give you a curvier shape. I don’t ask patients to gain more weight as I don’t think it’s healthy but also usually unnecessary. Best of luck.

Arian Mowlavi, MD, FACS (license on probation) · Answer

High definition VASER liposuction may be a solution to your issue. The definitive correction for liposuction deformities requires the advanced technology of ultrasound assisted VASER liposuction. As an official trainer of VASER liposuction, I encounter suboptimal liposuction outcome referrals weekly. VASER liposuction has been the only modality that has consistently corrected liposuction caused deformities. VASER liposuction ensures a smooth contour regardless of severity of contour irregularities by virtue of being able to remove any and all remaining fat comprehensively and uniformly. Finally, when skin redundancy irregularities are observed, Renuvion technology can be simultaneously applied to tighten your skin to optimize your overall contour outcome. A Skype or FaceTime consultation with a VASER specialist will help you get an accurate recommendation and pricing. 
Respectfully, 
Arian Mowlavi MD, FACS
Realself 100 Hall of Fame Inductee

Mats Hagstrom, MD (license on probation) · Answer

It seems to me you have plenty of fat to harvest for revision work. For a one your entire back and armpit area was never treated in this area in my practice would’ve been treated as part of your torso for the BBL. Your arms have fed and give great outcomes from liposuction when done by the right provider.There’s also Fat on your lower extremities though you may not appreciate liposuction results in that area.The practice is devoted exclusively to liposuction and fat transfer. Some plastic surgeons will limit the amount of liposuction on the abdomen in conjunction with a tummy tuck for safety reasons. This is completely appropriate. When it comes to revision work afterwards it’s generally safe to liposuction the abdomen aggressively at a later time.You definitely had liposuction of your abdomen because I can see the surgeons attempt to create a midline “linea alba”.Asking you to gain weight seems Sort of inconceivable to me since you have plenty of fat in the areas previously liposuctioned aren’t going to grow significantly with weight gain.I disagree with the notion that you don’t have that that can be harvested.Each surgeon does procedures based on their experience in their training. I have an immense amount of experience with liposuction and fat transfer since I only performing these procedures. To me it’s a mistake to not treat the back and the under arm area in conjunction with the abdomen. I generally treat the entire torso as a single anatomic unit in order to leave people with a natural even fat distribution. Whether it bothers you or not I can see the demarcation or the liposuction starts on your waist and where it doesn’t continue or it wasn’t done on your back. To me the fat thickness should be the same all the way from your shoulders to your bottom.I seem to be marching to my own drummer when it comes to this but in the end I’m fairly certain that eventually others will come to except that the torso should be treated as a single units and the left treated with the same fat thickness throughout.Best, Mats Hagstrom, MD

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