I believe in Florida, a plastic surgeon can only take 4000 liters of fat from the body for a BBL. What does that mean?

When harvesting fat from the body, does the 4000 liters count start after the fat goes through the centrifuge and sanitizing process and then injected or does the liter count start when the fat is initially withdrawn and then measured? Thank you for your time in answering this question.

Doctor Answers 2

4 liters (4000 milliliters) of supernatant fat is the limit in an office surgery setting.

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I think you meant 4000ml, NOT 4000 liters. And that volume is the supernatant fat, but the restriction applies in office surgery settings that are NOT accredited by a Florida-approved agency. Certified hospitals or accredited surgical facilities do not have this limitation, but rely on the credentials of the attending plastic surgeons. Non-plastic surgeon "cosmetic surgeons" such as Dermatologists do not receive these hospital privileges in most cases because they lack full training in plastic surgery, which is why they operate in offices without accreditation, and why the restrictions were made into law.

This is a safety issue, and it sounds as if you are more worried about "how much" fat can be transferred (like most patients), NOT how much can be safely transferred and how much of it will survive (based on technique, not volume of injections).

Injecting vast volumes of poorly-harvested fat in big blobs that will not survive because of lack of contact with living tissue for oxygen and nutrient osmosis (needed for fat survival) leaves you with a big booty full of dead fat. That "gradually 'melts away' over several months." Search that phrase here on RealSelf.

Here are the facts:
  • About half of the harvested fat is blood, fluid, local anesthetic, serum, and disrupted (dead) fat cells, most of which your surgeon will like to process away via one or several techniques.
  • Injected fat must be in close contact with living tissue in order to survive long term. This means that big blobs of fat injected will NOT survive, just fat injected in thin tunnels into living tissue.
  • Despite best measures, only about half of the injected fat cells will survive long term--and that is only if everything is done CORRECTLY!
  • This is why most BBL surgeons will safely inject several hundred ccs of fat per buttock cheek--more just doesn't work OR survive (but it does look impressive for a few months). Less than 1000cc is a common maximum, and 600cc per side is a common average.
  • More than one grafting session is often necessary for best results. Why?--read above.
  • 4000ml is what is removed, not what is finally injected. That's the answer you actually asked for. That means 1000cc per buttock cheek is a realistic maximum that can be injected with the maximum that can be removed and processed, AND 500cc is a maximum that COULD survive under optimal conditions.
Please check the credentials of the surgeon you select in Florida (or anywhere), as well as the accreditation of the surgical facility. If you are seeing a "cosmetic surgeon" who works in an office operating room, beware! An ABPS-certified plastic surgeon can work ONLY at an accredited surgical facility, even if it is in his/her office. Be sure of this. Best wishes! Dr. Tholen

Liposuction limitations

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Most plastic surgeons view the safety volume limitations as total amount of fluid removed

This typically is mostly fat but will include some of the numbing solution as well.

If safety measures are properly followed then 4 L of fat should not be removed if a BBL is performed at the same time though this is most likely done on the regular basis.

Few if any patients need 4 L of fat for a proper BBL.

However have you said patients often benefit by having four or more liters of fat removed during the liposuction part of the procedure.

The safety guidelines are generally based on outpatient procedures more fat can be removed if somebody has medical observation after the procedure.

The safety volumes weather sent by state law or as general guidelines set by the American Society of plastic surgeons are mostly based on swelling and fluid changes after surgery.

The amount of fat removed can cause substantial amounts of swelling after the procedure.

This can lead to patients becoming dehydrated to the point where blood pressure can be compromised.

When a BBL is added to that liposuction procedure even more swelling is seen.

for the great majority of patients having 4 L of fat removed in a single session is considered safe and routine procedure even with a BBL.

For some patients this may cause a physiological stress that's more than what is appropriate.

This is why the consultation is important.

Not only that but a properly trained plastic surgeon has the expertise to evaluate who is a candidate for what degree of liposuction.


Mats Hagstrom M.D.

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.