Other options than BBL? For skinny people

Question

Hello, I had a tummy tuck, breast implants, and some lipo in 2022. I am 5'2 and about 135lbs. I really want to get a BBL for butt enhancements and have been told I am not a candidate. I have done research on Sculptra which i dont think is a good fit for me since i would like a bigger enhancement, and the other option given to me is HA filler. Which is expensive and only last 2 years. What other options do i have?!!?

Matthew J. Nykiel, MD · Answer

Hey Charming! An option you may want to look into is Alloclae. It's one of our most requested procedures at the moment. It's a non-surgical solution to enhance body contours, correct hip dips, and add volume in targeted areas using highly purified donor fat, without incisions, liposuction, or general anesthesia. It's considered a good option for patients who don't have enough body fat for a surgical BBL. Do some research on it, it may be a good choice for you! Good luck!

Ryan A. Stanton, MD · Answer

Allow me to answer your question as best i can without any 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.  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.

Mats Hagstrom, MD (license on probation) · Answer

Candidacy is rarely black and white. On an average day if I see 10 consultations for body contouring, two of those patients will be perfect candidates, two of them will be non-candidates, and six of them will be somewhere in the middle meaning that they will get some benefit from the procedure, but less than perfect outcome.
Not the type of results you may put on your website, but still some improvements.
You didn’t include pictures and without pictures we can’t begin to make an assessment.
There is a great deal of subjectivity when it comes to estimating how much fat can be removed. Doing liposuction for fat transfer.
Having had previous Liposuction is definitely something that makes it more difficult but it depends on what area was treated.
The most common area treated to harvest fat for the BBL is treating the abdomen or the torso.
A generally viewed the torso as a single and atomic unit and generally treat the entire torso when doing liposuction rather than doing spot treatments.
 if I’m going to the front then I’ll treat the back if I’m gonna treat the lower part I’m going to treat the upper part.
If the amount of fat harvested from liposuction from the entire torso is insufficient to get a quality BBL, then I usually start with adding extremities.
I’m very good at doing arm liposuction, and this tends to give high-quality outcomes, but some women really have very little fat on their arms.
In our thighs can usually contribute a good amount Without compromising the female figure. 
I don’t limit myself to a single area and impatience, who have a low BMI it’s more a matter of is it justified to have liposuction of your entire body to get gluteal augmentation.
If you’re willing to consider fillers and the cost involved with that ongoing basis, then perhaps you would be willing to have liposuction of your whole body, and in that case, maybe that would actually work.
It also depends on how much of a fat transfer result. You need to see to justify having the procedure.
I would be careful of relying on a single providers assessment, in regards to being a candidates or not.
These decisions are quite subjective.
The number of plastic surgeons have truly mastered. Liposuction and fat. Transfer is fairly small.
Most plastic surgeons really aren’t that great at Liposuction.
The ones that specialize in body contouring And do it on a regular basis tend to be much better than those who do it every once in a while. 
Considering there is a substantial amount of variation among plastic surgeons in their skill and experience with this procedure I always encourage people to have more consultations than they may think necessary to find the right provider.
Personally, I think, having five or six consultations before considering choosing a provider is appropriate.
It’s time-consuming considering that the impact will affect you every day for the rest of your life, and the consequences of choosing the wrong provider I think, having that many consultations is totally justified.
To answer your question there are no other good alternatives.
If if there was, we would all be doing them.
Fillers are not going to work unless you’re independently wealthy, and are willing to spend stupid amounts of money.
The great majority of plastic surgeons in the United States, do not offer gluteal, implant augmentation.
There is a good reason why most of us don’t do the procedure.
The procedure has very high complication rates, high incidents of patient dissatisfaction, and the number of patients who have long-term high-quality success with high patient satisfaction is almost zero. 
There are patients who’ve had gluteal implants that was done well, with conservative size implants with modestly good outcomes, but the great majority tend to end up with problems, and eventually having the implants removed, which can eventually lead to deformity.
I generally recommend people stay away from gluteal implants. If you’re going to consider that option, then it becomes critical to find someone who truly specializes in that procedure exclusively and has sufficient experience.
There seems to be increased success with intramuscular placement using implants that are on the conservative side.
Without intramuscular placement or using large implants failure rates become very very high.
Based on the information provided, you may actually be a reason to be good candidate for what it sometimes called a skinny BBL.
Consider Reposting with pictures, showing your full body in undergarments from your neck to your knees, showing your front side and backside if you want an assessment.
Alternatively, you can schedule a few more in person consultations with other providers in your community who seem to have a lot of experience with the BBL procedure.
I’ve done fat transfer procedures on patients your height who weigh 120 pounds.
Sometimes individuals will have a surprising amount of fat on their extremities or some area that may not have been considered initially.
Best,
Mats Hagstrom, MD

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