Brazilian Butt Lift (BBL) is simply the AUGMENTATION (not lifting) of the buttocks with fat after the butt and its surroundings were shaped with Liposuction. The idea is NOT to simply pump fat into a smaller unattractive butt and transform it into a much larger uglier butt but to create a more harmonious, attractive looking butt which happens to be larger. What constitutes an attractive butt?I suggest you google the image BUNDA (Portuguese, spoken in Brazil, for Butt). The ideal, youthful female butt IS : - DISTINCT, It has clear borders of where it starts and ends. - HEMISPHERIC, it looks like a full round hemisphere NOT a pear or a blob - has a V ZONE, V shaped depression where the upper butt cheeks diverge (Some have 2 dimples) - has a SHELF or a BACK SCOOP ( medically a lumbar lordosis) in the lower back with - THREE mild muscle LINES of the lower back created by the ERECTOR SPINAE muscles Sculpting liposuction AROUND the buttocks can create much of this without putting fat into the buttocks. But, to get fullness and fill the lateral (Trochanteric) depression, some fat is required (i.e. BBL). FAT AS A FILLER Unlike other fillers, fat is quite different. Although it makes the skin appear much younger and in some cases radiant due to its content of stem cells it has several considerations. Fat survival in its new location depends on: - how much trauma did the fat suffer in the process of liposuction and transfer into the buttocks? The more trauma, the more cell loss - How fast did the blood supply of the buttocks reach and attach itself to the grafted fat cells? The longer it takes the fat to be nourished, the more fat cells will die and volume will be lost (This is caused by putting huge amounts of fat into the buttock, greatly increasing the pressure and blocking the blood supply. This is seen by putting the fat in in large clumps instead of small droplets. By doing so only the surface gets oxygen and the inner fat dies. This is caused by people seating on their butts increasing the pressure and shear forces and occluding the blood supply). - Fat is a living ENERGY STORING tissue. If you lose weight, it will gradually shrink – if you gain weight, it will get much larger. So, if your weight is unstable you must take this into consideration. - Fat HAS WEIGHT. The only way adding fat to the buttocks or breasts would magically lift them would be IF it contained Helium. It does not. The more fat we add to either the breast or the buttocks, the more weight we add to them and with time they WILL sag. BBL AND OBESITY If you have a BMI of 30 and higher, you are classified as “obese”. At this point, a lot of cosmetic operations would NOT look as nice on you AND be associated with a higher rate of complications. Your Options? Lose weight to enhance your results and your long term health OR find someone who will operate on you for PURELY financial gain and deliver a mediocre result, at best, which would make SUBSEQUENT surgery on the area much harder due to scarring. Personally, in many women with a full buttocks and borderline obesity, I advise weight loss or I would do a BACK SCOOP LIPOSUCTION which enhances the appearance of the already existing (large) butt and make it fuller appearing. The recovery is quicker and easier than a BBL and you will not have to avoid sitting on your butt. Peter Aldea, MD Memphis, TN