BBL - Can fat be transferred into dead space after removing silicone?

Hello Shar,
Thank you for your question regarding whether fat can be transferred into the "dead space" after removing silicone from the buttocks. The answer is "YES and NO". Silicone butt injections are usually removed with an open technique. This approach leaves a scar across the top of the buttock, and the silicone and associated scar tissue are removed. During this healing time, there is a "dead space" inside your buttocks where the silicone and scar tissue were removed. However, this "dead space" fills in with collagen. This filling-in process takes about 4 to 6 months or longer. The filling of this "dead space" can be demonstrated on follow-up MRIs obtained after silicone removal. About 4 to 6 months after silicone removal from the buttocks, you should consider a BBL or autologous fat transfer to the buttocks. Successful fat transfer to the buttocks depends on the following: having enough fat, the softness of the buttocks after silicone, and your care of the BBL after the procedure. Therefore, BBL and fat transfer are the mainstays and first treatment to reconstruct the buttocks after silicone removal. However, you need to wait 4 to 6 months for the "dead space" to close. Thank you for your interesting question regarding BBL reconstruction after the removal of silicone from the butt. Good luck. If you are still confused, most plastic surgeons offer free virtual or in-office physical consultations. Therefore, explore what other plastic surgeons have to say. Seek an experienced, board-certified plastic surgeon with significant experience in buttock reconstruction with fat (BBL) after silicone removal. Make sure they have performed many butt reconstructions after silicone removal procedures and have the before-and-after pictures to prove it. Carefully examine their before-and-after photos and review their RealSelf profile.  
If you cannot find an experienced plastic surgeon in your neighborhood, consider traveling out of state. Sincerely, Dr. Katzen. ( Plastic Surgeon, President of the American Society of Bariatric Surgeons, certified by the American Board of Plastic Surgery, Fellow of the International Society of Aesthetic Plastic Surgery, American College of Surgery, and International College of Surgery and ​member of the American Society of Plastic Surgery, American Academy of Cosmetic Surgery, RealSelf Hall of Fame, and RealSelf Doctor Advisory Board for Medical Review and Consumer Panel.)

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.

If you are expecting the fat to survive and hoping for any significant improvement and permanent result then the answer is “1”. Any “dead space” after silicone removal is full of scar tissue and devoid of healthy blood flow making fat survival extremely poor. In these scenarios, the only relatively safe, reliable, and permanent option to recreate buttock contours with fullness and projection is with buttock implants. Typically, Stanton Anatomic®️ gluteal implants produce the most natural and realistic buttock contours.

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. Getting it done right the first time around is not only the best chance for success, but also will save you from a lot of headaches and money in the future. Glad to help.

Yes, it is true that if fat grafts are place into the pockets where implants were placed, it would be a minimal contact with surrounding tissue to get proper nourishment and most of injected fat will not survive. However, if implants were removed long time before fat transfer, it is very likely that most of "dead space " is obliterated, non-existent; so fat grafts would be placed into healthy tissue that has good blood supply and will provide nourishment for fat grafts.. Hope this helps.

You cannot inject fat transfers into the space that was previous occupied by silicone as the fat will not survive. Fat has to be in contact with living tissue. Unfortunately, you have not provided photographs. An alternative to consider would be a buttocks lift where the excess skin and fat is used to make a flap and that can be used to fill in the hollow space.

Best Wishes,

Gary Horndeski, M.D.

In order for a fat transfer to be successful, the fat needs to be drafted using good technique into healthy tissue with a good blood supply.The tissue the fat is grafted into is the host tissue supporting the grafted fat until it establishes a new blood supply. There is no yes or no answer to your question.If you have a lot of scar tissue and non-vascular necrotic tissue than fat transfer may be less successful.It’s unlikely all of your gluteal tissue will be unhealthy, and some fat will most likely survive.There are a number of variables to take the consideration and a simplistic approach is making this a yes or no answer is probably not appropriate. By far the most important variable is provider selection so I suggest you focus your efforts on that.Find me the right plastic surgeon is far more difficult than people realize.The number of plastic surgeons who approach mastery of liposuction and fat transfer is in reality quite small. Best,Mats Hagstrom MD