Is it safe to get 360 lipo and BBL when I have sciatic nerve? What are the risks of paralysis?

Dear Mitchellg2,
as long as your surgeon follows recommendations, the risk of nerve injury is very low. If you are considering a surgery, I would suggest you to consult a board-certified plastic surgeon. 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

There have been many advances in Brazilian Butt Lift (BBL) procedures. Newer techniques emphasize that fat is not injected intra-muscularly. The sciatic nerve is below (deep to) the muscle level. This was a big risk in the past, but this has changed with greater awareness. Thus, there should be minimal risk to nerve injury. And any issues you may already have should not impact your candidacy for liposuction and BBL. Postoperative swelling may temporarily cause some pain/aggravation, but this should not directly injure the nerve in any way. So, as the swelling resolves, the discomfort should resolve. However, if you have a documented herniated disc or muscle entrapment, then this should be addressed preoperatively. Arrangements can be made at the consultation to make sure that any risk is minimized. Respectfully, Jules A Feledy, Jr, MD American Board of Plastic Surgery, American Society of Plastic Surgery

You actually have two sciatic nerves. One on each side. Sciatic nerve pain is usually related to lower back conditions causing pressure on the nerve roots as they exit the spinal cord.

The pain is often felt in the buttocks or thigh in the region covered by the sciatic nerve because that’s where the nerve goes.

There are all kinds of horrible risks that can happen in life but when we look at risks none of them are worth worrying about unless they have a significant incidence.

The magnitude of risk multiplied by the incidence is what creates risks worth worrying about.

This is pretty straightforward stuff. Everybody knows getting into a car with a drunk driver on a Friday night is probably not the smartest thing.

Life is full of decisions that include risk. Most people make these decisions unconsciously or based on emotions.

The fact that one person became paralyzed has no correlation with you becoming paralyzed from the procedure.

But you should ask yourself is what are the risks involved with this procedure and how often do they occur.

Having sciatic nerve pain does not put you at any significant increased risk for having serious medical complications. No plastic surgeon is going to promise or tell you that this well and make your sciatic nerve issues worse or better.

Because sciatic nerve pain is a condition involved with the lower back it is unlikely that having a BBL will impact the condition but it could and if you do not want to take risks then nobody has to have cosmetic surgery.

In my opinion the risks patients should be afraid of is being disfigured from this procedure. Serious medical complications including fatal outcomes do happen but they are pretty rare when compared to things like driving an automobile.

An average driver in the United States has approximately one and 10,000 chance of dying per year.

About a decade ago the BBL was called the most dangerous cosmetic surgical procedure because of a specific complication called a fat embolism that was described with older techniques specifically injecting fat on purpose deep into the gluteus muscle. This is the complication most people have been worried about because it often is fatal when it happens. The procedure was quoted as having an incidence of fat embolism‘s that were one out of 3000 procedures.

There is not been a formal recalculation of the incidence of fat embolism but there has been very few mentioned in the media since the American Society of plastic surgeons announced a set of recommendations for improving safety for the procedure.

Delivering consistent high-quality Liposuction and fat transfer results is far more difficult than most people believe. This is true for both patients and plastic surgeons.

Results from these procedures vary immensely based purely on who does the procedure.

It doesn’t take very long clicking through real self to hear horror stories of irreversible and permanent disfigurement from both Liposuction and fat transfer.

Patients post stories of bad outcomes from this procedures on an almost daily basis.

That said, there are also lots of success stories with patients being very happy with their outcomes.

In my opinion the most important decision and where to focus all of your efforts is by far related to choosing the most talented and experienced provider in your community.

Finding a talented plastic surgeon is not an easy task for a multitude of reasons.

Most people use the Internet as their primary source of information but unfortunately the great majority of information available on the Internet in regards to plastic surgery procedures is biased towards self promotion.

When I look at the providers I have the greatest respect for there are only two variables I have found that consistently hold true for these individuals. The greatest plastic surgeons tend to almost always have an immense amount of experience and this can be easily demonstrated by having a collection of before and after pictures that reads like a telephone book. The second variable is the ability to practice medicine for decades without leaving patients upset to the point of needing to leave retaliatory or slandering reviews.

What patients should be looking for his providers who have hundreds to possibly thousands of before and after pictures who can easily present examples of previous patients with very similar body characteristics to your own and who have the least number of justified negative reviews on all various physician review websites.

Confidence and experienced providers should have no difficulty talking about complications, undesirable outcomes, revision rates etc.

To get a thorough understanding of who the person is you’re consulting with and to get an accurate assessment I recommend patients exclusively schedule in person consultations and schedule lots of them.
The potential outcome for this procedure also varies substantially based on individuals candidacy for both Liposuction and fat transfer. Some people are simply not good candidates while others are exceptionally great candidates. It is paramount to understand your own candidacy for the procedure in order to be satisfied with and understand the outcome.
Judging physicians by their websites is nonproductive and often eliminates extremely talented providers who are not self promoting.

My recommendations is to schedule at least five in person consultations with local board-certified plastic surgeons who been in practice for at least a decade and seem to have substantial experience with the BBL procedure.

Whenever possible I recommend patients stay local for elective surgical procedures.

If at any time you have doubts about the experience or skill of the provider slow down and schedule more consultations.

The following is a pre-written list of general recommendations for those seeking cosmetic surgery. Some of the information is repetitive but it includes a few other points that are worth mentioning.

1. I recommend patients avoid traveling long distances for elective surgical procedures. There are of course instances where there is a lack of local talent and traveling to some degree is inevitable. If traveling for the procedure patients should be ready to travel to have the consultation, post operative appointments and follow up should there be issues or complications.
Patients sometimes do not appreciate the importance of in person consultations, that complications do happen or the number of people who have issues with their results or need revisions.

2. Schedule multiple consultations with different providers in your area who seem to have a good reputation for the procedure you’re interested in. Starting with at least five consultations seems like a reasonable number to me.

3. Whenever possible schedule in person consultations.
4. During in person consultations ask each plastic surgeon to show all of their before and after pictures for the procedure you’re interested in.

The goal is not to see the best results of their career but to get an idea of what average results look like and get some type of confirmation of how many of these procedures that provider has performed.

Ask to see results that were not as good as the doctor would’ve hoped for and talk about the differences in outcomes.

Honest and experienced providers should have no problems presenting this type of information.

A highly experienced plastic surgeon should have hundreds of before and after pictures for the procedure you’re interested in. At a minimum at least 20+.

5. Read all the reviews on various physician review websites paying close attention and avoiding providers with any significant number of justified negative reviews. Providers with an abundance of reviews often have aggressive marketing campaigns.

The plastic surgeons I respect most all have the single variable of not having justified negative reviews on their online profiles.
In my opinion justified negative reviews are far more telling than an abundance of positive reviews.

6. Avoid scheduling for surgery or making a deposit on the day of the consultation. Give yourself some time to think about the decision and make sure you finished all scheduled consultations before committing to having surgery that will permanently and irreversibly change your body.

When in doubt slow down and schedule more consultations.

Choosing the right plastic surgeon is the single most important variable to having a positive experience.

7. Don’t go chasing after technology or names of certain equipment. Instead focus all your efforts on finding the most experienced and talented board-certified plastic surgeon.

Best,

Mats Hagstrom, MD