Does sitting on a BBL pillow early on affect your results?

Question

I wonder if sitting on a bbl pillow for 4 hours five days after surgery (Will be flying home and sitting on a BBL pillow) can do any harm to the transferred fat? I realize a BBL pillow is better than sitting right on the butt, but it it totally harmless to the new fat or does it still affect it?

Roger Tsai, MD · Answer

Great question!  As long as you are sitting on the BBL pillow correctly where there is absolutely no pressure to the areas of grafted fat, including no pressure from the back of the seat while sitting, then the risk should be very minimal if at all.  However, may patients fall alseep and find that the pillow moved or that they are now leaning backwards onto the buttock.  In that case then yes of course there could be some minimal fat loss.  The issues is how long and how much pressure are on these areas - this will determine how much loss there will be.  In reality, I do have many patients that fly into town for this surgery and they fly back home within a week without any issues - just be careful.Best of luck and hope this information helps!
- Dr. Roger Tsai
Board Certified Plastic Surgeon

Luis A. Mejia, MD · Answer

hello thank you for your question and provided information as well.. based in your question its recommended use the bobby pillow for 1 month counting day after surgery because your can  run the risk of deforming your buttocks a bit.

Kenneth Hughes, MD · Answer

The main risk is related to development of a blood clot in the legs that can then migrate to the lungs. Ask your PS for a letter to the flight attendant requesting that every 30 minutes or an hour, you can get up and stand for a few seconds to take the pressure off.   This reduces the chance for fat necrosis. Kenneth Hughes, MD, ABPS Board Certified Plastic SurgeonLos Angeles, CA

Daniel Barrett, MD · Answer

Dear jeanparis,
I instruct my patients not to sit for 2 solid weeks. We provide them a specialized pillow that our patients can sit on during that time. They can sleep on their stomachs or sides. Fat viability depends a lot of surgeon technique. The fat has to be placed back into the buttocks as soon as possible so that it has a greater chance of survival. It has to be placed carefully so that not too much fat is placed in only one area.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Thomas Trey Sands, MD · Answer

Thank you for your question. Fat graft survival is dependent on a number of things. One of those things is pressure. Certainly you should not have as much loss in the buttocks by sitting on a BBL pillow however, it is common to graft the back of the thighs just under the buttocks to support the buttocks and this area may be more vulnerable to pressure with a BBL pillow. I would recommend only sitting short periods of time ( no more than 30 minutes) and then walking or standing in between. This can decrease the chance of graft compromise and it will also decrease the chance of developing a clot in your leg for which you are certainly as risk for traveling after surgery. Have a candid and detailed discussion before you travel with your plastic surgeon about this concerns and how they would prefer you to address them. Best of luck.

Tania Medina de Garcia, MD · Answer

Hello dear!!
Thanks for the question and provided information as well.
I recommend my patients not to sit for more than 30 mins. every two hours, for the first 2 weeks. If you have any concerns, I suggest you to follow up close with your plastic surgeon.
Hope this is helpful. Good luck :)

Mats Hagstrom, MD (license on probation) · Answer

there is what is ideal and then there is reality.  The perfect BBL recovery would be laying on your abdomen without moving for three weeks.  Nobody is going to do that nor would any bun be asked to  Minimal movement and avoidance of points pressure are the things you want to avoid.  To give an analogy if placing a skin graft on the back of the hand to cover a wound the doctor would often wrap the hand and put the hand and forearm in a splint or cast.  This is to protect the graft and minimize movement.  So, since complete immobilization and avoidance of pressure it's not realistic we give you postoperative protocols that have the minimum impact and still allow you to live in a quasi-normal life during recovery.  The absolute worst thing you could do is get daily deep tissue massage is of the area treated with fat transfer.  The concept of the BBL pillow is that pressure is placed on the back of your thighs in an area where fat is generally not grafted.  We typically explain these concepts to patients and ask them to do the best they can.  Each provider will have their own protocols. We don't have scientific evidence that sitting after a BBL has any impact but these come from basic principles of tissue transfer and from these we make our protocols.  This is difficult to test and confirm with scientific studies. Who is going to purposely set an a BBL to see what happens.  To do in an experiment to see if sitting next to difference have to patients would sit on their BBL and a half would not.  If you get chosen to be in a study asking to sit continuously on your BBL there's a high chance you would not be compliant with the study. There's no good animal model to do this either.  It is highly unlikely we will ever know what the true answer is.  Considering we lose a substantial amount of the grafted fat  we continue to recommend being cautious.  I do you want to talk a bit about traveling for cosmetic surgery.  Patients assume everything will go fine. The reality is people have lots of questions afterwards, complications do happen and patients do need revision surgery.  Real self is a pretty poor alternative than seeing your doctor after surgery.  Since results take several months it's not really feasible to stick around and wait until you can be assessed for the final outcome.  Asking a local plastic surgeon to take care of you after words when you're paid a different doctor for the procedure it's not going to be particularly popular.  When it happens I think it's fair to ask the patient to fly back and see the Doctor Who did the procedure.  Most likely you will not have a complication but what is your plan if you do it?  I keep a spare tire in my car. I generally don't get flat tires but I'm prepared in case I do.  I wouldn't opt for driving cross country without one.  I encourage people to stay local for elective surgical procedures. Most areas generally have talented plastic surgeons who do a fine job.  Some rule areas will not have the medical know how to deliver the best results in these cases traveling clearly makes sense.  Patients post daily requesting input on real self instead of seeing their provider because they traveled for surgery.  Some scared, desperate and frustrated.  The responses on real self are usually insufficient to answer the questions or properly reassure the patients Please take all of these factors into account when making your decision.  Best, Mats Hagstrom MD .

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