Overseas plastic surgeons do a great job with aggressive liposuction. How come no one in the US does the same? (Photo)

I had a brazillian butt lift 4.5 months ago, and i am sad that my doctor didn't take more fat off of my stomach. Was I supposed to ask him to be more aggressive? Many of these plastic surgeons from Dominican Republic, Columbia, etc do such a great job with liposuction that really gives a women a hourglass body. Are they just more skilled?

Doctor Answers 7

Overseas plastic surgeons do a great job with aggressive liposuction. How come no one in the US does the same?

You are a very astute observer and it is a very legitimate question.  The easy answer, I believe, is that we are lazy and have been accustomed to doing lipo surgeries taking up to a few hours and doing two to four such cases a day and charging a lot of money.  I have now been doing lipo for over thirty years and practiced this way for twenty five of these years, not realizing the potential of what we could really accomplish with aggressive lipo.  Then, six years ago, I came to San Diego where there is a great abundance of military men and women who are out of standard with their weight and our measurements with their livelihood and benefits jeopardized.  These can be very fit service persons such as Navy Seals, but their genetic lypodystrophy fat is greatly out of proportion with their general body fat that can generally be measured with an inner arm or forearm pinch, necessitating lipo for removal.  As more difficult cases presented, I found that I could remove up to 90% of the fat resulting in the kinds of changes you are referring to.  Along with the extreme fat removal also came up to 35% skin tightening that was totally unexpected, if the removal was circumferential.  However, to do my military circumferential aggressive lipo from the bottom of the breasts to the pubis takes me about 8 hours in the operating room, even with power assisted lipo with the Microaire PAL or Power X machines.  Most surgeons will not put up with spending that long in the OR, if not done under "awake anesthesia" as I do, there can be severe post-operative consequences form general anesthesia taking this long.  Also, in California, we are restricted to removing a total only 5000cc of any lipo aspirate.  I can usually get about 90% of that aspirate as pure fat.  Additionally, I can break up the remaining fat with a spatulated tipped suction cannula and get the body to gradually absorb about 4-6 pounds more.  To do such lipo in very fit patients such as the military men and women, or body builders, or MMA fighters is extremely difficult and takes much more time and energy for the surgeon to remove their fat.  I have patented a spatula-tipped cannula that helps greatly to get into this fibrous fat and remove the fat itself.

Carlsbad Plastic Surgeon
5.0 out of 5 stars 19 reviews

Overseas plastic surgeons do a great job with aggressive liposuction. How come no one in the US does the same? (Photo)

Unfortunately your photos can not be viewed. Many plastic surgeons from Dominican Republic, Columbia, etc may do a great job but there is no quality control or reporting of complications following surgery in these countries as we do in the US. Also many of the photos that I reviewed thus far are non-standardized or Photoshopped. Beware.

Ron Hazani, MD, FACS
Beverly Hills General Surgeon
4.9 out of 5 stars 289 reviews

Why Don't American Plastic Surgeons Do As Complete A Liposuctioning As Overseas Plastic Surgeons?

Them's fighting words!

Back in 1982, the Europeans brought liposuction to the United States at the ASPS meeting in Honolulu, Hawaii.  American plastic surgeons along with our Brazilian brothers in arms popularized liposuction and took it from its infancy to where it is today.  In 2015, arguably America has some of the best liposuction surgeons in the world. 

I know some BBL surgeons like to leave a little extra fat here and there so it can be harvested for a touch up at a later date.  It is possible at times that BBL patients are more interested in the appearance and size of their buttocks than the donor site, and there may be incomplete communication between the surgeon and the patient as to what their exact wishes are. 

I believe that cosmetic plastic surgery is a partnership between patient and surgeon, and open communication on both sides will increase the likelihood of success.  At times, patients make assumptions as to what the surgeon is going to do, and at times surgeons make assumptions as to what the patient desires. 

At this point, I think it would be appropriate for you to ask for a consultation with your BBL surgeon so that you and he or she can open a dialog.

Real expectations

One of the most important part of the surgery is what to expect from it. Having good comunication with your surgeon about results  before the procedure.
Here in Dominican Republic  we work with a lot of latina s bodies. Seen your pics , i see good no bad results. Maybe on a couple of months some retouch.
Always have realistic expectations.


Dr Hernandez Pizzoglio

Alejandro Hernandez Pizzoglio, MD
Dominican Republic Plastic Surgeon
4.8 out of 5 stars 129 reviews


Hello dear, thanks for your question and provided information as well... Every surgeon has its own way to do surgery, besides that, it depends on the country, it is something that everyone know's that here at the dominican republic the results are different because the liposuction is more aggressive.. But that always depends on the surgeon per country

Tania Medina de Garcia, MD
Dominican Republic Plastic Surgeon
4.5 out of 5 stars 398 reviews

Overseas plastic surgeons do a great job with aggressive liposuction. How come no one in the US does the same?

There are a number of factors involved in the result of a BBL and the liposuction involved.  There is a gamut of considerations including starting anatomy, amount of fat present, quality of skin, underlying musculoskeletal anatomy, surgeon dependent factors, and healing and patient dependent factors.

Kenneth Hughes, MD

Beverly Hills, CA

Kenneth B. Hughes, MD
Los Angeles Plastic Surgeon
4.9 out of 5 stars 492 reviews

Overseas plastic surgeons do a great job with aggressive liposuction. How come no one in the US does the same?

Thank you for the photos and question. Liposuction is the number one operation in the US, and the outcome depends who does the procedure, what patients want and how educated they are about the procedure. In the US, not only plastic surgeons, but a variety of other specialties engage in this type of surgery from dermatologists, gynecologists, ENT surgeons, ER physicians to family practitioners. Obviously, the expected outcomes vary greatly. Most plastic surgeons do the traditional liposuction technique of fat debulking. Some of us moved beyond that, and in a person with your body type, the liposuction procedure is not debulking, but revealing. We reveal the underlying musculature, create shadows, depressions and elevations in the appropriate anatomic places to create an athletic or more feminine contour. Not a lot of US surgeons are trained in this advanced body sculpting techniques. I had to go abroad to achieve this higher technical ability in body sculpting. I use the VASER technique which allows me to treat the deep and superficial fat layers, which is not possible with traditional liposuction. I think the philosophy of your surgeon was to collect fat only and place it into the buttocks for enhancement.  A major part of the operation is sculpting the areas from where the fat is removed from, otherwise you end up with a suboptimal result. I always sculpt the area of fat harvesting, never entertain the thought to leave some fat just in case I need to come back to collect some more at a future date. The planning should be to contour all the areas from where you collect fat from for a BBL, and if you need more fat in the future, is to collect it from an untouched area like the thighs, legs or arms. Unfortunately, I do see a lot of secondary cases in my practice, where I have to go back to the areas treated by the previous surgeon and this is always very challenging. See a board certified plastic surgeon experienced in advanced body sculpting techniques for an in person consultation/evaluation. Good luck with you further body enhancement.

George Marosan, MD
Bellevue Plastic Surgeon
4.8 out of 5 stars 38 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.