Skinny BBL - little to no result - second round offered but unsure if I can gain fat? (Photo)

Question

I am 4 weeks post op, skinny 'BBL' with vaser lipo, abdominal edging and implant exchange. They knew I was petite (5ft 1) and on the skinnier side, but still said i would achieve my goal pics. I wanted a rounder shape and to fill my hip dips. When I came round I was told they could only get 400cc fat, 200cc in each flank - middle part empty!!!!! It has now gone!! I struggle to gain weight yet they've offered me a second round at no charge - I don't trust this is good advice and I'm scared.

Ryan A. Stanton, MD · Answer

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.

You are in good company with many others who had high hopes for BBL but instead received disappointing results (lumpiness, unevenness, lack of projection in the central and/or lower buttock, insignificant hip augmentation, post-deflation sagging, fatty necrotic cyst or scar tissue, etc.) as most of the fat melts away. It is not quite as much the quality of the doctor nor liposuction technique but rather the quality of the procedure that is a large part of the problem.  Thus, going back for additional rounds of BBL most often produces the same disappointing results but at another financial loss.   Beware, if a surgeon asks you to purposely gain weight (i.e. fat) before BBL, know that the fat you lose first as you get back to your baseline weight after surgery is that very same fat that was transferred into your buttock, hence your new buttock shrinks first, the fastest, and the most...so please do not fall victim to this recommendation. In other words “skinny BBL” is bogus, period.

Fillers, such as Sculptra and hyaluronic acids,  for augmentation of the buttock/hips are a rip-off, period!

Buttock/hip implants, however, provide a more reliable, predictable, relatively safe, and permanent result, especially for adding projection to the hips and central buttock, and often help smoothing out lumpiness. Occasionally a lower buttock tuck may be advantageous for lower buttock fold asymmetries and/or sagging.  When considering buttock implants make sure that the surgeon is going to be placing the implants within gluteus muscles , (a.k.a. “intramuscular pocket”), and that they are using anatomically correct, oval-shaped implants, such as Stanton Anatomic ®️ implants. 
Please keep in mind that an extremely few number of board-certified plastic surgeons specialize in these buttock implants so be sure to consult with one that is reputable and experienced. Unfortunately you may have to travel long and far away from home to find this particular surgeon. Glad to help.

Daniel Barrett, MD · Answer

Dear TechnoCatsAndDogs66,
it is hard to tell for sure without an examination. Based on your photos, it looks like you don't have much extra fat so you probably won't get much better results after revision. If you are considering surgery, I would suggest you consult a board-certified plastic surgeon. Only after a thorough examination, you will get more information and recommendations.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Mats Hagstrom, MD (license on probation) · Answer

I’ve never met a person who was happy after gaining weight.
The exception would be those with eating disorders.
Unless you plan on maintaining the weight gain, then gaining weight for fat transfer makes no sense.
This type of work is highly complex and the number of plastic surgeons who are really good at it are far and few between.
To start with it’s important that we treat the torso as one anatomic unit when doing liposuction.
This means that not only the abdomen flanks and lower back should be treated, but the entire back and the under arm area (armpit) all the way to the side of the breast are potential sources for harvesting fat.
I usually refer to this as a “full torso”, “leave no fat behind”
A full torso basically the entire midsection except the breast.
 Some fat can be harvested by doing a second round of liposuction. If you had VASER then the amount of fat left behind is probably not very much.
In my experience, 25% of the fat harvested during the primary procedure can be harvested from secondary Liposuction in patients who’ve had no change in weight.
Anticipating how much fat can be harvested from someone based on a physical examination is tricky.
 Being able to make accurate assessments is something that requires years of skill and experience.
Did you have an in person consultation with this provider before scheduling surgery?
How many plastic surgeons did you interview before selecting this provider? 
If secondary liposuction is not an option, or the torso has no more fat to give, then I typically turn to extremities.
Arms can give spectacular liposuction results and inner thigh blending with a front of the thigh, can serve as excellent sources for harvesting fat.
I’ve had plenty of patients who had more fat on their inner thigh than they did on their entire torso.
Each person will have their own unique fat, distribution and getting an accurate assessment always requires an examination.
Most people who are thin want a yes, or no answer if they are a candidate for fat transfer.
Rarely is the answer as simple as yes or no.
There are definitely people who simply don’t have subcutaneous fat, and the procedure is simply not justified.
For most of the patients the answer falls into a gray area and the deciding factors come down to how much Liposuction is the patient willing to have and does that justify the results.
A sufficiently experienced surgeon should be able to assess how much fat can be harvested and should be able to show you a large number of quality outcomes based on that information.
In other words a sufficiently experienced provider should be able to predict with accuracy the type of outcome you’ll have, and show you an impressive collection of previous patients, who looked similar to how you do.
Being talented at Liposuction and fat transfer is more than just the technical aspect of removing and grafting fat.
Includes the ability to make accurate assessments and deliver predictable outcomes.If your provider couldn’t deliver results the first time, then it is unlikely they’ll be able to deliver results with the second procedure.
Gaining weight and being chubby is probably not on your wish list.
Gaining weight will cause visceral fat to enlarge and give you a bigger midsection.
It is not the right way to do this.
The fact that weight gain was suggested is in my opinion, suspect by itself.
Your surgeon should’ve examined you, given you an accurate assessment, and communicated in a clear, straightforward manner of what this procedure could or could not deliver.
Surgeons are responsible for surgical outcomes, and patients are responsible for provider selection.
Best,
Mats Hagstrom, MD

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