Trangender patient who wants to feminize my figure. Is a BBL procedure an option for my body type? (photos)

Question

I am a transgender patient hoping to get a BBL soon. INothing too dramatic, just to transfer enough fat to help feminize my figure. I’m currently 5’8 157lbs. But I have concerns that there simply isn’t enough fat to even operate. And if it matters I’m still fairly muscular due to having been an athlete for some years, even after being on HRT for the past 3 years. I also wonder about putting on weight for this procedure and have heard both yes and no about that. Thanks in advance!

J. Timothy Katzen, MD, FACS · Answer

Hello,
Thank you for reaching out with your question about whether a Brazilian Butt Lift (BBL) procedure is a suitable option for you as a transgender patient looking to feminize your figure. Given your description and provided pictures, here are some key considerations:
Current Body Fat: At 5'8" and 157 pounds, with minimal body fat as observed in your pictures, the primary requirement for a successful BBL – sufficient fat for harvesting and transfer – is not met in your case.
Weight Gain for BBL: To undergo a BBL, gaining weight might be necessary. Approximately 20 pounds could provide enough fat to successfully transfer to the buttocks and hips. However, this approach requires careful consideration and planning, as weight gain should be healthy and sustainable.
Alternative Procedures: Considering the lack of sufficient fat for a BBL, you might want to explore the option of buttock and hip implants. These implants can provide a more defined and feminine body shape without the need for fat transfer.
Tailored Approach: Each body is unique, especially in the context of transgender body contouring. It’s crucial to have a personalized approach that takes into account your specific goals, body type, and health considerations.
Consultation with Specialists: It's highly recommended to consult with plastic surgeons who have experience in transgender body contouring. They can provide more personalized advice and help you understand the risks, benefits, and potential outcomes of different procedures.
Comprehensive Assessment: Before proceeding, a comprehensive assessment by your healthcare provider or surgeon is essential to ensure that any chosen procedure aligns with your overall health and transition goals.
In conclusion, while a BBL might be an option, it appears that without additional weight gain, the procedure may not be feasible for you currently. Buttock and hip implants could be a viable alternative. Consulting with experienced professionals will be key in making an informed decision.
Sincerely,
Dr. Katzen

Giovanna Ghafoori, MD · Answer

Congratulations on your journey. An in-person exam will ultimately help determine whether you are a good candidate for a feminizing BBL, as well as the degree of improvement you might achieve. Looking at your photos, you are indeed quite lean, and your expectations would need to be adjusted accordingly. That being said, even a small amount of transferred fat, strategically placed, often can yield favorable results — in your case, since you have overall good buttock volume and shape, fat transfer to the hip dips, and possibly the flatter buttock area if additional fat was available, would be a priority.

In reviewing your photos, it does appear that there are some fatty deposits, likely from the HRT, around the umbilical area that may be usable. Often, there are some hidden deposits in the axillary region, and it looks like you may have a little there, as well. Both of these sites would experience contouring benefit from the fat removal. There appears to be some fatty deposition in the inner thighs and upper hip-lower flank areas. These deposits are actually feminizing in an attractive way when they are not excessive, and removal would be counter to your goals.

Another consideration, in isolation, or as an adjunct to a BBL, is a “non-surgical BBL.”  This would entail the Off-Label use of a product (meaning the product is being used outside of the FDA-approved indications, and has not been investigated and deemed safe for the altered use by the FDA), called Sculptra, in which a micronized, powdered substance, similar to the make up of a particular absorbable suture used in surgery, is injected into the deeper skin/upper soft tissue level. The body’s inflammatory response to this ultimately substance induces collagen production, which may provide limited volume and structural support. Results do take months, and repeat treatments (as well as maintenance treatments) are usually required.

Regarding whether one should gain weight prior to a BBL does not have a simple answer. No doubt, additional fatty deposits would give more treatment flexibility and optimize results and volume. However, the added weight may or may not accumulate in areas most conducive to liposuction removal. For example, being genetically male, a considerable proportion of the added fat could be deposited as visceral fat, which is internal and not accessible. Also, there may a disproportionate deposition in the flanks and chest area. The flank fat would be readily accessible to liposuction, but this fat tends to be more fibrous and may be of more inferior quality for fat transfer compared to other regions. Fat deposited on the sides of the chest would be good fat for removal, but likely fat on the from of the chest would be preserved to help maintain a feminine look. The other dilemma of pre-BBL weight gain is planned post-BBL weight loss to address the undesirable fatty deposits not conducive to weight loss. Any successfully transferred fat will be responsive to weight gain and weight loss, and the subsequent loss of volume is likely.

Wishes for a successor surgery and a speedy, uneventful recovery should you decide to proceed.

Mats Hagstrom, MD (license on probation) · Answer

Fat transfer would be the procedure of choice.
For individuals who have a low BMI or lack of sufficient fat the question becomes is the procedure justified.
Some results can always be obtained, but in order to get a quality fat transfer would most likely require lip sectioning most of your body.
 I do not recommend gaining weight and based on your pictures I think you have a propensity for a visceral fat distribution so weight gain will just give you a big belly without a significant increase in subcutaneous fat harvesting.
Rarely do people feel better about themselves being heavier.
 Losing weight after procedure, makes the idea of gaining weight for fat transfer pointless.
Assess how much fat can be harvested from liposuction on low BMI patient is one of the hardest parts of this type of work, and for sure requires an in person consultation.
On top of this the number of plastic surgeons have truly mastered liposuction and fat. Transfer is relatively small.
 Having Liposuction of most of your body if your provider is not well, selected could potentially lead to catastrophic deformities or other undesirable outcomes.
There are a lot of variables to take the consideration.
In the end, patient candidates the provider selection are the two important variables. Understanding your own candidacy i.e. how much fat do you have to harvest? How will your results turn out? Is best obtained by getting in person, consultations by sufficiently experience providers.
Finding the right provider typically requires having multiple in person consultations.
During each consultation, ask each provider to open up their portfolio and show you their entire collection of before, and after pictures of previous patients lead similar body characteristics to your own.
 When reviewing before and after pictures, always confirmed the timeframe of when after pictures were taken.
Early fat transfer results can look very impressive but do not in anyway represent final long-term results.
You should also ask specifically exactly what areas were treated with Liposuction and look very carefully at transition zones between treated and untreated areas.
 if you move forward with the procedure, you will most likely have subtle results and you will need liposuction of your entire torso with possible removing fat from extremities if fat is available.
For individuals who don’t heal well simply having that number of incisions put on their body may be as sufficient deterrent to not have the procedure unless it can give a significant improvement.
 What works for one person may not work from someone else and let me again emphasize the importance of provider selection.
The number of plastic surgeons who’ve truly mastered this procedure are in a small minority and are not necessarily easy find.
When in doubt, slow down and schedule more consultations.
Best,
Mats Hagstrom, MD

Trangender patient who wants to feminize my figure. Is a BBL procedure an option for my body type? (photos)

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