Only Liposculpture/ Lipo or BBL in this case?

Question

33 year old female, active & very healthy nutrition style still with fat deposits on legs all over &skin with cellulite/irregularities. Height is 5'6", current weight is 153lbs. Lost 20lbs within 3years which didn't help the skin issue. Recently had tumescent lipo on inner thighs, knees & flanks& now need a revision of contour irregularities. Wondering if a BBL is smarter to achieve my dream look or liposculpture only to improve the dimply deflated butt and legs?

Alan Gonzalez, MD, FACS · Answer

Hello @Courageous350663, thank you for your question. I suggest a generalized liposculpture so that the size of the fold is adequate and improves in a significant way. You can also think about improving the buttock with TID in your surgical plan. To obtain more information and recommendations, it is best to consult one or more board-certified plastic surgeons. Best wishes! Alan Gonzalez MD, FACS.

Andre P. Marshall, MD · Answer

Hi Elena07, 
Liposuction or Liposuction with BBL is completely up to you and what your ultimate goal or dream look is. There are treatments for cellulite available. In regards to contour irregularities after previous lipo, these can often be treated with revisionary surgery and or additional modalities such as Renuvion to provide radiofrequency energy to the fibers underneath the skin. 
Dr. Andre P. MarshallDouble Board Certified Plastic SurgeonBeverly Hills, CA 90210

Daniel Barrett, MD · Answer

Dear Elena07,
based on your photos, you look like a good candidate for a BBL. Liposuction of your abdomen, back and flanks should give you more curves and hourglass shape and fat transfer to buttocks should give you more projection. I would suggest you to consult a board-certified plastic surgeon because 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

Mats Hagstrom, MD (license on probation) · Answer

Delivering consistent quality liposuction results is more difficult than most people believe. Most plastic surgeons despite board certification and having an overall good reputation aren’t actually all that great at the procedure. To master body contouring requires years of experience with a commitment towards excellence with performing thousands of liposuction procedures.
Inner thigh liposuction is technically difficult and often does not deliver the results patients had hoped for. Contour is highly dependent on skin laxicity and removing the fat does not improve the skin laxity in this area. The area is prone to getting indentations in the mid inner thigh if not done correctly.
There are multiple tude of reasons why inner thigh Liposuction fails to deliver results patients had hoped for but those who specialize in body contouring generally all agree that it is a challenging area to treat and it should be reserved for patients Who are good candidates. 
Most plastic surgeons do the procedure under general anesthesia with the patients laying on their back. This is not a good position for contouring the inner thigh. inner thigh liposuction should be done with patients laying on their side and this is a much better procedure done with patients awake using local anesthesia with or without sedation. some plastic surgeons have the skill and experience to do body contouring without general anesthesia. It is also possible to position patients on their side during general anesthesia but it is a cumbersome, time-consuming and unpopular positioning request to do. Simply repositioning a patient under general anesthesia requires six people can take up to 30 minutes.
This is why doing liposuction with patients awake as multiple advantages though the greatest is the ability for the patient to move on their own and hold different positions allowing the surgeons to contour their body appropriately.
Revision work is many times more difficult than primary liposuction and can easily make things worse.
Correcting poorly down liposuction is generally done with revision liposuction, fat grafting or a combination of both.
Revision liposuction is based on removing more fat and since removing fat created the problem this can potentially make things worse.
Grafting fat can be successful but the amount of fat that can be grafted is often limited because the area where it’s needed is now devoid of host tissue to support the graft.
These are some of the reasons why revising poorly done liposuction results is so difficult and patients need to be careful about having revisions and also who should do them.
A BBL primarily adds volume. It can add shape to some degree especially in the transition from the buttocks to the love handles.
Fat transfer generally will not treat cellulite and can easily make cellulite worse.
I don’t see you as being a good candidate for a BBL. Based on your pictures your bottom has enough size compared to your thin waist and making your bottom bigger will make you disproportionate while not giving you the smooth skin you’re hoping for. It may be a procedure that you want to consider but those are my thoughts based on the information posted.
If you want to move forward with the BBL then I would start looking very carefully and before and after pictures of patients who are very similar body characteristics to your own.
Like I mentioned earlier delivering consistent quality liposuction results is more difficult than most people believe it. Fat transfer is even more so.
On top of this A significant number of plastic surgeons have quite distorted versions of what an attractive body should look like when it comes to doing body contouring especially with the BBL procedure.
I see too many patients who’ve had liposuction and done under auto thigh in order to emphasize having a big butt which in my opinion creates a very unnatural body contour I call the “lollipop look”. These cartoon caricature versions of women’s bodies are undesirable and patients need to be careful for what they ask for but more so be selective in choosing the right provider.
Both Liposuction and fat transfer can give spectacular body transformations that are breathtaking when done correctly and patients who are truly good candidates.
Candidacy and surgeons skill are both equally as important. There’s little patients can do in regards to candidacy with the exception of weight loss when indicated but patients do have the ability to choose the right provider.
Finding the right provider is easier said than done. My best recommendation for finding the right provider is to have multiple in person consultations. I recommend patients avoid virtual consultations whenever possible.
During consultations ask each provider to show their entire collection of before and after pictures for the procedure you’re interested in. Being shown a few sample pictures which most likely represent the best result of the providers career is insufficient to get a clear understanding of what average results look like in the hands of each provider.
This is why patients need to be advocates for themselves and vet their surgeons carefully. it’s completely appropriate to ask the provider to open up their portfolio and show as many pictures as they have or feel comfortable showing.
For example you may wanna ask the provider to show as many pictures as they have of patients who have similar body characteristics to your own. You may also want to ask them to show you results that are excellent, average and less than. We all have a variety of results and it’s fair game to ask to see those pictures.
And experienced surgeon should have no difficulty showing you a minimum of 50 sets of before and after pictures for a common procedure like the BBL. for fat transfer procedures make absolutely sure after pictures were taken at least three months from the date of the procedure since early results can be very impressive but do not at all represent final results.
Highly experienced surgeons will have hundreds or even thousands of before and after pictures for commonly done procedures.
Surgeons who are thorough, detail oriented and service patient advocates will show this including enthusiasm for the procedure during the consultation.
I also recommend reading all reviews on various physician review websites avoiding providers with any significant number of justified negative reviews. The absence of justified negative reviews is more important and more telling than having an abundance of positive reviews.
In the end I recommend patients stay on the side of caution and slow down and schedule more consultations until they feel quite comfortable they found a plastic surgeon who has the skill and experience to deliver the results they’re looking for.
Quality plastic surgeons are not only good at performing surgery but also at making quality assessments.
The ability to accurately predict who is going to get what results takes years of practice. The ability to predict results accurately is equally as important as delivering quality results.
In the end you’re a surgeon is responsible for the outcome of the procedure and you are responsible for choosing that surgeon. Considering that they didn’t get it right the first time they may or may not be the right surgeon to do the revision work.
I have shared with you my thoughts on the subject. My recommendation is to be highly selective before taking another step.
The names are used in plastic surgery for various devices or marketing terms like Liposculpture have no input or importance when it comes to delivering results. liposuction is Liposuction and the name of the device used or spinning the name of the procedure does not change the outcome nor does it change the skill of the provider.
Good luck with your decision making.
Mats Hagstrom MD

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