BUTT AUGMENTATION

Pros

• Butt augmentation procedures can add volume and shape to flat rears or contour the curves you already have.
• Implants should last forever. They’re made of a semisolid silicone (not a gel, like breast implants), so there’s little worry of rupture or leak. 
• A BBL slims and contours other areas of the body via liposuction. 
• Implants combined with a BBL create a full and natural-looking result.

Cons 

• Both surgical butt augmentation methods require at least two weeks (and sometimes six weeks or more) of downtime. 
• BBLs can be a risky type of cosmetic surgery. The mortality rate has recently dropped dramatically as surgeons have adopted safer methods, but you'll still need to make sure that your plastic surgeon is following the latest safety protocols. 
• If an implant is too big, you’ll be able to see it through the skin—especially if you bend over. Some also find them to be palpable and uncomfortable, especially when sitting. “People who are reasonable about the size of their implants tend to be very happy with them,” reports Dr. Franco. 
• The success of BBL or butt implant surgery is extremely dependent on the experience of the surgeon. Be sure to choose a board-certified plastic surgeon who performs the implant procedure and/or BBL you’re interested in on a regular (at least monthly) basis.

• Average Cost:
• $12,722

• Range:
• $3,999 - $22,000

Your butt augmentation cost depends on the type of augmentation method you choose. On average, the surgeon’s fee for buttock implants is higher than that for a BBL.

Your cost will also depend on the experience level of your doctor and their office location. As a cosmetic surgery, butt augmentation isn’t covered by insurance.

The butt augmentation photos in our gallery have been shared by the surgeon who performed the procedure, with the patient's consent.

BBL surgery candidates

A BBL is typically a good option for healthy patients who have sufficient fat to transfer. People with a BMI greater than about 22 should have enough fat. 

“I tend to like to inject 800–1,300cc per side, depending on a person’s body frame and desire,” says Dr. Franco. “But even if we only get 400–500cc of fat, that’s still going to be a good bang for your buck compared to something like Sculptra,” an injectable collagen stimulator sometimes used to enhance the butt and hips. 

Some doctors advocate gaining weight before BBL, to have more body fat to harvest. However, doing so could lead to an increase in both subcutaneous fat and visceral fat. Visceral fat cannot be accessed or removed by liposuction, and it’s much harder to lose through diet and exercise, notes Dr. Okoro. “Most people have enough fat for fat transfer, so there’s rarely a need to gain weight beforehand,” he says.

Related: Doctors Say the Skinny BBL Makes Butt Augmentation a Viable Option for a Whole New Set of Patients

Skin quality is also key to BBL surgery, because it determines how successfully a surgeon can contour your body shape via liposuction. “Having loose or excess skin is one of the reasons we most commonly turn people away for a Brazilian butt lift,” says Dr. Franco.

Butt implant candidates

Butt implants are for a niche group, says Dr. Franco. “They’re best suited for people who are too thin for a fat transfer to really make a difference and people who are looking for more projection and shape than a BBL alone can provide.” 

For best results, good candidates for implants can’t have too much loose skin—unless they’re willing to combine their implant procedure with a butt lift or a nonsurgical skin-tightening procedure, like BodyTite or Renuvion. Implants can create a rounder rear, with more projection, but they don't have much effect on loose or excess skin.

Buttock enhancement surgery is the most common way to boost a booty, but for those averse to surgery or general anesthesia, injections of biostimulatory fillers, like Sculptra Aesthetic—made of collagen-triggering poly-L-lactic acid, the same material comprising dissolvable sutures—can add volume, with minimal downtime. 

Be advised, however, that buttock injections like the “Sculptra butt lift” are not true replacements for a BBL or butt implant. 

“If you’re looking for a dramatic change to your butt, it’s going to be very, very difficult with Sculptra,” says Dr. Franco. “You’ll need a large amount, and it would be very expensive.” In fact, it can be almost as expensive as a BBL surgery—think: tens of thousands of dollars—even though results last only about two years.

Plus, with fillers, nothing is being taken away as it is with a BBL. “You don’t have the benefit of subtracting love handles to give someone more of a figure,” says Dr. Franco. “People don’t realize that if you don’t do a good job with the lipo, which is where you can really shape the torso, you’re not going to get a great butt.”

Related: 5 Things You Need to Know About Butt Injections

Silicone injections (sometimes called “butt shots”) have also been promoted as a way to increase the size of your rear end, but doctors on RealSelf strongly recommend against this treatment. The U.S. Food and Drug Administration (FDA) has also posted this warning on their website: “The FDA has warned against getting filler injected into the breasts, buttocks, or spaces between the muscles. Using injectable filler for large-scale body contouring or body enhancement can lead to serious injury, including long-term pain, infection, permanent scarring or disfigurement, and even death.”

“The difficulty with silicone injections begins with the quality of the silicone itself. I have seen many cases where industrial-grade silicone has been injected inside the human body. This can be a tremendous disaster,” says Dr. Raj Ambay, a plastic surgeon in Wesley Chapel, Florida. “Problems can include infections, granulomas, cellulitis and persistent skin infections, disfigurement, and skin dimpling.” 

Related: 5 Things That Should Never Happen with Butt Augmentation, According to Plastic Surgeons

The nomenclature for buttocks surgery can be confusing. It used to be that the term “butt lift” (or “butt tuck”) referred to a surgical procedure that removed loose, sagging skin from above the buttocks, to elevate and improve the contours of the rear, making it perkier. It was often performed after significant weight loss, either by itself or as part of a body lift to more completely hike the lower body.

Now that fat transfer and buttock implants have become so common, however, people often say buttock lift when they mean buttock augmentation, explains Dr. Franco. “When people say butt lift with augmentation or butt augmentation, they’re referring to adding something, whether that’s fat or an implant,” explains Dr. Franco. “They’re not always sure how they want to achieve an augmentation, but they know they want to do something to enhance their buttocks.”

RealSelf Tip: Beware of creams or supplements that promise buttock enhancement. “Other than being genetically blessed and/or doing rigorous dedicated exercise, there’s no ‘natural’ way to grow the buttocks, other than surgery,” says Beverly Hills, California, plastic surgeon Dr. Ryan Stanton.

Whether you get buttock implants or a BBL for your buttock augmentation surgery, expect to have at least two weeks of downtime. This recovery period helps the implants to “settle” (so they’re less likely to move around) and the fat to “take.” 

You can also expect the following during your buttock enhancement surgery recovery:

• You‘ll experience discomfort, bruising, and swelling for a few weeks.
• Your surgeon may prescribe pain medication for the first few days, and you can manage pain with over-the-counter pain relievers after that. 
• During your recovery time, you likely won’t be able to sit unless you’re using the restroom. “Patients can sleep on their back, stand, walk, and kneel facing forward in a chair during those first two weeks,” says Dr. Stanton. After that, your surgeon may allow you to use a special pillow that keeps pressure off your rear end.
• You’ll also need to wear a compression garment for two to three weeks following implants or four to six weeks after a BBL.

Related: 8 Products Plastic Surgeons Recommend for a Successful Brazilian Butt Lift Recovery

With either method, you’ll see more volume and contour immediately, but final results can take between six months and a full year to surface. 

Implants are going to be really tight and look a little high post-surgery, and the buttock area isn’t going to be nice and round yet, says Dr. Franco. “It’s a preview, but it’s not your final result—it’s going to get better.” It takes about six months for your new body shape to reveal itself as the swelling goes down and the tissues relax over the implants. 

With BBL, how you look in your compression garment post-op is how you’re going to look three months down the road. “At three months, your butt is what it’s going to be permanently, but swelling from the liposuction continues to improve for up to six months,” says Dr. Franco. “That means the overall result keeps getting better because the smaller your waist, the better your butt.”

The results of both butt augmentation procedures are long-lasting: 

• With a BBL, the fat cells that survive the transfer will remain (the typical retention rate is 40–50%). 
• Butt implants will only need to be removed if a complication arises.

See butt augmentation before and after photos

Gluteal implant risks and complications

Butt implant surgery carries risks of incisional separation, implant extrusion, infection, and seroma (a buildup of fluid). It’s also possible for the implant to move, leading to asymmetry and pain. Complication rates have been dropping, mainly due to doctors gaining more experience in the procedure. 

BBL risks and complications

BBLs have a higher mortality rate (on par with that of a tummy tuck), but due to the recent adoption of new techniques, they’re reportedly getting safer—when performed by board-certified plastic surgeons. 

Recent research from a task force of board-certified plastic-surgeon members from the American Society of Plastic Surgeons (ASPS) and the International Society of Aesthetic Plastic Surgeons (ISAPS) shows a drop in mortality rate from 1 in 3,448 in 2017 to 1 in 14,952 in 2019. 

The main safety precaution that should be taken during a BBL is injecting fat only above the gluteus muscle. If placed into the muscle, below the muscle, or under the fascia that covers the muscle, there is a risk of fatal fat embolism, where fat enters the gluteal veins and travels up to the heart and lungs, causing death.

Additionally, many plastic surgeons are now offering what’s called an Ultra BBL, or ultrasound-guided gluteal fat grafting, during which they use ultrasound technology to visualize the anatomy and accurately target safe planes for fat injection.

Other risks of the BBL include asymmetry and issues related to fat necrosis. Not infrequently, some amount of transferred fat does not survive the transplant, says Dr. Stanton, “leaving one cheek bigger than the other.” Moreover, when fat cells die, hard cysts and dimpling can also result.

Related: New Risk-Reducing Guidelines Help the Brazilian Butt Lift Reform Its Reputation

Aesthetic Plastic Surgery National Database Statistics, The Aesthetic Society, 2019.

Rios, Luis, and Varun Gupta. “Improvement in Brazilian Butt Lift (BBL) Safety With the Current Recommendations from ASERF, ASAPS, and ISAPS.” Aesthetic Surgery Journal, 19 Apr. 2020.

Sinno, Sammy, et al. “Determining the Safety and Efficacy of Gluteal Augmentation.” Plastic and Reconstructive Surgery, vol. 137, no. 4, Aug. 2016.