Dr. Hughes: . . . that without any blood. And that's largely because of the tumescent effect of the anesthesia that I put in before. The tumescent solution contains a little bit of lidocaine, not really important in a general anesthesia case. The important component is the epinephrine, which causes vasoconstriction after about . . . complete vasoconstriction after about seven minutes. So, that's when I start on one side and infiltrate the fluid. By the time I finish with the other side, it's been about seven minutes. So hence, there's not a great deal of bleeding. Then, by the time I've liposuctioned this on a first pass, I'm ready to liposuction the second area.

So, there is actually some thinking involved in what people call mindless liposuction. I think liposuction is the hardest procedure I do, probably. Seven hundred liposuctions a year, and I do rhinoplasties probably, you know, depends, 100, 200 a year. Tummy tucks, 200 a year. Breast augs, 400, 500 a year. Breast lifts, about half of that, maybe 200. So, I do hundreds of these different types of procedures, which other people consider very challenging. And actually, I would say liposuction, to get a great result, is the most challenging.

So, I switched to smaller cans as I divulge some of this. Some people are far more fibrous than others. This lady is particularly fibrous. So, the fat is harder to extract. It takes much longer, more demand on the part of the surgeon to get the fat out.

Please adjust the light. So, basically I can feel the probe at all times, and I'm basically right on top of the ribs right now, and I am finessing this area so that she can have a much smaller waist. Kind of repeating the same process on the other side. I will then, you know, in a few minutes, switch to the other side and come at it with my left hand, doing the exact same maneuvers. I've found that right-handed folks, if you just stay right-handed, there's always an area that's under-resected, once you're not careful. So, I've tried to develop both hands, so that I can get optimal improvement.

You can stop to . . . To make sure this nice fat . . . If you ever run into bleeding or anything like that, I usually stop on that area to make sure the blood pressure is okay, things of that nature. Then, you can usually go back in and resume that all without any difficulty. If there's a lot of bleeding, you should just stop. It's not worth it.

So, now we're going by the umbilicus, the belly button here and shaving down some fat. As you can see, I'm kind of pinching to tell the relative thickness of the flap. As the flap gets smaller and smaller, obviously I'm pinching less and less of a flap, and that's how you determine flap uniformity in your end point of liposuction.

My end point will be a lot different maybe than someone else's, because I tend to take out a lot more fat. The reason I have to do that is, number one, patients don't want to do the surgery three or four times, and neither do I. The second reason is that we do these Brazilian butt lifts, they . . . About 50% . . . There you go.

So, as I was saying, I try to, you know, get these things right the first time, so that patients don't have to come back for touch-ups. Touch-ups are always harder because of the scar of the liposuction. So, I don't have any revisions, probably. In the last year, I did probably 500 Brazilian butt lifts. I maybe revised three of them. And the three that I revised, honestly I couldn't tell much of an issue, but I try to keep patients happy.

So, second reason to get as much fat as you can is you need to use the fat for the Brazilian butt lift at that time. I don't think that you should freeze it. Until I can get some data that says that freezing doesn't harm the fat cells, then I'm going to put it in at the same day. So, that's why I need to get the optimal amount of fat the first time. So therefore, you should always try to liposuction as much as you can without creating an issue. So, that's what I'm doing.

So, we'll finish up here on the abdomen and the flanks, and then we'll flip her, and we'll do the posterior flanks and the back. So, right now, I'm just finishing off this other side here, going around the umbilicus. She had no umbilical hernias on exam. But nonetheless, sometimes people can surprise you. So, I always keep an eye on this, and I'm always feeling with the probe.

We poured out a great deal of fat. As you can see, she's come in a great deal. This is really just a fine-tuning process. So, you can see it's the same principles over and over. I'm basically holding a small piece of skin and fat, and I'll liposuction that in a uniform manner. Then, I just go back and forth over that area, kind of going farther away from the point and smoothing and checking for thickness through multiple maneuvers.


What Does a Brazilian Buttlift Procedure Entail?

Dr. Kenneth Hughes takes us into the operating room as he performs a Brazilian Butt Lift procedure on a 120lb. patient.