I’ve been seeing more and more consultations lately asking for better bottoms. And the demographic of the women who want these has been changing too. Back when I first started doing these a few years ago, patients wanted to be full and round and BIG! And while I still do get those requests, the most common catchphrases I get now during these consultations are “natural”, “contour” and “lift”. My staff and I compare notes and we’ve also noticed that there are patients asking for bottoms who have had multiple children and could use tummy tucks or breast lifts too, but they prioritize their bottoms over their breasts and tummies. Not only that, I’m also seeing more smaller-framed, fit females who just want a little more. These used to be patients that plastic surgeons would say were not candidates for fat transfer because they don’t have much fat, but again, I’m finding that because their expectations and goals are reasonable, they are ultimately achievable… with fat! Not implants.
Let’s do some role-playing. Imagine we are standing in front of a mirror together. Yes, face the mirror first. Creating or improving the buttocks starts with the waistline. There used to be a Victorian-era term “wasp waist” because back then, women wore corsets to create the illusion of a tiny waist. They could squeeze themselves even down to 19”! The most envied women were those with waists so small that you could wrap your hands around them. So they could barely eat and breathing was difficult, but they looked amazing! These days, we have resorted to waist trainers for a similar goal. Ok, back to the consult. Here is where I point out where your waist should be and whether there is fat to be harvested from the abdomen and flanks (love handles). We may also look at your thighs and arms. Then I have you rotate 90 degrees so we can look again at your flanks from the back and also your back. These are usually high yield areas for fat harvesting, even in tiny people. I tell you that 90% of what I do for this procedure is in the liposuction, or liposculpting as I like to think of it. It’s not enough to just take out as much fat as possible, you need to appreciate anatomy and have a 3D vision of what you’re trying to achieve. Carving out the foundation is the most important step. Filling with fat is just the icing on top. I can make you look like you have a rounder, fuller bottom just with lipo! BUT, while we have it, no reason to waste all that wonderful fat!
Looking at the buttocks themselves, most women who want this surgery have V-shaped or square buttocks where the waist and hips are similarly proportioned and then there is volume loss in the buttocks themselves. My goal is to create an A-shape or upside-down heart-shaped bottom. Essentially taking from areas that have too much and replacing it where you need it most. And for most women, that deficit is at the top of the buttocks where you expect that nice curve of the back and waist to flare out into a rounded bottom. However, it is not enough to only fill where there is the most need. The buttock is like a pyramid, in order to get the projection (tip of the pyramid) that you want, you first need to build up the base and work up!
I always tell my patients that fat survival in the buttocks is approximately 50%, 70% at most. They will feel huge right after surgery, but by 4 weeks after surgery they’ll think that their buttocks have shrunken considerably and worry that more will go away. At this point, I show them their before photos and they are reassured that their results are there.
Getting more technical, I am required by safety regulations to keep my total liposuction volume to 5 liters or less. That’s 2 and a half big Coke bottles. Once I process and purify the fat, I typically have a yield of 2.5-3 liters (a little more than half). Then I take that and inject it into the buttocks. I may or may not use it all depending on your goals and your anatomy.
Now, safety is my top priority when it comes to surgery. And there has been a lot of press about the dangers of fat transfer to the gluteal areas. There is even a multi-society task force made up of specialists who have carefully evaluated the data on deaths due to fat transfer to the buttocks and who make recommendations so that you are protected. Fat injected without taking precautions can end up in the gluteal veins and in the most dire circumstances lead to rapid decline and death! The mortality rate for this procedure is 1/3000, the highest of any elective, cosmetic procedure!
Post-operatively, you go home the same day in a compression garment that I like you to wear for 4-6 weeks. I encourage you to keep pressure off your buttocks (limited sitting, sleeping on your side or tummy) for 3 weeks (this is conservative!) to allow the fat to integrate with your body and allow the best survival. There are booty pillows and pool noodles and footballs that you can perch on to keep pressure off the area. It’s not comfortable, but the results are worth the effort. I see you 1 week after surgery to make sure you are feeling well and that there aren’t any issues.
Many of my patients worry that the fat will go away. I tell them that this fat acts just like the fat from the areas that I took it from. Typically these are the stubborn areas that don’t want to budge even with dedicated diet and exercise. If you gain a lot of weight, your bottom will grow. If you lose a lot of weight, your bottom will shrink.
That’s just about it! It’s not a terribly uncomfortable procedure, you are sore for the first few days, similar to doing an intensive full-body workout when you’ve been out of shape for a while. Collagen remodeling peaks at 3 months so you will see improvements in your skin up to that time. I recommend maintaining the tone of the buttocks with gluteal workouts, but other than that, go and shop and enjoy!
