Body contouring BBL

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What is BBL Liposculpture: Technique and Safety

Liposculpture (lipomodeling) is a minimally invasive plastic surgery procedure that allows fat to be removed from problem areas of the body (abdomen, waist, lower back) and transferred to areas where fat is lacking (most often the buttocks). The augmentation of the buttocks with fat is called the "Brazilian Butt Lift" (BBL – Brazilian Butt Lift). Since I prefer a more athletic shape of the buttocks, I prefer to use the term “Athletics Butt Lift.”

Safety comes first. Ultrasound-guided BBL

I perform this procedure using my author’s DualWave Sculpt technique — a combination of ultrasonic and vibro-tumescent liposuction. This approach provides the best result with minimal trauma, faster recovery, and a significantly reduced risk of complications.

• Ultrasonic liposuction is used when it’s necessary to reduce the amount of subcutaneous fat by breaking down fat cells through high-frequency vibrations that heat the tissues and simultaneously enhance fibrosis.
• Vibro-tumescent liposuction is applied when it’s important to reduce the thickness of the fat layer while preserving the viability of fat cells (adipocytes) for further lipofilling. For successful lipofilling and to achieve the highest fat survival rate, it is crucial to inject live, undamaged fat cells.

For maximum patient safety, I use an ultrasound device. The ultrasound sensor allows for precise control of the cannula position and the fat injection area, ensuring the highest accuracy and an ideal aesthetic outcome.

Advantages of the DualWave Sculpt Method

BBL liposculpture (Brazilian Butt Lift) is recognized as the fastest-growing surgery in terms of the number of procedures performed in the USA and Europe. Numerous studies have confirmed that the transition line from the waist to the buttocks is the most prominent symbol of sexuality for both the female and male body.

Before undergoing liposculpture, lipofilling, or 3D body contouring (body sculpting) procedures, patients with fuller body types should maintain their current weight. Patients with a lower weight (body mass index below 18) need to gain additional weight. The exception applies to patients with a body mass index above 30 — they need to lose weight before surgery until reaching a BMI of 25.

For slim patients with a BMI of 18–21, Skinny BBL is recommended. This procedure is a variation of the classic BBL and makes it possible to increase buttock volume while also improving the contours of the waist and hips using a minimal amount of fat. At the same time, liposuction of more body areas may be required to harvest a sufficient volume of fat tissue. It is important to keep in mind that gaining an extra 1 kg of weight provides only 100–200 g of fat tissue. This is because the gained weight is evenly distributed throughout the body, while fat is harvested only from specific areas.

With Skinny BBL, it is also possible to achieve a significantly more defined athletic abdominal contour, depending on the patient's preferences.

Indications for BBL Surgery

The core of body sculpting involves drawing fat from certain areas  (liposuction) and then transplanting it into areas with a deficit of fatty tissue (lipofilling). Fat can be selectively drawn for this purpose.

For the buttocks, it is crucial to take fat from the loins. This achieves a beautiful “waist-to-buttocks” transition. The main secret is effective liposuction of the loins and sides to form an ideal waist and moderate augmentation of the buttocks, making them more resilient.

Photo: Brazilian Butt Lift 2 years post-op and narrowing of the waist 6 months post-op

Additionally, liposculpturing can be used to create an athletic abdomen. For instance, one can form a deeper central line and more defined abs. Interestingly, the primary clients for abdominal sculpting procedures are fitness instructors, both male and female. Some of them struggle to achieve a nicely defined abdomen despite their efforts. In such cases, liposculpture provides a solution. In about an hour, one can achieve results that might otherwise take years of effort.

If we talk about the ideal proportions of female buttocks (as opposed to male), then the point of their maximum lateral projection should coincide with a perpendicular passing through the middle of the gluteal fold. In this case, the apex (the most protruding point of the thigh line) will be "in its place" (photo 1)

Before the operation, the apex is lowered relative to the middle of the fold by 8 cm, which is perceived as a gluteal fold (photo 2).

In this case, I did not remove fat from the gluteal fold area, but added volume above it. Although there is an option for one-time reduction of the gluteal fold and moving the apex up. This area is corrected exclusively with fat. The implant is always installed only in the central zone, and the shapes and lines do not change in the lateral zones. This is the great advantage of fat.

Photo 3 shows the location of the implant. It is clearly visible that the implant will only increase volume in the central zone, but cannot affect the position of the lateral line and the apex of the thigh. That is why for creating beautiful buttocks, one implant installation is not enough, it is desirable to supplement volumes with fat or do everything with fat.

BBL Surgery Technique Step by Step

Anesthesia

• Ultrasound-guided BBL surgery is performed under general anesthesia (gas anesthesia with Sevoflurane or intravenous with Propofol, which are easily tolerated)

Surgical Technique:

• Stage 1 – Liposuction. To harvest fat, I use the most advanced technique, DualWave Sculpt — a combination of ultrasonic and vibro-tumescent liposuction. Tumescent liposuction with PAL vibrating cannulas allows fat cells to be separated without damaging them (the fat is broken down much more evenly than with classical suction liposuction, which tears the fat out by force). A special fluid is injected and evenly distributed through the tissue using a vibrating cannula, which helps loosen fat cells from their fixed position into a free-floating state. Only after this step, the cannula is switched to fat harvesting mode. Liposuction is not performed completely to zero — to achieve a smooth, even contour without bumps, a thin layer of fat must be left. In most cases, I leave about 40% of the original fat volume, which ensures the smoothest and most natural result.

• Stage 2 – Lipofilling. Using an ultrasound device, I identify precise anatomical landmarks for fat injection. Then, under ultrasound guidance, a thin 2 mm cannula is used to inject the fat. The procedure is performed without incisions — only through micro punctures about 3 mm in size. Between 50% and 80% of the transferred fat typically survives, depending on the area and the amount of fat injected per unit of surface.

I was among the first to adopt the tumescent vibroliposuction technique, as the use of vibrating cannulas allows fat tissue to be separated with minimal trauma, thus preserving viable fat cells for further transplantation. As a result, the cell survival rate and engraftment efficiency are significantly higher than with other liposuction methods.

Duration of the operation: 1.5 - 2 hours

Photo: Result immediately after Brazilian Butt Lift

#1 photo side view.
You can notice not only the change in shape, but also the size of the buttocks due to the injection of fat, as well as liposuction of the lower back.

#2 photo top view.
This angle allows you to assess not the volumes, but directly the shape of the body. The body has acquired its ideal features. By removing fat from the outer part of the thigh - the gluteal fold, and then injecting it into the buttocks, giving the desired shape. As a result, we obtained beautiful smooth, symmetrical body lines.

#3 photo 3/4 view
You can immediately see how the volume has increased and how expressive the curve - the lower back has become.

BBL Fat Transfer: Harvesting and Injection Areas Explained

The diagram below shows the layout and approximate size of fat harvesting (liposuction) and injection (lipofilling) areas.

How Much Fat Can Be Injected Into the Buttocks During BBL?

There is no definitive answer to this question, as any number provided will be approximate.

After liposuction, the lipocollector (a specialized container for material collection) contains a mixture that includes:

• live fat cells,
• damaged fat cells,
• blood cells,
• Klein’s solution, which is injected into the liposuction areas.

Each doctor uses a different amount of Klein’s solution depending on their experience and clinical needs. Sometimes the solution can make up 50% of the mixture, and sometimes up to 90%. Before injecting the fat, Klein’s solution is partially removed to preserve the maximum number of viable fat cells. However, due to the mixing of components, it is impossible to completely drain the solution, and a portion of it remains in the lipocollector. This is not a drawback, as the solution contains a high concentration of stem cells and growth factors that enhance the survival of the injected fat cells. Modern approaches to lipotransfer suggest that completely removing the solution is not advisable.

Therefore, if a doctor states that 1000 ml was injected into the buttocks, this could mean anywhere from 300 ml to 700 ml of fat tissue. This amount depends on the quality of the patient’s fat, the preparation method, and the doctor’s expertise.

In my practice, I strive to achieve a ratio of approximately 70-80% fat tissue and 20-30% solution for optimal results.

Combining BBL with Other Surgeries

Liposculpture DualWave Sculpt can be combined with almost any surgeries that do not require extensive intervention. In my practice, I often combine Ultrasound-guided BBL surgeries with rib reshaping, complementing them with corset wearing, diet, and exercise. In this case, there is an opportunity not only to remove local fat traps on the lower back and make the buttocks more rounded, but also to reduce the waist circumference.  Rib reshaping (controlled fracture of the lower ribs) is suitable for girls with a wide chest frame and minimal fat layer, when liposuction does not provide the desired result. 

Rehabilitation After Liposculpture BBL

Most patients go home the same day.

• Pain sensations. Mild discomfort in the injection area may occur for about a week

• Compression clothing. Compression clothing is worn immediately after the surgery and should be worn for a minimum of 2 months. If you wear compression garments for longer - 3-4 months, it will only be a plus. Wearing compression clothing may cause discomfort during the summer season - this is the only factor that may affect the seasonality of the operation

• Bruising and swelling. Any liposuction, regardless of the method used: tumescent, laser, ultrasonic, leaves bruises. The amount of bruising is very individual. However, tumescent liposuction leaves minimal bruising, which is due to the fact that 

• You can sit and lie down immediately. However, during the first 4 months, try to sit upright and lie only on your back or stomach. Lying on your side is not allowed.

It is important to avoid sitting on cold surfaces, as this may cause local inflammation or an abscess.

If you are planning a vacation after liposculpture, take a break for 2-3 weeks. As for camouflage, using tonal means is not prohibited.

Fat Transfer Survival: What Percentage of Fat Really Lasts?

On average, about 50% of the injected adipocytes (fat cells) survive. The remaining cells undergo necrosis and are eliminated by the body.

The survival rate of adipocytes depends on a number of factors:

1. Fat harvesting method. The degree of cell damage depends on the liposuction technique used. The most gentle and fat-preserving method is considered to be the tumescent liposuction technique.

2. Thickness of the injected layer. The thinner the layer, the higher the chance that each cell will be in contact with the surrounding tissues capable of integrating it. Accordingly, the greater the volume injected into one area, the lower the survival rate and the higher the risk of necrosis.

3. Postoperative care. It is critically important for adipocyte survival. Any physical impact — pressure, vacuum, massage, vibration, cooling, or overheating — can increase the percentage of necrotic cells and therefore decrease the number of surviving cells.

This is why I strongly recommend avoiding or minimizing such physical impacts during the recovery period. Otherwise, the number of dead cells may become so large that it causes inflammation in the surrounding tissues. This inflammatory process is usually of an aseptic nature (i.e., not caused by infection).

How Long Do Liposculpture Results Last?

“Waist-buttocks” liposculpture

For maximum effect, which consists of the contrast between the waist and buttocks, it is important to lose weight immediately after the operation (in the first month) while the fat has not yet integrated. Then the waist will become slimmer, and the buttocks will retain their volume. In the future, you need to try to maintain your ideal weight and avoid fluctuations of more than 1.5 kg, then the result of the operation will be lifelong.

To achieve this, it is necessary to understand the principles of the participation of introduced fat cells (adipocytes) in the body's energy balance. The fact is that only those tissues that are fully integrated into the body at the moment (have full trophism, capillary network, etc.) can participate in the energy supply of the body. It follows that in the case of an energy deficit, the body is not able to draw energy from newly introduced fat cells, since time is needed for the integration of these cells, provision of trophism, and the growth of a new capillary network.

This explains why if a woman loses weight immediately after liposculpture with fat transfer to the buttocks, everything will slim down except for the buttocks. Conversely, when a woman maintains her weight for 6 months (the introduced fat has had time to integrate) and then starts losing weight after 6 months, everything will gradually decrease, including the buttocks.

Liposculpture DualWave Sculpt should not be seen as a method for weight loss or slimming down. Lipomodeling is about shaping beautiful lines and contours using fat. Fat extraction is typically done in small amounts, usually 1-2 liters, so this procedure does not significantly impact overall weight.

FAQ Brazilian Butt Lift Surgery

Content author - plastic surgeon Valentyn Zykov

• Practicing surgeon since 1998
• I perform more than 500 operations a year
• Laureate of the 21st national program "Person of the year"
• I operate in Poland (Warsaw) and Greece (Athens)

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