Q: Dr. Eppley, I am interested in buttock augmentation. However, looking at the before and after pictures, it doesn’t look like much of a difference. I would like a really big butt.
A: While the definition of a really big butt is open to various opinions, let me give you the overview of buttock augmentation options and the reality of their outcomes and the process.
SYNTHETIC INJECTIONS Known as black market injections of silicone oils and even caulking compounds, this is an illegal procedure that has a high rate of conplications. While a much larger buttock size can be immediately obtained at the cheapest price, this is not a good trade-off when one risks severe buttock lumpiness, skin pigment changes, infection, chronic pain and even death from necrotizing fasciitis and pulmonary emboli. But when you injected in a hotel room or house by someone of absolutely no training with non-medical and non-FDA approved materials, these results should not be surprising.
FAT INJECTIONS This is the most common method of buttock augmentation today and the most popular. The name Brazilian Butt Lift is what it is most known by. While it is the most popular, that does not mean it is the most effective because it isn’t. Improvements in buttock size can be expected to be modest as best. It is popular because it is a natural material and there is the concomitant body contouring benefit of the liposuction procedure that is needed for the fat harvest. The survival of fat, no matter what you may read, is far from assured and even at its best a 50% survival of what was be injected I would consider a spectacular success.
IMPLANTS The most assured method of sustainable buttock augmentation is with the use of FDA-approved soft buttock implants made from silicone gel elastomers. Implants will produce the biggest size that will last but is a more invasive surgical procedure with a significant recovery and costs. There are two ways to place buttock implants, above and inside the gluteal muscle, and this will also influence the result and the recovery. The best place to put implants is inside the muscle. (intramuscular) This is the best for implants long-term and is associated with the least potential complications but the size increase will be moderate (350cc or less) and the recovery is the hardest. In a small person the buttock size change can be very significant. In larger patients, it will be more moderate. If the implants is placed above the muscle, the largest available implants can be placed in most people (up to 600cc) and the recovery is less than when placed inside the muscle. But there are higher risks of infection, fluid collections and implant shifting than when the implant is placed inside the gluteal muscle.
In short, you can now see that different methods of buttock augmentation have different outcomes, risks and recovery associated with them. So when your goal is a ‘really big butt’, your only good options is a buttock implant placed above the muscle. Whether someone is willing to expend that effort is why so many patient opt for fat injections…but should only do when they are understanding of what the final result will likely be.
Dr. Barry Eppley