Q: Dr. Eppley, I am going through a divorce due to domestic violence. I have lost a little over 100 pounds since I left my abusive marriage with our son. I for so many years buried my head into food. Even though I have lost all of this weight I often look in the mirror and cry due to the way I look. I feel empty inside, I want to feel beautiful and content with myself. I want back all of that confidence that he took from me. I have a lot of extra skin from all of the weight I lost. I am only 30 years old but I dress like a 40 or 50 year-old due to my body’s look. I don’t want to feel like I am dying inside anymore, I want to feel alive again, confident, young, and beautiful. These are the goals I want to achieve. Most of all I want to be able to bring my son to a beach in a bikini he is so young I do not want him to miss out on things due to my insecurities, He has suffered so much due to this divorce and domestic Violence. I try to keep a positive outlook on everything. I have attached some pictures so you can see what you have to work with.
A: Thank you for sharing your very personal story and in losing in the weight. This is obviously a transitional period in your life and changing how your body looks would be a complementary component to it. The excess skin and fat represent both physical and emotional baggage. In looking at your pictures, I can see that you would get some good benefit out of the following procedures… a full tummy tuck, liposuction of the lower abdomen (prior to its removal) and flanks with transfer to the buttocks, and a breast lift. Together these would all make a significant improvement in the shape of your body and reverse some of the effects of your prior weight gain.. All those procedures could be done together with the tummy tuck as the foundation procedure which is the one that really involves any significant recovery. Breast lifts are relatively painless and fat injections to the buttocks only as minimal discomfort.
While all four procedures would provide the most benefit in terms of body changes, the most important one is the tummy tuck with flank liposuction. That is the foundational procedure that produces the best benefit out of all the potential body procedures.
Dr. Barry Eppley
Q: Dr. Eppley, Can stem cells be used for buttock augmentation practically? I mean can we use stem cells to culture enough volume to be used in buttock augmentation ? I am trying to avoid fat harvest .
A: Fat injections have a certain percentage of stem cells in them so they are used routinuely in the procedure. But stem cells can not be used alone. The sheer quantity of stem cells that would be needed in volume is beyond what can be practically done if used alone. But it would be possible, and maybe even ideal, if cutured stem cells were added in increased numbers to what naturally occurs in fat to get improved volume take and preservation.
On a practical basis, however, stem cells can not be used for buttock augmentation for numerous reasons. It would take 200cc to 300cc of stem cell volume per buttock to be able to do it. This can be done by numerous companies but at around $1500 to $2000 per 3cc to 5cc aliquot, it would be prohibitively expensive. In addition, the FDA has recently clamped down on stem cells being harvested, grown and then returned even to the same patient. So it is now not even allowed by federal regulations.
Dr. Barry Eppley
Q: I am very interested in buttock implants. I was initially treated with fat grafting and spent a lot of money but the results did not last. This is why I don’t trust fat grafting and won’t do it again. I was greatly disappointed when I looked the same 3 months after the procedure. Any suggestions would be greatly appreciated.
A: The choice between using your own tissues (fat grafting) versus an implant for augmentation of any body area can be a difficult one. The advantages and disadvantages of either approach are classic and predictable. A synthetic implant will produce a stable amount of augmentation but at the price of more invasive surgery and the risks of infection, seroma, implant migration and extrusion. Conversely, fat injection grafting has none of these risks but its volume retention and predictability of a long-term augmentation result is variable. In some cases, the results of fat grafting can be completely resorbed within a few months. For others, a second fat injection surgery is needed to get the desired augmentation volume.
Whether fat injections or an implant is best for anyone’s buttock augmentation starts first with the size and shape of one’s buttocks and what one’s end goal is. For some, the size of the buttocks one wants is very big and they have little to start with so an implant would be best. For others, their buttock size goal is more modest and they have something to work with from the beginning. For them, fat injections would be a good choice. If one has no significant fat to harvest on the abdomen, flanks or thighs, then implants will need to be used.
If you have had one unsuccessful fat injection surgery, then buttock implants become more appealing. You might feel differently if some of the fat from the first surgery survived.
Dr. Barry Eppley
Q: What do you think of hyaluronic acid for buttock augmentation? It seems like it would be a lot easier to do than using your own fat or putting a synthetic implant in your body.
A: While the family of hyaluronic acid fillers are commonly used for very small volume facial augmentation, they are very rarely or never used to try and fill other body areas which require much larger volumes. While it may be a biologically sound concept, it is an economically terrible idea. The volume of hyaluronic acid needed, if we use fat as an analogy, would be around 350cc per buttock or 700cc per procedure. If we use the cost factor in the U.S. of $375/1cc syringe for Restylane that would be a buttock augmentation at a cost of $262,500…all for a result that would last 3 to 4 months. Using Juvederm, which would last twice that long but at a cost of $550/1cc syringe, the procedure would cost $385,000.
While your own fat make not always be reliable in terms of volume survival, it is easy to see that it is a far more economical approach for buttock augmentation.
Dr. Barry Eppley
Q: I was interested in the buttock augmentation with fat injections. I was wondering what parts of the body the fat is taken from, whether I would be a good candidate for the procedure, and the time it will take to heal.
A: The use of injectable fat grafting for buttock augmentation, also known as the Brazilian Butt Lift, has become popular as an alternative to the use of buttock implants. The success of the procedure is based on three factors; having enough fat on the body from which to harvest from, having enough buttock subcutaneous tissue to inject into and how well does the inject fat survive.
Patient selection is the key element in the first two factors and can be determined before surgery is ever performed. The best donor site to get then most fat is usually the abdomen, flanks, and thighs. In general, a harvest volume of at least 1,500 ccs is needed to end up with a processed and concentrated volume of around 800ccs. This allows 350cc to 400cc to be injected into each buttock. Less volumes than this will usually not make the procedure worthwhile. The patient also gets the benefit of contouring from the harvest site as well. Whether one has enough fat to harvest is very easy to determine. Whether one has enough buttock subcutaneous tissue into which to inject is a bit more subjective. Buttock far augmentations work better in those that already have ‘some butt’ present. Completely flat and non-existant buttocks will have a much better result with an implant.
Recovery from buttock augmentation with fat injection is related to the donor site and not the buttocks. Overall recovery is just a few short weeks whicih is far less than when buttock implants are used.
Dr. Barry Eppley