Your Questions
Your Questions
Q: Dr. Eppley, I am interested in buttock augmentation. I am a 53 year old athletic woman who had liposuction years ago that left me with misshaped and sagging buttocks. A skin lift four years ago helped just a little, but, as photos show, still a big problem. I am wanting to fill out my buttocks but keep an athletic look, since the rest of my body has good muscle definition. Is there a buttock augmentation procedure that will enable me to continue to do extreme sports?
A: The residual problem with your buttocks is a volume issue not one of a skin sag. The dilemma you have is that of two treatment options, fat grafting and implants, one of the them (fat grafting) is not a viable option due to your very lean body. Buttock implants, while effective, poses both a recovery and potential physical activity limitation (during the long recovery process) for what your physical standards are. (extreme sports) It would probably take three months for a full recovery. Given these issues, I do not see any method of buttock augmentation that will work for your specific physical needs. While full gluteal muscle function will return, the impact of intramuscular buttock implants is suspect in very highly athletic people.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am 21 years old, 5 ‘0” and weigh105 pounds. Am I qualified for butt augmentation with fat. (Brazilian Butt Lift) If not what do I need to do to gain more weight or is there anything I can take to gain weight?
A: At your low weight, you are not a candidate for buttocks augmentation by fat injection. And there is no amount of weight that you could reasonably gain to get you to the point where there would be enough fat to make the procedure worthwhile. Even if you did gain a large amount of weight, the fate of the fat that is harvested and placed into the buttocks would be suspect with subsequent weight loss. Only buttock implants would be effective in someone who is so small with very low body fat.
Buttock implants are more reliable in terms of the volume that they provide (fat survives vary variably) but they have a higher rate of potential complications because they are an implant which is not naturally there. I would not say they are any less safe that fat, just that there is more potential complications and recovery than just using you own natural fat as the ‘implant’.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in the Brazilian Butt Lift and would like to know how many procedures you have performed? I have attached two pictures and would like to know what kind of results you would expect with my body type. I am not wanting a big Kim Kardashian booty just some volume to add some shape. Looking at my attached pictures do you think this is achievable?
A: It is a good thing that your Brazilian Butt Lift (BBL) objectives are not like that of Kim Kardashian as you simply do not have enough fat to harvest to achieve that amount of buttock size increase. The success of BBL surgery depends on two important factors, how much fat does one have to give and how much fat will survive after being processed and injected. When you realize that less than 50% (at best) of what comes out as liposuction harvest ends up as buttock volume addition, the reality of what is achievable by the BBL procedure comes into focus.
What one means by ‘just some volume to add some shape’ is open to interpretation, the question is really whether the procedure is worthwhile. There is only one guarantee with the BBL operation and that is the body contouring that results from the liposuction harvest. When one does not have a lot of fat to harvest and process, a realistic buttock augmentation goal should be ‘just something more than what I have’. As that is the only assurity you can get from the procedure.
Many successful buttock augmentation results occur from the combination of reducing what lies around the buttocks and augmenting what lies within…more so than a real substantial buttock size increase. Such would be the case with your body type.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I would like a breast reduction. I would like that fat from my breast to be use for a buttock augmentation. I know this is a very large request but I hope it can be considered. I am a k cup. I’m only 5’3. The pain from my breast are unbearable. I’m only 17 years old. My breast have prevented me from so much and I have been turned down by so many doctors that I have lost count. My only wish is that I can have these procedures done before my senior year so I can finally experience my life as a normal teenager.
A: By your physical description and breast size, there is no question you would benefit physically and psuchologically with a breast reduction. However it is not possible or advised to take breast tissue and use it for buttock augmentation. Breast tissue is not pure fat but a mixture of fat and breast tissue. Within that breast tissue are tissue cells that may or may not in the future, become cancerous. Thus should not transfer any tissue for an elective aesthetic augmentation that has any potential for future malignancy. In addition, a breast reduction procedure does not remove tissue by a liposuction method but by an en bloc excisional method. This does not make it amenable to an injectable method even if it was appropriate fat tissue to use for buttock augmentation.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have researched the Brazilian But Lift procedure for quite awhile and have been to two doctors for consultation. One discussed the Aqualipo option but they could only show me two pictures and the results were slight. I have attached some photos of myself to give you a better idea and to see if it is feasible. I do want a noticeable result–the more the better! Lastly, I am getting married at the end of the month and will leave immediately on a cruise. I am trying to find the most feasible option for me right now to where I could be healed up enough for the honeymoon, possibly a surgery date the first week of June. Thank you for your time!
A: Based on your pictures, I could not see you getting a significant buttock augmentation effect with fat injections alone. (Brazilian Butt Lift) You have to have enough fat to harvest to inject and then there is the variable of how much of the injected fat will survive. Between these two issues, you are more likely than not to end up with a moderate augmentation effect at best. While everyone’s definition of a dramatic outcome is different, my experience is what most patients want as dramatic is not what you would be able to achieve. Unless you combined the fat injections with an intramuscular implant, I do not see a dramatic result occurring.
That issue aside on a realistic basis, it would be very close to having this kind of procedure and being ready to go on a honeymoon (and enjoy it) just three weeks after the procedure. Six weeks of recovery is best in advance of this type of body operation. The liposuction harvest portion would be extensive (you would need every cc of fat you could get) and your body will be enduring a fair amount of trauma in so doing.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I know for sure I want a Brazilian butt lift I don’t know how the procedure works. Do you take the fat from the stomach as I sure have plenty to give?
A: In a Brazilian Butt Lift (BBL), the goal is to get the maximum amount of fat possible to do the transfer injection procedure. In most people, the important question is whether they have enough fat to justify undergoing the procedure and to meet their aesthetic buttock size goals. The greatest donor site for fat is the abdomen, waistline and flanks. This is where about 80% of available subcutaneous fat depot sites exist in just about anyone. This harvest site is also the side benefit of the BBL, a natural body contouring effect from the necessary harvest site. This body site reduction is also why many BBL results look as good as they do…not because the buttock size increase is that great but but because what lies around the buttocks has gotten smaller and more shapely.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, what are the pros and cons of buttock augmentation by fat grafting? I can’t decide between getting an implant or having fat injections done. Fat injections seem better but I read about some bad experiences with them.
A: The pros and cons of buttock augmentation by fat injection grafting are well known and are relatively classic between the effects of one’s own tissues vs. a synthetic implant. The pluses of fat injections in the buttocks are the body contouring benefits of the liposuction harvest, a much easier recovery, few if any complications such as infection or seromas, and a natural augmentation effect. Its negatives are the incredible variability and unpredictability of fat graft retention (may have partial or complete resorption of the fat), a small to moderate buttock augmentation result for most patients, and the potential need for more than one fat grafting session for the best result.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in a Brazilian Butt Lift (fat injections to the buttocks) but I have a few questions. I want at least 900ccs of fat injection done. Are you able to meet this request or do you have a fat injection limit? I want my upper and lower abdomen, flanks and lower back for the taking of the fat to accentuate my buttock. Please let me know if this is possible. Thanks
A: When it comes to the Brazilian Butt Lift (BBL) and the amount of fat that is injected, the first important question is how much fat does a patient have to give. Liposuction is used to harvest fat from as many body sites as is needed. In thin patients with little fat, a BBL procedure may not be possible. In patients a moderate amount of fat will have to accept a modest BBL result. In patients with more fat then a large amount of donor material can be obtained and a bigger result will occur. The second issue in a BBL is to understand that concentrated fat is injected not just the liposuction aspirate only. Just because 2 liters of fat aspirate is obtained, for example, does not mean that 1liter can be injected per buttock. Rather the liposuction aspirate must be filtered and concentrated so that only pure fat is injected. As a general rule, about 1/3 of the liposuction aspirate turns into concentrated fat. Thus 2 liters of aspirate becomes roughly 700ccs of fat and that means 350cc can then be injected into each buttock.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’m interested in getting buttock implants and fat grafting to my hips and butt. I know I don’t have much fat but I really want a much bigger butt. I have attached some pictures of me and a picture of my dream butt. How possible is this result?
A: Thank you for sending your pictures. You clearly have little fat to contribute to your buttock or hip augmentation. Your buttock augmentation result will come largely (95%) from the effect of the buttock implants. The ideal picture you have shown is not a realistic result. That is not going to be achievable no matter what implant size is placed. With an intramuscular implant approach with a maximal volume of 300 to 350cc, that result will be about 33% to 40% of your ideal buttock size result. If the implant is placed above the muscle (subfascial) with a maximal volume of 500 to 550ccs, you will get about 60% to 65% of your ideal result. Any addition of a small amount of fat will add little to the implant-created result.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, which has the most effect on your buttock size, implants or fat injections?Which has the better results because I do have some fat from having a baby.
A: The choice between fat injections or implants for buttock augmentation depends on numerous factors. The most significant are how much fat you have to donate and how much buttock size increase you desire. Whether ‘some fat’ is enough to achieve a visible change depends on what your body looks like now. The largest donor source of fat is the stomach area although it can be taken from many other places as well such as the flanks and thighs. The minimum amount of fat one should have should be at least 1.5 liters to be able to put reduce it down to 400cc to 500cc per buttock. I wold consider this to be the minimum to justify the surgical effort. For some women, much more may be needed. If fat is inadequate then the only option is going to be implants.
If you could send a picture of your body and your height and weight that would be helpful in providing a more specific answer.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I really want a bigger butt but realize that I don’t have any fat in which to inject. I am too thin to get much of a anything. That leaves my only option as buttock implants but I have heard only bad things about them. Are they really that bad? What is the real truth about them?
A: Buttock implants have gotten a historic bad reputation that to some degree is undeserved. When placed by an experienced surgeon into the intramuscular location, they can produce some very good results that fat grafting can not. Intramuscular buttock implant placement will be limited to usually under 400cc for most patients although this can make for a very impressive change despite the seemingly small volume. Buttock implants can also be placed above the muscle in the subfascial location, where much larger implants can be used, but the risks of complications such as infection, fluid collections and implant shifting are higher. Buttock implants can be a very effective and safe buttock augmentation option but what is bad about them is that the recovery is going to be longer and more difficult than that of fat grafting.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Hello..I was looking into getting butt injections prefer the hydrogel. I was seeing if you do this…thank you.
A: Any type of synthetic filler injections into the buttocks I do not do. None of these injectable buttock augmentation materials are FDA-approved nor, quite frankly, should they be done. There are neither safe or indicated for this type of cosmetic procedure and they have never been formally evaluated by an FDA regulatory process. Thus these are ‘black market’ treatment procedures and are what we as plastic surgeons consider to be both illegal and unethical to be done. The only safe and approved injectable buttock procedure is fat injections. This is done by using your own fat acquired by liposuction, concentrated and then immediately re-injected into the buttocks.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am considering butt augmentation with fat injections. I am 25 years old, 5’5″ and 185lbs. Am I a good candidate? I have read various things about recovery times and costs, what are yours?
A: The main qualifications for buttock augmentation by fat injections (aka Brazilian Butt Lift) is whether one has enough fat to harvest to make the procedure worthwhile. While I obviously don’t know what you look like, your listed height and weight strongly suggests that you do. Recovery times for the procedure are going to be similar for everyone, no matter who does it. The recovery is largely related to the liposuction harvest and is like any other liposuction procedure where fat is taken from the abdomen, flanks and back. Depending upon what kind of work you do will determine how long your recovery is…a sitdown job will be 10 to 14 days whereas a very physical job may be up to three weeks. Understand that recovering for work is different than a complete recovery from the procedure.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I would like information on liposuction and butt augmentation. I would like information on estimated cost and recovery time. Thanks I hope to hear from you soon.
A: Thank you for your inquiry. The questions you have asked are broad with different options and make your questions impossible to answer without being very procedure specific. I would need to know more specifics about what exact liposuction and buttock augmentation procedures you desire.
1) What areas of fat removal by liposuction are you seeking? How many different body areas?
2) For buttock augmentation, is it by implants or fat injections?
This information is vital because much of the costs of surgery are based on the time that it takes to do them. For the sake of the most common method of buttock augmentation, which is fat injections from abdominal and flank liposuction harvests (aka the Brazilian Butt Lift), I will have my assistant pass along some costs to you later today for this approach. Those costs will range between $6500 and $8500 depending on how much liposuction is done/needed. This combination has the dual advantage of contouring multiple body areas by reduction of body areas around the buttocks which makes any buttock size increase look even better. Depending on the type of work that you do, I would anticipate a minimum of 10 to 14 days until you get comfortably back to most normal activities of daily living.
Dr. Barry Eppley
Indianapolis, Indiana
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
Indianapolis, Indiana
Q: Dr. Eppley, I have been researching your site. I am hoping to have breast reduction covered by insurance after the first of the year. I have a doctors appointmentt with my primary doctor next week to hopefully begin the process for this to covered by insurance. My question is that I would also like to have butt augmentation with fat transfer. Is it possible to have both surgeries at the same time?
A: It is possible to have both a breast reduction and buttock augmentation at the same time. From a recovery standpoint, it is really a combined breast reduction and abdominal and flank liposuction since the harvest for the buttock augmentation is from liposuctioned fat. I have done this exact combination of procedures a few times and patients have had no problems. As an aside, your primary care doctor can do little to help you get your breast reduction approved. Such as approval must emanate from a consultation with a plastic surgeon who will write a predetermination letter. Ultimately your insurance company will decide based on your weight, breast size and the amount of anticipated breast tissue removal.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am 36 yrs old and have been wearing padded underwear since I can remember. I am ready to have a bottom of my own that I can feel good about.This is my only insecurity and I am ready to do something about it. I want to be able to for the first time fill my jeans out and not have a belly that hangs over them.
A: There are two types of patients that seek buttock augmentation. The first and by far the most common is the patient who simply wants to make larger what they already have. They do not really have buttock hypoplasia or underdevelopment but want to enhance what they already have. This is very common in certain ethnic groups, particularly African-Americans and Hispanic women. The second group and the least common is the patient who really has not buttocks at all. They are completely flat and may even have resorted to padding as you have described.
This second group is the most challenging to treat because they have little to no subcutaneous fat in the buttocks and small gluteal muscles. This makes the recipient site for the most common method of treatment, fat injections (aka Brazilian Butt Lift), very limited. Often they may be quite thin as well without adequate fat donor sites. This leaves them the only option of an actual silicone buttock implant. Such implants can be very effective but they are associated with a longer recovery and other implant-related risks.
Dr. Barry Eppley
Indianapolis, Indiana
Q: I want butt implants to give me a much larger butt. I was told that’s 400cc implant would give me the size I want but I think that’s too small. Can I send a picture of my butt and a picture of the size I want? Can you tell me what size implant would give me the results I want?
A: Buttock augmentation using implants involves two considerations; size of the implants and implant location. (above or below the muscle) Size of the implant affects whether it can be placed above (subfascial) or below the muscle. Buttock implants are made of a soft flexible silicone material and come in either round or shaped configurations. Like breast implants, buttock implants are commercially available in different sizes (volumes) and dimensions. The most commonly used buttock implants are round shapes with sizes up to around 400cc with a projection of 5 cms. Larger buttock implants are available in shaped sizes up to about 550ccs but with less projection. The larger a buttock implant becomes the more difficult it is to place it under the gluteal muscle. When possible it is always best to place a buttock implant under the muscle.
When considering buttock implant size, the desired area of enhancement and its dimensions are important considerations in implant selection. These are drawn and measured during a consultation and are important in buttock implant selection. Whether one can achieve the the buttock size one sees in a picture may or may not be possible.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Hi, I’m interested in getting a buttocks lift with the fat injection procedure. I am currently a student and therefore do not have a lot of money, I’ d like to know if you offer payment plan options and, if so, what would be an approximate monthly payment. Thank you.
A: Fat injections are one of the two options for buttock augmentation. Often referred to as a buttock lift or the Brazilian buttock lift, it ‘lifts’ the buttocks by adding volume and expanding the buttock skin. Probably calling it a lift is a bit of an exaggeration. It is really a buttock augmentation, any lifting is purely coincidental.
As for financing of any cosmetic procedure, there are few if any plastic surgeon’s and their practices that would directly do the financing. Many patient’s ask about whether we finance and it is an understandable question. But plastic surgeon’s are not experts in banking or lending and therefore do not do it directly. It is also not prudent to provide a non-returnable service upfront and then hope to be paid until completion later. For this reason, plastic surgeons use outside financing companies to which they refer their cosmetic patients. There are numerous ones and each plastic surgery practice has one or two that they have had good experience using. In my Indianapolis plastic surgery practice, we have used many over the years and currently use Care Credit. Once patients have the quote for surgery, they can go online and see if they qualify. They have many different financing options which allows patients to choose the length of the loan and their monthly payment.
Dr. Barry Eppley
Indianapolis, Indiana
Q: I would like to know few things about butt implants Dr. Eppley did my breast implants few years ago and now i would love for him to do my butt. I want to go big. What sizes and shapes can I pick from?
A: Buttock augmentation is similar to breast augmentation in some ways but different in others. Buttocks implants, unlike breast implants, are made from a very soft and flexible solid silicone rubber material. They are not fluid-filled. Like breast implants, they can be placed above (subfascial) or under (actually into) the gluteal muscle. Those two different locations carry greater significance in buttock implants than in breast implants,, particularly in terms of recovery. Intramuscular implant placement is preferred but that also limits the size of the implant that can be used and makes the recovery much more prolonged and uncomfortable. One’s anatomy also can also drive this choice because if there is little subcutaneous fat present over the buttocks, the intramuscular location will produce a smaller but more aesthetic looking result. (concealing the implant edges better)
Buttock implants come in either round or oval shapes and have volumes ranging from about 150cc to 400ccs. Unlike breast implants, in which the size range that can be used is much more variable, the size and shape of buttock implants must be more closely matched to the surface anatomy and measurements of one’s buttocks. In the buttocks you don’t have the luxury of just putting in whatever size implant you want. The risks of postoperative problems and complications is higher when you do so.
Dr. Barry Eppley
Indianapolis, Indiana
Q: I’m 29, very healthy and I weigh 128 lbs. I have always wanted a more rounder shapely butt for years but never could get enough money for the procedure and was afraid of the risks associated with the procedure. My self-esteem is very low because of my small buttocks. I just want to feel good and feel secure about myself and my looks.
A: While buttock augmentation can be done with either an implant or fat injections, your small frame and low weight leave you with only the implant option. The good thing about buttock implants is that they produce a very nice result in a single operation and the augmentation is stable over one’s lifetime. Because it is an implant, however, there is a longer recovery and there are potential implant risks of infection or seroma formation.
The key, in my opinion, to your buttock augmentation is to place the implant into the gluteal muscle and not to place too big of an implant. Going above the muscle in the subfascial plane is not advised with low buttock soft tissue coverage. Getting good closure of the muscle over the implant during the surgery is important as it helps reduce the risk of any problems.
Recovery is the biggest short-term concern for buttock implants and one should really allow about three weeks before returning to work and most more normal activities. More physical activities like working out, running, and cycling will take up to 6 weeks until one is more confortable to do them.
Dr. Barry Eppley
Indianapolis, Indiana