Your Questions

Q: Dr. Eppley, I have had this problem for over 16 years since I was young. I was injected a couple of times when I was sick but now these holes have become permanent and it  makes me feel ugly about myself. I can’t wear tight clothes or talk of leggings because it looks so ugly and weird. I am alway covering it up with shirts and long clothes. I feel like an outsider and so embarrassed to show myself naked. I am seriously considering a surgery but don’t know exactly what I should do. I don’t want butt implants. I am okay with my butt size. I just want the holes off or maybe filled. Any kind of miracle to make my butt even so I can be able to wear leggings without covering up my butt. I just want a normal butt.

A: As best as I can tell from the one picture you sent and knowing that these buttock deformities came from injections to treat an illness, it appears you have areas of fat atrophy (which is why they dip in) and hyperpigmentation. This is not rare from medication injections done decades ago when administered as a child or teenager. The indentations can be filled with fat injections. Whether the overlying hyperpigmented areas can be excised (cut out) and closed as an improvement will require seeing some better pictures. Ideally, fat injections to the various buttock areas should be done as a first stage followed by the excisions.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I would like a smaller waitst and larger buttocks. Would fat injections to my buttocks accomplish both goals? Here is a picture of me from behind in my underwear.

A: Based on this one rear view picture, it appears like you would be a good candidate for fat injections to the buttocks. (aka Brazilian Butt Lift) What makes one a good candidate for the procedure is whether one has enough fat to harvest. Your one picture clearly shows some flank fullness so I will have to assume that there is also some abdominal fullness as well. Your fat supply is not enormous but narrowing of the abdomen and flanks will help make the buttocks look bigger as well. As long as you have enough fat to harvest (1.2 to 1.5 liters is usually the minimum needed) then it is worthwhile to place the subsequently concentrated fat (600cc to 700ccsor 300cc to 350cc per side) into the buttocks. One also has to accept the reality that fat injections into the buttocks usually make a modest change in size and the amount of fat survival is not always predictable.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I would like to make my butt bigger by using fat injections instead of synthetic implants. But I don’t think I have have enough fat of my own to do ti as I am too thin. Is it possible to get body fat from my boyfriend to inject in my butt instead? He has plenty to give.

A: Buttock augmentation by fat is known as an autologous procedure, meaning fat is transferred from one part of the body to another. You must use your own fat otherwise it will be rejected and/or get infected. Fat grafts are just like any other organ or tissue transfer, your body’s immune system will only recognize itself. Anyone else’s fat will be seen as foreign and be attacked. If you don’t have enough fat on your own, you would then need to consider getting implants for buttock augmentation.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley,I am really considering butt augmentation (but I’m nervous).  I am a 33 year old women, who was born with one leg longer than the other and mild scoliosis.  It was no problem in the begining because it was barely noticeable.  Now, however, my shorter leg is much bigger than the longer leg, and it has caused my butt cheeks to be very uneven.  My guess is they were probably uneven all along, but now it’s very noticeable.  I can’t buy jeans or pants because they are either too big on the small side or too tight on the big side, and it makes my butt that much more noticeable.  Anyway, my left butt cheek is bigger (meaning its more round and it hangs down longer) than my right butt cheek.  Before I get this fat transfer done, is there anything else I can do on my own (maybe exercise) that will even my butt out, or is surgery my only option?  And, if surgery is my only option, will that also change as years go by, because I will always have one leg longer than the other, that causes one to be more dominant? Thanks for your time.

A: There are no exercises or any other non-surgical methods that will change your buttock size.

When it comes to buttock asymmetry, there are two obvious approaches…make the smaller side bigger or the bigger side smaller. The bigger method usually involves fat injections to the buttocks and the smaller method involves a lower buttock tuck with or without liposuction. I do not have enough information to tell you which is the more reliable approach. It is also possible that a combination of the two may give you the overall best result. I would have to see photographs of your buttocks to better answer that question.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I know it will cost more money if you are a plus size women to receive Buttock Augmentation by Fat Transfer but is it still safe or do you recomended the person lose weight first. I would love to get the procedure but want to do what works the best. I want my butt area to be considerably larger and I thought being bigger would be better for what I’m trying to achieve because I have more fat to transfer but its only been a bigger headache considering most of my weight comes from my breast area. 

A: Your understanding of how much fat that can be transferred to the buttocks is correct. The more you have to give, the more that can be transferred. It is never a good idea to lose weight before having a BBL (Brazilian Butt Lift) because you are going to lose it from the donor sites,, (abdomen and flanks) The fat that is liposuctioned out for transfer has to be filtered, washed and concentrated before being injected into the buttocks. This means that only about 1/3 of what is suctioned out will be usable. This makes it clear why few patients ever have too much fat to use. I would have to see a picture of your stomach area/body to see how much you have to give you a specific answer as it applies to you, but these are some basic guidelines about fat transfer to the buttocks.

Dr. Barry Eppley

Indianapolis, Indiana

Q:  Dr. Eppley, I have a very flat butt and have been researching buttock augmentation with fat transfer. (aka the Brazilian Butt Lift) I have a good amount of fat to take from my stomach area so I think I am a good candidate for the procedure. I know that not all fat survives after it is injected, so how does one compensate for that problem? What are realistic expectations for how much fat will survive? How does one know how much fat to transfer in a buttock augmentation surgery? How much fat can I expect to retain with my new butt and will it be permanent?

A: While fat grafting is very popular and can be highly successful, it is far from an exact science.  There are so many unknown variables in doing it that no one can predict with any accuracy how much fat will or will not survive afterwards. Every patient and their fat is somewhat different leading to a wide variety of results. What we do know about fat grafting is that it is very safe and many people have more than enough to donate. What I have observed about fat injections into the  buttocks (aka Brazilian Butt Lift) is that it often will produce less of an effect than many patients want. This is because of the combination of unrealistic buttock size expectations for some and the variable retention of the injected fat. As a general rule, I inject as much fat as possible (between 300 to 500cc per buttock) and judge the final outcome at three month after surgery. There is never a fear that the result will be too big. The real question is whether it will be big enough.

Dr. Barry Eppley

Indianapolis, Indiana

Q:  I would like to know if Dr. Eppley has any experience in removing free silicone oil from the butt? I had silicone injections in my butt and would like it removed and replaced with my own fat.

A: Once silicone oil is injected into any tissue it can not be removed, from a practical standpoint, from the recipient site. The oil is dispersed throughout the tissues in many islands or droplets (really pools of oil) so it is not just one large collection which can be evacuated. It is not like an implant where it is in just one location as a congealed or formed mass. During buttock lifts I have run across injected silicone oil several times and it just runs out as you hit every subcutaneous pocket that it is in. The only way the silicone oil can be removed would be to completely cut off one’s entire buttocks. Therefore, it is best left alone.

The good news is that the silicone oil is not in the deep muscle but in the fat or subcutaneous tissues under the skin. Buttock fat injections can still be placed with the silicone oil in place as they are placed deeper into the gluteal muscle and deeper fat. I am not aware that the presence of silicone oil causes any problems with doing fat injections to the buttocks or necessarily causes greater problems because it is there.

Dr. Barry Eppley

Indianapolis Indiana

Just when you think you have heard it all, a new and bizarre tale of cosmetic surgery rears its head. If I didn’t know any better, this story may well have happened in China or the back streets of a remote Siberian city.

From the Garden state of New Jersey in Essex County, a group of female patients (six to be exact) ended up in hospitals after undergoing buttock enhancement. Apparently, they received buttocks enhancement injections containing caulking material. The same material that is used to caulk windows and bathtubs was injected to make their glutes larger. Different from medical-grade silicone, the substance used in these Mengele-like botched procedures was believed to be a diluted version of a nonmedical-grade silicone. Traditional buttock enlargement procedures are done with either a medical-grade solid silicone implant or with fat injections.

Apparently administered by unlicensed providers, the women were admitted to hospitals following  the injections after developing raging infections. They were treated with surgery and antibiotics and appear to be recovering (although, you can be certain their buttocks will never be the same).

While many may wonder why anyone would want their buttocks enlarged (since many women would actually want them reduced), this is a popular request amongst certain ethic groups where a fuller and rounder buttocks is more appealing. Some have called this the Jennifer Lopez effect.

While these cases are certainly a tragedy, the looming question is how could this happen? In a country with the finest and most advanced medical technology in the world, how does someone come to the fate of having their butt caulked?

While injectable aesthetic treatments, such as Botox, collagen and fat, have been a real advance in plastic surgery, there is a rare, dark side to the concept. Because injection therapy is not surgery, it is not regulated like traditional plastic surgery procedures. There is no oversight and many of these treatments take place in a wide variety of settings by ‘providers’ of all backgrounds.

Because of their apparent simplicity to administer, injectable treatments are often viewed as a commodity. As in, ‘what treatment can I get for the lowest price’? While searching for bargains is commendable in many retail situations, a faux watch or look-alike handbag does not carry the same risk as do faux injection materials.

While not common in this part of the U.S., black-market injectors do exist and their practitioners prey on the weakest and least educated consumer- those that often can least afford it. As crazy as the butt caulking incident sounds, there has been a recent history of dubious practitioners  providing cosmetic implants of nonmedical-grade materials. They function in a makeshift office for a short time, then get put out of business…only long enough for other shady providers to take their place.

Most of these incidents happen in large metropolitan cities with a high percentage of immigrant populations. In such an environment it is easy to hide, to be invisible to the authorities, and find plenty of victims before moving on. Smaller cities like Indianapolis are more difficult for unlicensed providers to remain anonymous as they are more quickly exposed, and appeal to a much smaller population.  

The conclusion is …Caveat emptor: Buyer beware.  If the costs of the procedure look too good to be true, there is probably a reason.

Dr. Barry Eppley