Your Questions

Q: Dr. Eppley, I have questions about Brazilian Butt Lift surgery. What is the average percentage of the fat transfer that stays on the buttocks? After the surgery are the buttocks firm?  I have not had children yet, when i have children if I would like to go forward with the procedure again if I lose the fat from mybuttocks afterwards will that be dangerous to go through another procedure?

I am very interested in this procedure and would like the best results. Do you have a way to show patients what the body will look like after surgery before the actual procedure?

A: On average the amount of fat that persists in most Brazilian Butt Lifts (BBL) is around 50% to 80% in my experience. But any fat transfer is not completely predictable and every patient will have varying degrees of fat retention. Initially the buttocks are firm from the immediate volume full but that softens quickly in the first month. Fat transfers do not create the firmness that comes with buttock implants. The buttocks will end up bigger but they will still feel soft. There is no harm or danger in the future to having another BBL procedure.

The key question is whether what one wants to achieve with BBL surgery can be done based on one’s goals and what they look like now. To determine whether BBL surgery has a reasonable chance to achieve your goals, I would need to see pictures of your buttocks/body now and what your buttock augmentation goals are.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley,  I am interested in getting a Brazilian Butt Lift. I am a 24 year old female who is not comfortable and is ashamed of her body. I have been doing research on Drs where I currently live and I haven’t found a Doctor who meets my expectations. And I have seen your woek and I like what you do.I think I am a perfect candidate for a Brazilian Butt Lift since I have some extra fat over my entire body gained after I had my son via c-section three  years ago. I really really want a better body with an “S” shape on the sides. I want my butt and my hips enlarged and I am really hoping you are the one who can make my dream come true. 

A: As you know the Brazilian Butt Lift or BBL procedure is a dual benefit operation where multiple body areas are contoured through the redistribution of fat approach. The liposuction harvest areas create reduction while the fat transfer to the buttocks causes an augmentation. While the Brazilian Butt Lift is a very common operation today, and I have done many of them, the keys to a successful and satisfying outcome are based on realistic patient expectations and an understanding of the natural biology of fat transplantation. Let me highlights these key points:

1) The liposuction harvest is not an overall body liposuction procedure. The goal is to obtain as much fat as possible for the buttock injections for which the vast majority comes from the abdomen, flanks and back areas. The reduction of the waistline above the buttocks plays a major role in helping the buttocks appear bigger.

2) There may be undesired aesthetics from the liposuction harvest in the abdominal region, particularly in women that have had chldren. (loose skin) Ay such loose or irregular skin may require a secondary tummy tuck to create the best abdominal contouring effect.

3) The size limitations of the buttock augmentation increase in BBL surgery is a direct result of how much fat one has to harvest. Thus some buttock enlargement goals are not possible for some women because there is a mismatch between what they want and what they have to give to try and achieve it.

3) The amount of fat that is available to be injected into the buttocks is but a portion of what is harvested. Since the best type of fat to inject is a concentrate of the total liposuction aspirate, not all fat volume that is extracted ends up being injected. It must be concentrated which in women usually means about 40% of what is harvested is useable for injection. (e.g., 1,000 of fat harvested = only 400cc to be injected)

4) The survival of injected fat is not predictable and is never 100%. Thus some of the injected fat will die and some of the initial volume increase will be lost over the first six weeks after surgery. This fat transplantation biology fact seems to confuse many patients as they wonder why their results are ‘disappearing’ over the first month or so after surgery.

5) The final outcome of any BBL surgery takes 6 to 12 weeks after surgery to stabilize and see the final result. But it will not end up as full as one what sees in the first weeks after surgery.

These are the important concepts to understand so that one can have a realistic expectations about what to expect from their BBL surgery results.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am interested in buttock augmentation. I(Brazilian Butt Lift) What is the cost, how long would I have to be off work. what does it mean by not all of the fat would survive?

A: The cost of Brazilian Butt Lift surgery is variable based on the ‘size’ of the assignment. The more fat that needs to be harvested is going to take more surgical time and costs. But on average the total cost of BBL surgery is in the range of $7500 to $8500. Recovery from BBL surgery is essentially like recovering from a major liposuction surgery. While I suspect you could get back to work in about 2 weeks after the procedure that does not mean you would be fully recovered. That probably takes about a full size weeks. The success of BBL surgery depends on how much fat actually survives the harvest and transfer process. What the amount of fat survival will vary amongst patients, it is far to say that not all of the fat will survive, usually only about 60% to 70% will be retained at the most optimistic estimate. This is why in most Brazilian Butt Lift surgeries it is important to harvest as much fat as possible and place as much as the buttock tissues can tolerate.

Dr. Barry Eppley
Indianapolis, Indiana

Q: Dr. Eppley, I want a Brazilian butt lift and tummy tuck. Can I get a combined surgery package and price for these two procedures.

A: The combination of a Brazilian Butt Lift and a tummy tuck can be done together. But that is a tough combination in terms of recovery and discomfort. I have done it and patients do get through it but it will be a lot tougher than you envision. Ideally it is better to harvest all the fat that one can from the abdomen and flanks for the Brazilian Butt Lift  and deal with the loose skin in a second surgery. (tummy tuck) Whether the combination or staged approach would be better for you depends on what your abdomen looks like now.

While patients understandably would like to combine these procedures to lower costs and have just one big recovery, that approach can be short sighted. In women that have very large abdomens and a lot of excess abdominal skin, it may be more prudent to stage the two procedures. That way the best result may be obtained for both the Brazilian Butt Lift and the tummy tuck with a lower chance of complications.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I’m wanting to do a Brazilian Butt Lift lift. Can that be done at the same time as with a Mommy Makeover?

A: A Mommy Makeover (breast and abdominal reshaping) and a BBL (Brazilian Butt Lift) can be done at the same time but it create a very difficult recovery. It would all depend on what the exact Mommy Makeover procedures need to be and whether such a combination may negatively impact the results of any of the three procedures. For example if the Mommy Makeover needs to include a full tummy tuck there will be less fat that can be harvested for the BBL to avoid compromising the healing of the tummy tuck incision. I would need to make that evaluation during an actual consultation or you can send me pictures of your body type for a preliminary evaluation.

While it is always desirous to maximize the number of operations one can do in a single setting for economy of recovery and economic resources, there are operative combinations that can ‘fight’ against each other and may even compromise their results. This needs to be looked are carefully in these type of body contouring procedures.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am a 35 year old woman. I have attached some pictures for your reference. I would like you to give me your opinion on what you could do to make my shape more curvy. (widen hips, increase buttock projection and decrease waist, back and arms size) I think liposuction to the abdomen, flanks and back plus re-distribution to the buttock and hip area is certainly something I would like to consider. 

As you can see in my pictures I also have had a breast augmentation and have been told that these are polyurethane, so they may be hard to remove. I would like your thoughts on what you may do to make my breasts slightly smaller and less projected, but more natural and rounded.

Could you tell me how long I would need to stay in hospital, then in the area before I fly home ( and details of how soon I can fly) Thanks!

A: Thank you for sending your pictures and providing your body contouring objectives. I believe you are correct in the approach to improving your body shape through a combination of aggressive liposuction of the abdomen, waist, back and arms with redistribution of the fat aspirate to your buttocks. That combined procedure has a name and is the well known Brazilian Butt Lift with assured body contouring benefits from the fat harvest and buttock augmentation from the liposuction ‘discard’.

In regards to your breast implants, these are harder to remove than smooth silicone shell implants but let’s not confuse harder with impossible. Most likely they have some degree of encapsulation which makes them look very ‘stuck on’ and firm due to the encapsulation. Removing the implants and their capsule with a slightly smaller volume implant should make them softer and a little less projected. It would ultimately be helpful to know what the implant volume is when planning their replacements and I would probably drop the volume down by about 50cc.

This type of body contouring surgery is done in my private surgery center, not a hospital, where the costs are much lower. Given that you are from afar, I would keep you overnight but you could go back to the hotel the next day. I would anticipate you flying home within 5 to 7 days after the procedure at most.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am roughly 75 pounds over my ideal weight looking and to have a Buttock Augmentation with Fat Injection.  (Brazilian Butt Lift) My question is do you do what’s considered “Large Volume Liposuction” or do you have an issue with larger patients?

A: . One’s weight per se does really influence the ability to have a successful Brazilian Butt fit surgery…unless one has very little fat to harvest to be able to do the procedure successfully. (have enough fat to inject) Therefore patients that have excessive weight do not represent a limiting factor in being to do the BBL procedure. The only issue with patients with more weight is that they realize the liposuction harvest for the BBL is not going to make them thin nor serve as a weight loss method. Also there is a safe limit of fat harvest which is generally around five liters and that is where it is prudent to stop no matter how much more fat may be able to be harvested. Going about that ceiling and venturing into true large volume liposuction increases the risk of complications such as deep vein thrombosis and pulmonary emboli. Also it really can make the recovery period prolonged and can take weeks until one is fully functional again.

Lastly, using the ratio of about 1/3 fat concentrate results from the unfiltered liposuction fat harvest, the amount of fat that can usually be maximally injected is around 1,500 to 1,800cc or 750cc to 900cc per buttock.

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 am interested in the brazilian butt lift. I originally booked the procedure with another doctor. However, he will not be available for the procedure now and he mentioned you as one of the doctors I should see. I am hoping to get the same service as he was providing, which was liposuction of the arms, back, abdomen, flanks and inner thighs with a minimum 1000cc injected into each buttock.

A: I certainly do a fair number of Brazilian Butt Lifts. The key question, however, is whether you have enough fat to harvest that could be filtered and concentrated to be able to inject 1000ccs per buttock. That would be exceptionally unusual. To be able to get 2000cc of injectable fat, you would have to have close to 6,000cc (6 liters) of fat to harvest. That may be possible in you but since I have never seen your body I could not tell if that was so. What most patients don’t understand is that only concentrated fat should be injected not just the liposuction aspirate. Taking the liposuction aspirate and getting rid of the blood, broken fat cells, free lipids and the tumescent solution usually results in a 60% to 70% shrinkage of volume of ‘fat’ that has been harvested. Thus only about 1/3 to 40% of the lipsuction harvest ends up being useable for injection.

For most Brazilian Butt Lift patients, the maximal amount of fat that can be harvested and injected is done as most patients have an overall deficiency of fat for the procedure (based on their goals) rather than an excess. For this reason, I do not promise any patient that a specific amount of fat will be injected as that is an unpredictable number until the fat is harvested. I would have  a good feel for an approximate amount that could be done in looking at one’s body and thus an estimate could be given before surgery.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, How long does a fat butt lift take? Am I a good candidate  for it based on my pictures?

A: The Brazilian Butt Lift is a procedure that does take from where you don’t want it and puts it into your buttocks. However, the caveats to the procedure are that only so much fat can be transferred, based on what you have to give, and thus the final results will be affected by that volume. Secondly, since much of the donor site will come from your abdomen and flanks, this will create a create a greater overhang of stomach skin that is probably best to deal with at the same time. While a tummy tuck could be delayed until later, it is more ideal to have it done at the same time as the Brazilian Butt Lift

Depending on what is done, the time of surgery will vary. For a Brazilian Butt Lift using only liposuction, the procedure is around 2 1/2 hours. If a tummy tuck is done at the same time this would extend the total operative time up to 4 hours

Given these issues, the best way to get the greatest understanding of the benefits and limits of the Brazilian Butt Lift procedure would be to come in for a consultation to discuss these issues in detail.

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 have a question about the Brazilian Butt Lift.  I am wondering with this procedure if the fat could be taken from my stomach? Also is there an extra fee for the liposuction that takes place for the fat transfer to the buttock?

A: The fat harvest portion by liposuction of a Brazilian Butt Lift is included as part of the overall buttock augmentation procedure and fee. That is, perhaps, one of the great appeals and bonuses of the procedure. While the amount of fat that will survive after injection is unpredictable, the body contouring effects from the liposuction harvest are predictable and assured.

The stomach is almost always the first place on the body that is liposuction harvested. And for the vast majority of patients it is also the greatest source of donor fat material.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am interested in a Brazilian Butt Lift. Could this procedure include having liposuction for weight loss reasons as well as butt enlargement? It seems like you get two benefits at once, a bigger butt and dropping your weight at the same time.

A: Every Brazilian Butt Lift requires liposuction to harvest the fat that needs to be transferred by injection into the buttocks. This almost always comes from the abdomen, flanks and waistline and as much fat is taken as possible in most cases. But to call this liposuction harvest, or any liposuction procedure, a weight loss method would not be appropriate. That is not what it accomplishes. Liposuction is a shaping technique but it does not create any substantial or sustained weight loss in most cases.

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 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 am a 20 year old female. I used to weight 105 lbs and gained a lot of weight after going on the Depo shot. I currently weight 145 lbs. My height is 5’0 so I believe it is a lot of fat for my size. I have fat on my arms and back and a lot on my belly area, also my legs are very thick. I would like to know an estimate on having the fat removed from those areas and having it place on my butt and breast. I am a B cup and would like a little more in that area but don’t want to go for implants at all. Maybe around a 36C. I have a little fat on my butt but I would like it to be round and firm with a little more extra fat. I wear a size 7 going on 8 pants, I can also fit a size 9 already. A lot of my fat is on my thighs. I’ve been interested in having this procedure done for a while but I’m not sure on the price and would like to know how much you would charge for the procedure. I have looked at your reviews online and I was very impressed. So if I do decide to get the procedure I would definitely like to go to you. Can you give me an estimate on the procedure for both breast and butt together and an estimate for butt only? Thank you very much for your time. I’m looking forward to hearing back from you.

A: Thank you for sharing your body description and your goals. With these in mind let me provide with some clarifications.

1)      While liposuction can effectively remove fat, it cannot do it equally well everywhere on the body. The thigh is a particularly challenging area because circumferential thigh liposuction can not be done. It can not effectively reduce large thighs. The outer thighs (saddle bags) and the knees can be treated but only some areas of the contours of the thigh can be changed.

2)      Transferring fat from liposuction to the buttocks is commonly done and is known as the Brazilian Butt Lift. Provided one has enough fat to harvest, the shape and and firmness of the buttocks can be improved.

3)      Fat grafting to the breasts, however, is not so simple for an augmentation effect. While fat can be injected directly into the buttocks without stimulation, it can not be done so in the breasts. The breasts must be pre-treated by an external suction device (Brava) for weeks before the procedure, have the injections, and then have the suction device used for several weeks after. Fat injections into the breasts are a lot like planting seeds to grow. The ‘garden’ must first be prepared and fertilized to receive them. Also it is highly that you would have enough (after processing and concentrating it) to inject both the buttocks and the breasts at the same time. You would have to pick either the breasts or the buttocks for fat injections, you can not do both.

Dr. Barry Eppley

Indianapolis,Indiana

Q: Dr. Eppley, I am 46 years of age and a runner in great health–I use to love my breasts, but now not so much.   Looking at either breast lift or augmentation and brazilian butt lift.  I have always had a flat butt, especially flat since I run…and sit all day–have great legs want the rest of my body to match.   Seeking cost of both surgeriess (I realize average is best you can estimate, not having seen me), all scenarios.   Would like to save an pay up front if possible, will not finance.   PS – I do have that baby belly fat still in there, so I’m sure it can be used to help my buttocks out!  🙂 Thank you!

A: One of your problems will be easy to solve and that is the breasts. Breast implants will provide an immediate and permanent solution to a larger breast mound, of a size of your choosing. Whether you would really need a breast lift I am not sure but as long as your nipple is above the lower breast fold you would not. I will assume that since you are a runner that you have breast deflation not breast sagging. The more difficult problem to solve is that of your buttocks for three specific reasons, none of them surgical per se. First, would a runner in great shape really have enough fat to harvest for an effective brazilian butt lift…in most cases usually not. Second, even if enough fat were transplanted the odds are high that being a runner will result in the fat being absorbed quickly…burning it off. Those who have less fat do so for a reason. Thirdly, like breast implants real buttock implants are the definitive permanent answer but in a runner the recovery might be longer than you want.

Expect silicone breast implants to be around $ 5,700, a brazilian butt lift to be around $ 4,500 since yours is small and buttock implants to be around $ 5,900.

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 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 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 want a fuller butt to compliment the rest of my body. I don’t have any pictures at this time but I’m a black female with what they call a flat butt that doesn’t go with the rest of my body. What are my options for getting a bigger butt?

A: Buttock augmentation can be done by two techniques; implants and fat injections. Each as their own advantages and disadvantages. By far the most common buttock enlargement method today is fat injections also known as the Brazilian Butt Lift. Fat injections offer the advantages of simultaneous body contouring from the liposuction fat harvest and a natural method of enlargement that has a fairly quick recovery. It’s one disadvantage is that there is no predicting how much of the fat will survive. As a general rule, fat injections can produce only a modest enlargement in buttock size. Synthetic implants have the advantage of a permanent method of buttock enlargement that can produce a larger result that is maintained. Its disadvantage is that it requires a small intergluteal scar and has a longer and more difficult recovery.

While many patients can choose between implant or fat injections, some will have no choice but to have implants. If one has little or inadequate donor fat to harvest, then fat injections can not be performed.

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 would like to know of you can take fatty tissue from another part of your body and inject it into your butt to make it rounder where it has dropped due to loss of elasticity. I am a 50 year old lady and I am a diabetic.

A:  Transferring fat, usually from the abdomen and flanks, into the buttocks is a very common procedure today. Known by the name of a Brazilian Butt Lift, fat is obtained by liposuction, concentrated and then injected into the gluteal muscle and subcutaneous tissues for an augmentative effect. While the inadvertent body contouring benefit from the procedure is assured (fat reduction), how well the fat that is transferred into the buttocks is not. Survival rates vary widely from 10% to 90% with most patients having an approximate 50% survival rate. What factors affect survival of the injected fat is not precisely known. But having diabetes may be a factor that adversely affects survival, particularly if you have insulin-dependent diabetes. Diabetes that is treated by oral medication is less likely to have a significant impact on fat graft survival.

Another treatment consideration besides fat injection is a lower buttock lift. When the buttock falls over the lower skin crease where it meets with the upper thigh, it may be better treated by excision and re-establishment of a well-defined skin fold. This can also be combined with fat injection for volume increase for an enhanced effect.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have been debating about getting a Brazilian Butt Lift for the past two years and I’m finally ready to do it. I have waited so long out of fear that I will pay all this money and then the fat will just resorb. Is there any further encouragement that you can give me?

A: All surgery has risks and there is no doubt that the biggest one in the Brazilian Butt Lift is the unpredictability of how much of the fat will survive later. Fat survival rates vary widely but my observation is that up to 50% of the injected fat is retained after six weeks. There is a lot of variables that go into a successful fat injection transfer from the harvest method, to fat preparation and to the injection technique. You, of course, have no control over how the surgery is performed so make sure you choose your surgeon wisely and one that has a proven history of successful patient outcomes with fat grafting. The one benefit that you will absolutely be assured, however, is the contouring that will come from the fat harvest. Most commonly, fat is taken by liposuction from the stomach and flanks as these areas offer the greatest amount of available donor material. Other sites can be used as well but usually only contribute small amounts of fat. Regardless of the harvest sites, you can be assured of the contouring benefits of the procedure. That is the one guarantee result that comes with every Brazilian Butt Lift.

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:  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