Dr Kourosh Tavakoli: What is the recovery time with BBL?
The recovery time for butt lift is actually reasonably quick so what you’ve got to think about the Brazilian Butt Lift or augmentation using fat is it’s like major liposuction. That’s what all it is, and inserting fat into the buttock hurts a little bit but the most of the ache and recovery comes from all body liposuction because you gotta get enough reservoir of fat to inject into the butt because you gotta lose some of it so then you end up reshaping the whole body, so patients receiving essentially a whole body liposuction.
Do you use implants with BBL or only Fat Transfer?
Not when it comes to buttock … I don’t … And my training and when I started in practise I did a few of them and there were a lot of issues with the body implants I find, except breasts … Obviously, I do a lot of them and it works well. But in particular, in the lower body, I wasn’t very comfortable with the use of implants.
Why do BBL patients have their implants removed?
So basically the biggest problems with that surgery of the buttock is the region that’s got a strange blood supply and is close to, obviously, not a clean part of the body so infection is an issue. Extrusion of the implant is an issue, pain, chronic pain is an issue and if that doesn’t happen long term, long term visibility of the implant is a huge issue. ‘Cause typically the girl who gets a buttock implant is very thin as opposed to the Brazilian Butt Lift where the girls are quite robust and they have a lot of fat the surgeon can play around with.
So if a thin girl gets an implant, like a breast implant even, you can see the age of it a lot more than you can see a breast implant. Essentially, the girl is confined to wearing jeans because as soon as she gets into a bikini you can see that outline of the implant, which quite embarrassing.
Do you take fat from a specific part of the body?
Wherever they choose but typically has to be the waist because without defining the waist, the bum doesn’t look good. So bum usually is like a square and the surgeon has to sculpt it and sculpt the waist and the thighs and not take too much off the outer thigh because you wanna create the hourglass figure, ’cause girls who typically girls who want BBL aren’t thin girls anyway, so they are curvy and they need to obviously embrace the curviness.
Yeah, so those areas of the waist and inner thigh are very important and front. My biggest reservoir of fat is the anterior thighs so I need girls who have a lot of fat around the thigh to get them out of liposuction to a good amount so we can harvest the fat, wash it down so it’s nice and … The way we clean the fat, get the blood out so it’s like a nice fat for injections so it increases the take of the fat. And some girls go for their abdomen region or arms but usually the not fantastic reservoir of fat is the back area and the front of the thighs.
Is Cellulite an issue with BBL or Liposuction?
Yeah, I think you gotta be very careful with cellulite. I think cellulite a lot of it is preexisting so I’m, normally map the body and explain to the patients about cellulite and the fact that it may worsen after liposuction. It may not. It definitely is technique-driven. But sometimes cellulite is something that is obviously genetics and it will stay with the patient.
We talk about cellulite a lot, so if there’s a huge amount of cellulite I just don’t like to do liposuction. So the Brazilian Butt Lift is tied with knowledge, my knowledge of liposuction. To do a good Brazilian Butt Lift you would have had done a lot of liposuction because the flaws and the problems will come from liposuction.
There’s inherent problems with actual injection of the fat, but the liposuction, because it’s so extensive, if it’s rippled, patient’s left with cellulite, excess skin, stretch marks, all those issues, they can come from bad liposuction. It can take away from the result of your BBL.
The advantage of it is you’re taking your own body’s fat but the disadvantage is you can potentially, potentially damage some other part of the body in trying to achieve a more beautiful bum. Now nobody would accept that. No patient is going to accept to have a more beautiful buttock, but ripply, uneven legs.
The process is not as simple as opening an implant and handing it to the surgeon. It’s a biological implant. Fat is a biological implant. And it gets harvested over a prolonged period of time because one of the issues we have is making people understand that a breast augmentation takes 50 minutes and a buttock reshaping and BBL takes 5 hours. Hence, the costing.
Is there a limit to the amount of fat you can take?
Not really. I don’t ever take more than 5 litres, which is fine internationally and in Australia. I mean, the days of 10, 12 litres of fat liposuction are gone. I don’t do mega liposuction. The reasoning is I don’t have big patients because we screen them, only for their own sake. To operate on someone who needs 12 litres of liposuction, I personally think that’s unethical because that person needs a dietician.
So our patients are very fit. The girl we did, few days ago, she’s fit, goes to the gym 5 days a week. Perfect diet. Just has disproportionately large legs, genetic, and she wants to redistribute it. So we take that fat and redistribute it so we make it more even, more curvy, more sexy.
A lot of the principles of BBL comes from knowledge of liposuction so if you’re a newcomer, you gotta know your liposuction back to front. Then, there’s particular areas of expertise when it comes to actual fat injection, fat harvesting, fat injection, which is very unique to BBL but, like 80% of the physical work is between laborious liposuction, curving the body, curving the thighs. It’s not a straight up and down. Creating curves. That’s like 80% of your work and then 20% is processing. 10% of that is done by the nursing staff. The process of injecting the fat is 10% of our work. Yet, 80% of our work is being behind the scene lipo-ing.
If you watch my Snapchats, I’m lipo-ing for hours and doing it slowly so that I get an evenness.
What is important for aftercare with BBL?
Going back to the gym or body reshaping procedures. You gotta go back to the gym. Keep your diet. ‘Cause you can lose it. I don’t think there’s any other operation in plastic surgery that does need so much more aftercare than big amount of liposuction plus fat grafting because if you don’t stick to your diet, you lose your shape, you lose your boundaries, then you’ve almost done this operation for nothing.
It does depend on a lot of factors. There’s a completely different concept of using an implant augmentation anywhere in the body where you just make an incision, you open the pocket, and you put an implant, and person goes to the gym or doesn’t go to the gym, it doesn’t really matter.
Here, we’re using a biological implant and using aspects of the liposuction, plus the skin has to retract. That’s the other concept. For a BBL patient to look amazing, there are a few criteria. One is good fat harvest, good liposuction technique. Good method, but also, in a motivated patient that has very good skin texturing and contractability, if their skin doesn’t retract, you get a big bum and a very floppy skin.
Again, comes back to the concept you’ve got to select your patient. If you think that skin’s not gonna retract ’cause of what you said, cellulite or other factors, then you just have to dismiss that patient. Just say, “Look, I can’t help you.”
Is there an age limit?
I think, generally speaking, the younger person will do well because of their skin. But also, I think, conceptually, I don’t think a 40+ got the concept of the bigger butt because it’s more of a younger person. It’s trendy. My 45, 50-year-old patient would just laugh at the fact that their bum’s gonna get bigger because all their life, they’ve thought big bums are not in, especially in Australian culture. There’s a lot of negative connotation to having a big butt. It’s more of a Latin American sort of movement, African American movement, which is hip to the young girls through hip hop music and popular culture.
Having said that, I did a 47-year-old who wanted it done and the week before, we did a mommy makeover. ‘Cause a lot of the mommy makeovers, we do what we call mini BBL. Just take a little bit of fat and just make them neutral. So, have a bum which is deflated and just take them to neutral. It’s really a buttock reshaping, as opposed to augmentation. So we don’t take them beyond the envelope of the thing. Just putting, it’s like the analogy of putting small implants in someone’s breasts, which they become neutral. So they’re deflated and I’m doing a lot of that. I just say, “Look, the fat’s gonna come off and it’s gonna go in the bin. Do you want me to just put it back so you’re just plump, not augmented?”
We’re gaining a lot of positive feedback in those patients. Kind of saying, “Oh, we’re under the anaesthetic and he’s taking the fat and he’s just gonna go straight out.” That fat is, in some women, there is not a huge supply and then once you get rid of it, you’ve got rid of it. Or you’re gonna get it replaced with this scar tissue down the track and they come back in four years’ time and say I’m now ready to just have a cut list of the BBL. It’s like why, I’m gonna go back in a field of scar tissue. That’s why repeat offenders of liposuction aren’t the best candidates.
And I think this operation really does well more than any other operation again the first operation. So a young-ish person, 18 to sort of 40 is a prime candidate, motivated, that’s got a typically disproportioned lower body to upper body, genetics, family, or cultural. They are the ones that can benefit from redistribution of the fat.
What type of recovery garment should be used?
Look, there’s zillions of garments on the market and especially in America. This, that, and cushions, and … I just cannot feel, you gotta keep off it. Just have a compression garment. Thing is, anything more isn’t required, just what typically would be used in liposuction surgery for the past 10 years. I think that’s what we use. We don’t have a particular BBL garment, we just use liposuction.