Ask Dr. Pane: Do I have enough fat for a BBL, and can I get a Brazilian Butt Lift under local anesthesia only?

The Question

As the Brazilian Butt Lift, or BBL, gains popularity, we at Atlantic Coast Aesthetics get a lot of questions and correct a lot of erroneous assumptions or outright misinformation about this procedure. The BBL is intended to enhance the volume, shape and projection of the buttocks, creating a more prominent posterior. Unfortunately, the Internet is not the best place to go for information or to form a realistic opinion about what is and isn’t possible with a BBL. One example is this question, from an ACA follower on Instagram, who asks:

“Do I have enough fat for a BBL? And Can I Get a Brazilian Butt Lift Under Local Anesthesia only? More details… I would like to have a BBL done under local anesthetic only. I don’t desire to have a large butt, I would be happy with just rounding it out and filling in the dimples and having a shape that isn’t so boxy.”

The Case

Dr. Pane evaluated the patient’s pictures on Instagram and compared them against her “wish” pictures of what she wants the final result to look like. The patient appears to be between 5’2” and 5’3”, and around 110-120 pounds.

The Answer

In this case, Dr. Pane feels comfortable saying that based on the images the patient provided, she is likely to get good results which closely align with the desired outcome. A BBL can absolutely be done under local anesthesia, the only real sticking point being how much pinchable, or excess, fat is available to harvest to implant into the buttocks and from where the fat can be harvested..

Because the patient has a relatively slight build, many surgeons may decline to perform BBL on this patient without using prosthetic implants, or indeed at all. If the patient wanted a larger posterior profile, rather than a simpler rounding and softening of the somewhat angular lines of her buttocks as currently shown, they may need to do a gluteal fold tuck, as one of the commenters on this patient’s question thread mentioned. However, Dr. Pane disagrees with this evaluation because the patient does appear to have sufficient pinchable fat around the waist and lower abdomen for a traditional BBL. While Dr. Pane can and does do these procedures, there is a specific set of indications which determine whether a patient would benefit more from a gluteal fold tuck than a BBL, and in this case he does not see these indicators as being visually present.

Despite this, Dr. Pane notes that pictures are always a poor substitute for an in-person clinical evaluation. This is because what pictures show can change based on lighting, posture and a number of other factors. Therefore, what appears to be present or absent in pictures may reveal itself to be the opposite during hands-on analysis of the patient’s body, changing what at first glance would appear to be an ideal candidate into someone who would benefit more from an alternative approach. Another factor to consider is the patient’s medical history and phenotype. Clinical evidence shows patients with some hair color may react differently to anesthesia than others, in some cases requiring up to 20% more anesthetic to achieve the same results. The patient’s total history, health and build must be taken into account, making clinical examination by far the best and safest way to ensure the patient knows what their body will actually tolerate and be capable of in terms of body sculpting outcomes.

Another consideration Dr. Pane stresses is that of making sure the surgeon with whom you choose to proceed has a skill set which allows for different options and corrective measures. While in some cases there is one “best” or “only” way to achieve a given patient’s required goals, in the vast majority of cases there are numerous routes from current condition to desired outcome. Choosing a surgeon who can offer a range of options and methodologies and can demonstrate the skill to utilize these options, and with whom you feel comfortable and safe, may mean the difference between the body you’ve always wanted and a medical boondoggle.

If you have a question for Dr. Pane or the staff of ACA regarding anything to do with cosmetic surgery, we welcome the chance to educate, inform and speak with you! Simply call us at (561) 422-4116, follow us on Facebook, Instagram and Twitter, or email us at https://acplasticsurg.com. Your question may even be the focus of our next Ask Dr. Pane segment, answered live on the air by our founder and Chief Medical Officer, Dr. Thomas A. Pane himself. Remember, at ACA we believe the only bad question is the one you don’t ask!