A 33 year old patient came in who had already had liposuction and fat transfer to the buttock a few years ago with another surgeon. She has a tummy tuck scheduled elsewhere. What she wanted from me was projection, the part fat is worst at. I am publishing the exchange nearly as it happened, identifiers removed, because the questions she asked are the questions everyone asks about buttock implants.
The visit
Me: “I got your pictures, those are very helpful, and I looked at your history. Have you had any problems with anesthesia before? And you’re 5’3 and you weigh 185?”
Her: Yes, which I will be losing a little bit more weight because I do have a surgery coming up in November for a tummy tuck. So I know my shape is gonna change a little bit, because they’re gonna try to even out my hips and stuff.
Me: “And you’re interested in the buttock implants? So you’re a great candidate. The implants, what they’re gonna do the most, they’re gonna give you a little bit of hip, but not really much. It’s mostly gonna be more projection. It rounds it out and makes it a little bit tighter. The incisions are gonna be in here, so in the nude, standing, you don’t see anything.”
Me: “In terms of the size that I can put in, it’s really gonna depend on how wide your muscle is once I get in there. I try to maximize depending on each person’s muscle size. I think we can get close to your wish pictures. We’re probably gonna be able to start with a 450 or 550 type implant, which is gonna give you a lot of volume and a lot of projection. If I have room for more, I can put a bigger one. I’ll have the whole range. Sometimes what we do, we start with whatever fits now, and then later on we can always switch to a bigger one for more projection.”
Me: “So when they do your tummy tuck, they’re gonna do a little bit of fat grafting to your hips?”
Her: They are, they’re gonna do kind of a BBL too, but honestly, I don’t think that they can really do much with the fat that I already have. So that’s kind of why I wanna do this.
Me: “I did notice that, for example, here you have a little bit of a dip, they can put a little bit of fat here. And then also in this transition from here to here, they could add some. And it’s completely safe. Once you have implants, there’s really no worries with the implant, because the implant is gonna be solid, so you really can’t puncture it or break it or anything like that. These implants should last a lifetime. We only change them if there’s a problem or if you want a size change, but otherwise you don’t have to worry about them.”
The asymmetry question
Her: I think my right buttock is smaller than my other one, so I’m hoping that they can kind of fix that.
Me: “I think the best way to fix that is with a little lipo and fat grafting. For the implants themselves, it’s better to put the same size on both, because we’re only really putting the projection. I do see that this one’s a little narrower here, a little dip.”
Me: “Later on, once you’re done with everything, if you still need a little more volume, there is something called allograft, which is a donor fat that we can inject even in the office. You don’t have to go under general anesthesia, and it can fill in that area just to give you a little bit more symmetry.”
The recovery question
Me: “The surgery is a little bit like a tummy tuck, but on the buttock, because we are working in the muscle. So you will be sore for a couple of weeks. It’s kind of like breast implants, but in the buttock, where the buttock’s always moving. So it does take a little while to get used to them. Usually it takes like a full six months for you to forget that they’re there, kind of like the breast implants. You’ll have some pains that come and go, but in the end it’ll become part of your body.”
Me: “For this surgery, we want you to be here at least for six days just to make sure you’re healing well and the scar’s healing well. The thing we worry the most about is if the scar opens up, then the implant can get contaminated and we would have to remove it. But I can tell you in the last hundred that I’ve done, we’ve had zero, so I don’t wanna worry about it.”
Her: You think it takes about six months to fully heal?
Me: “It’s gonna look great right away, but the pains that come and go is what you’ll be feeling for about six months. Of course, it’s most intense in the beginning and then it keeps getting better and better. I think in about four to six weeks you’re back to exercise and everything back to normal.”
Her: How long until you can fully sit on it?
Me: “Because we’re not doing any fat grafting, you can sit on it right away. But we’ll give you a cushion where you sit on your thighs, because it’ll be a little bit uncomfortable, but there’s really no problems with that.”
Her: As far as out of town patients, do you suggest a hotel?
Me: “Most patients stay within two blocks from here, and then my nurse will visit. So you could have this before your tummy tuck if you wanted to, or I would say at least three months after the tummy tuck. Three months before or three months after.”
The dimples
Her: My buttock is very square. It’s cute for what it is, but I want to maximize.
Me: “I did notice that you have a few dimples. I think it may get better with the implants, but if you wanted to treat those at the same time, we do have something called Aveli. Essentially, what you have is a fiber that’s pulling and making that dimple. So I go in and break that fiber, and it also helps so it pops out more, so you get a little more projection.”
Her: Is that added on top of the cost?
Me: “Yeah, it is additional, but it can be done at the same time. I’m gonna have my coordinator call you, and she can show you with or without.”
My exam note that day: rather full buttocks, the left buttock might be a little larger, a hip dip on the right side and a dip in the transition zone from the buttock to the thigh, some satellite dimples on the buttock.
What I tell everyone about implants versus fat
To another patient the same month who was weighing the two: “Implants I really recommend if what you’re looking for is more projection. It does give us better projection than fat. But even when I put in implants, I still put a little bit of fat around it to give it shape. With the implant we can really tell how much you’re going to get in projection, because it will pop. Fat is a little bit squishier, so it doesn’t pop as much.”
And on why I put them inside the muscle: “I do put them inside the muscle so that they don’t drop afterwards.”
That is the whole subject. The implant gives the projection, the fat shapes the edges, and the scar has to heal. Get those three right and the result does not shrink when you lose five pounds.
I am a double board-certified plastic surgeon, a Mayo Clinic fellowship alum, and I teach plastic surgery as a Clinical Associate Professor at Texas Tech University Health Sciences Center.
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