Brazilian butt lift (BBL)

A BBL (Brazilian butt lift) is an operation in which we use your own fat to adjust the volume and shape of your buttocks through fat injections. You may also see it called Brazilian buttock contouring or buttock fat transfer. We prepare tissue taken from localized areas of excess fat on your body and transfer it to the buttock areas where you would like more fullness.

You can describe the change you have in mind for your buttock shape during the examination. We choose areas for fat removal with attention to the transition between the waist and buttocks and the existing volume distribution. During fat injection, we use real-time ultrasound imaging.

Buttock contouring with your own fat

The first stage of a BBL is liposuction, or suction-based fat removal. We prepare the tissue obtained from localized excess fat for transfer to the buttocks. This places the donor area and the buttocks receiving volume in the same body contouring plan. For example, if there is excess fat at the waist and a wish for fuller buttocks, we plan around the transition between these areas.

A lack of fullness in the upper buttocks, indentations toward the sides, or limited backward projection are among the reasons for considering fat transfer. These wishes may require fat to be distributed in different areas. A wish for greater overall buttock volume focuses on a broad area, while a plan for a specific indentation focuses on tissue transitions around that part.

Pelvic width, gluteal muscle structure, subcutaneous fat distribution, and skin elasticity all contribute to buttock appearance. Fat transfer works in the subcutaneous tissue over these structures. Bone structure affects the width of the buttock base, while fat distribution creates the soft contours over it. BBL planning focuses on subcutaneous volume while accounting for the existing bones and muscles.

The volume that can be added to the buttocks depends on tissue in the donor areas and the subcutaneous space in the buttocks. Having abundant donor fat does not mean there is room for every desired volume in the buttocks. Subcutaneous tissue thickness, the area where fat will be distributed, and the skin are examined together with the desired volume.

Waist and buttock proportions: what we assess

Existing buttock volume and where it is concentrated guide us in selecting fat transfer sites. We can begin the consultation with the part of your buttocks you would like to change. If you want to emphasize the curve seen from the side, we focus on the rear of the buttocks; if you want to change the waist-to-buttock transition, we focus on the side contours.

We use shapes named with letters such as H, O, A, and V to describe buttock form. The H shape describes straight side contours, while the O shape describes a rounded volume distribution. In the A shape, the curve is more pronounced in the lower portion, while in the V shape, upper width is more prominent.

These letters describe the distribution of volume around the buttocks. Buttocks may show features of more than one shape, and these names do not indicate a need for surgery. The area the person wishes to change and the tissue structure there guide the choice of where to add fat.

Buttock width seen from behind and projection seen from the side are different features. Adding fat to the sides affects the outer contours, while adding volume to the rear affects the side-view curve. Removing fat from the sides of the waist also changes the waist-to-buttock transition. The same wish for fullness may therefore require a different fat distribution depending on waist width and thigh shape.

Hip dips are concave areas on the outer sides of the hips between the pelvis and upper thigh. This appearance relates to bone structure and surrounding fat distribution. Outer thigh fullness, by contrast, describes volume at the upper outer thigh. Hip dips and outer thigh fullness can coexist, so an indentation considered for fat addition and the outer thigh area considered for fat removal are examined separately.

The location of the fold beneath the buttocks, upper buttock fullness, skin quality, and the transition to the thighs are part of the examination. A fold caused by sagging skin and an indentation related to fat distribution are different tissue features. If there has been a previous buttock injection or operation, the technique and treated area also inform the new surgical plan.

The buttocks may already differ in volume and shape. In that case, the areas receiving fat and the amount allocated to each may differ on the right and left. The examination records where these differences lie, taking account of transitions to the waist and thighs.

A lack of volume across a broad part of the buttocks and small surface skin dimples are different findings. The examination distinguishes whether the concern relates to upper fullness, the outer buttock curve, or the skin surface. This defines the area targeted by fat transfer while separately clarifying expectations involving the skin itself.

Where is fat taken from for a BBL?

The abdomen, sides of the waist, back, and thighs are areas where fat may be taken for a BBL. The area where fat is removed is called the donor site, and the buttocks receiving it are the recipient site. Fat thickness, distribution, and the elasticity of the overlying skin differ in each donor area. Selection depends on the shape of the donor area itself as well as the tissue needed for transfer to the buttocks.

The abdominal fat that liposuction can remove lies beneath the skin. Fat inside the abdomen around the organs is outside the procedure’s working area. This distinction helps clarify how much of the visible abdominal fullness can be included in a fat removal plan. Excess abdominal skin is also a separate examination finding from the amount of fat.

Excess fat at the sides of the waist can affect the transition to the upper buttock border. Fat distribution in the lower back continues this contour. When fat removal is considered in these regions, the waist is assessed from both the back and side. If the back skin folds, the relationship of the folds to fat and excess skin is examined separately.

When thigh fat removal is planned, fat distribution on the inner and outer surfaces is examined separately. Since the outer thigh lies next to the side of the buttocks, removing fat there also affects the outer buttock contour. The aim is not to remove all fat from the donor area. The tissue layer to be preserved beneath the skin and transitions into neighboring regions define the boundaries of fat removal.

Previous liposuction of the abdomen, waist, or thighs is considered in a new fat removal plan. The thickness and distribution of the remaining fat may require selection of another donor area. Information about which regions were included in the previous procedure is used alongside the tissue findings from the examination.

Who may be suitable?

People seeking a change in buttock volume or shape who have enough tissue in potential donor areas may be candidates for a BBL. Their general health must also be suitable for surgery. If there is insufficient fat tissue, this method may not meet the desired volume increase. Examining the donor areas is therefore as much a part of the surgical decision as examining the buttocks.

Buttock skin elasticity and the presence of sagging affect technique selection. A lack of volume and substantial excess skin create different needs. Fat transfer adds volume, while removal of sagging skin is the role of lift surgery. When excess skin is substantial, its location and relationship to the fold beneath the buttocks help determine whether a lift is needed.

Uncontrolled chronic disease and smoking are among the general factors that may require postponing a BBL plan. Cosmetic fat transfer is not performed during pregnancy. The preoperative consultation gathers information about existing illnesses, current treatments, and smoking. Suitability for surgery is based on this health information together with the amount of fat and buttock shape.

A stable weight helps planning based on the current shape of the donor areas and buttocks. If substantial weight change is intended, fat distribution around the waist and the volume needed in the buttocks may also change. A BBL is a body contouring procedure and does not replace weight-loss treatment.

Fat removal and preparation for injection

During liposuction, we remove localized excess fat with a cannula, a thin tube used for fat removal and transfer. After preparing the fat, we inject it into selected buttock areas with specialized cannulas. We adjust its distribution according to existing fullness and the shape plan agreed with you.

Fat collected through liposuction may contain accompanying fluid and free oil. During preparation, the tissue to be transferred is separated from these components. Filtering, washing, and centrifugation (separation by spinning) are among the methods that may be used. The prepared fat tissue is then placed in containers for injection.

The material collected during fat removal and the tissue prepared for buttock transfer do not have the same composition. Preparation is the separation step between fat removal and injection. The volume to be injected into the buttocks therefore cannot be calculated directly from the total collected material. Transfer planning is based on the prepared fat tissue and the recipient area in the buttocks.

Small skin entry points that allow passage of the cannula are used in the donor regions and buttocks. Their positions are selected according to the direction in which the cannula needs to reach the target area. Since abdominal fat removal and buttock fat injection take place in different regions, entry points are arranged accordingly. In a buttock lift involving skin removal, the incision pattern depends on the location of the skin to be removed.

A BBL is performed in a hospital operating room under general anesthesia. Anesthesia preparation reviews general health and the scope of surgery, including the donor areas. If another surgical procedure is considered alongside buttock fat transfer, it is also included in the anesthesia plan.

Real-time ultrasound and safe BBL

We perform fat injections under ultrasound guidance. During the procedure, we use real-time ultrasound, meaning we watch the layer containing the cannula on a screen as we inject. In this technique, which we call ultrasound-guided safe BBL, we place fat only beneath the skin and above the muscle.

We avoid the area beneath the muscle because major blood vessels run there. We do not inject fat into or beneath the muscle. Working within the subcutaneous space above the muscle throughout injection and viewing the cannula position with ultrasound form the anatomical basis of our technique.

A fascia, a connective tissue layer, separates the subcutaneous fat from the muscle in the buttocks. The injection area lies between the skin and this layer covering the muscle. Subcutaneous tissue thickness may vary across the buttocks. Visible fullness alone does not show which layer contains the cannula internally.

The ultrasound probe, the imaging head, transmits images of tissue layers through the skin to a screen. These images allow observation of the subcutaneous tissue, muscle fascia, and injection cannula position. Real-time imaging helps monitor the cannula’s relationship to the fascia as it moves. Selecting the fat transfer area during the examination and imaging the injection layer during the procedure are different stages of the plan.

Ultrasound during BBL injection is used for imaging. The ultrasonic energy used in VASER liposuction separates fat tissue during fat removal. Ultrasound serves different purposes in these applications. The fat removal technique and imaging the layer during buttock injection are separate procedures.

How it differs from buttock implants and a buttock lift

In a BBL, the person’s own fat tissue provides the volume. Buttock augmentation with an implant places an artificial volume-adding material in a surgically prepared pocket. Fat transfer distributes tissue through areas beneath the skin, while an implant requires a specific placement pocket. The difference in mechanism is which material adds volume and how it is placed.

A buttock lift removes sagging skin and repositions the remaining tissues. A BBL adds volume through fat transfer. The word lift in Brazilian butt lift can cause confusion between these procedures. Pronounced sagging and a lack of volume in the same person may create separate surgical needs for the skin and fat tissue.

Which procedures can be planned with a BBL?

VASER liposuction is one method that may be used for the fat removal stage of a BBL. Fat tissue separated by ultrasonic energy is removed with a cannula and prepared for transfer. The areas of the waist, abdomen, or back selected for liposuction depend on the intended buttock shape and fat distribution in those regions.

If there is also skin laxity in a donor area, plasma skin tightening may be included in the same body contouring plan. This method applies controlled heat beneath the skin with the aim of contracting collagen fibers in the connective tissue. Buttock fat transfer adds volume, while plasma treatment targets skin laxity in the selected region. Surgical removal of substantial excess skin is a different procedure.

Excess abdominal skin may also bring a tummy tuck into consideration. A tummy tuck addresses excess skin, liposuction addresses localized fat, and a BBL addresses buttock volume distribution. After weight loss, the abdomen, waist, and buttocks may have different tissue needs, so findings in each area are identified separately. Whether procedures are performed together or in separate operations depends on surgical scope and general health.

What should you pay attention to after BBL surgery?

Nutrition and corset use

After BBL surgery, we recommend drinking 2-3 liters of water a day to prevent edema and following a protein-based diet. We ask you to wear your corset for 4-6 weeks from the day of surgery. You can remove it briefly for activities such as showering and using the toilet.

We recommend hand-washing the corset we put on you after surgery. If you need a second corset, you can contact our clinic coordinator.

Drains, showering, and stitches

You will have 2-4 drains, depending on the areas operated on. Our nurses empty the drains when needed and measure the fluid collected. The drains are removed when Dr. Hakan Bulam considers it appropriate; this may take 1-5 days, depending on the person.

After you leave the hospital, we ask you to empty your drains when they are full, record the amount of fluid, and share it with our nurse. If you prefer, you can photograph the drain before emptying the fluid and send the picture to our nurse. You can shower 24 hours after the drains are removed.

The stitches in the small incisions made for liposuction will fall out on their own within 2-3 weeks. These areas do not need dressings.

Sitting and sleeping positions

We recommend avoiding pressure on the areas where we inject fat. For this purpose, we ask you to use the BBL pillow we provide after surgery when sitting and sleeping for 3 weeks. Supporting your back with pillows can help you find a comfortable sleeping position.

You can also sleep on your stomach if you wish. However, if you have had a tummy tuck together with your BBL, you must not lie on your stomach.

Massage, exercise, and swimming

We consider lymphatic drainage massage necessary for an easier and faster recovery after surgery. You can start immediately after surgery and have a total of 8-10 sessions. We recommend massage only on the areas where fat was removed; areas where fat was injected should not be massaged.

You can start walking from the 2nd week after surgery and other activities after the 4th week. You can swim in the sea or a pool from the 2nd week. Early edema, swelling, and localized firmness decrease over time, and your tissues regain their natural consistency within 3-6 months.

You can message our clinic coordinator on WhatsApp with any questions.

These timeframes may vary depending on the person and the extent of surgery. Dr. Hakan Bulam will clarify them for you at your follow-up appointments.