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Fat Cell Buttocks Enhancement

Presented By

Doctor/Presenter’s Name Here

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© 2015 All Rights Reserved United States Copyright 2015 Published by Mini Books Express

Without limiting the rights under the copyright above, no part of this publication may be reproduced, stored in or introduced into a retrieval system, or transmitted in any form or by any means (electronic, mechanical, photocopying, recording, or otherwise) without the prior written permission of the publisher of this book.

Cover: Art design by R.L. Comstock

Disclaimer

The information presented in this book is not intended to replace the medical advice of your personal physician or any surgeon performing cosmetic surgery. In addition, the information expressed by the author in this book is the opinion of the author based on experiences in performing these procedures.

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Table of Contents Chapter 1 Fat Transfer Today ………………………………………………….7 Chapter 2 Body Fat Cells ……………………………………………………... 19 Chapter 3 Consultation With Your Plastic Surgeon ..………………………… 22 Chapter 4 Gentle Liposuction and Fat Cell Preparation .……………………... 26 Chapter 5 Fat Cell Isolation and Preparation …………………………………. 30 Chapter 6 Scars ...…………………………………………………….……….. 40 Chapter 7 Recovery from Surgery …………………………………...……….. 44 Chapter 8 Summary of Fat Grafting ..………………………………….……... 47 Chapter 9 Possible Complications ..………………………………....….…….. 48 Chapter 10 Frequently Asked Questions …………………………….……….. 50 Chapter 11 Storing Fat Cells ………………………………………...……….. 54 Chapter 12 Glossary ..……………………………………………….…….….. 56 About the Doctor/Presenter ...………………………………………...…….. 58

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1 Fat Transfer Today

The new fat grafting technique has ushered in a new era of buttock contouring procedures. Using autologous fat, which is fat harvested from a patient's own body, has become the most effective and safest long-term method of buttock fat injections currently used among plastic surgeons across the country. With today’s best methods of liposuction and fat grafting, fat transfer now dominates the buttock rejuvenation field. The latest methods performed by experienced plastic surgeons are especially good for buttocks to contour and enhance. With highly-developed innovations, fat is harvested from the hip, stomach, or other areas of the body where there is sufficient unneeded fat, and is then re-injected into the patient’s buttock. Wherever there is a loss of volume in the buttocks, it is possible with the new fat transplant procedure to augment the sagging, flat, or hollow-like appearance. With the aid of liposuction, after carefully removing the fat cells, the fat cells are salvaged for injecting into the butt. This offers plastic surgeons a method of obtaining the fill material needed to correct the appearance of the buttock where there is a loss of volume. Using a patient’s own fat offers a safe, unique advantage and creates an entirely new approach without the need for any foreign material being injected into the buttocks. The new advances in harvesting, purifying, and injecting have made it a very desirable option in buttock enhancement and to overcome some of the signs of aging. Autologous fat (your own fat) is especially suited for buttock contouring even though in some cases the procedure may need to be repeated in order to build up volume and to compensate for a small amount of the fat being absorbed by the body; even so, using autologous fat is a long-lasting option. Appearance of Your Buttocks

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It is a fact of our social order that physical appearance has an impact on our self-image and on how others perceive us. A more youthful body---and in women, well-developed breasts, a flat stomach, and a full head of hair----are visible and important, but ultimately, it is important to many patients that their buttock have a rounded, well-shaped appearance as well.

Over time, plastic surgeons have tried relentlessly to improve the buttock appearance in their patients and to offer a more youthful look. Today, modern technology has been able to slow down or correct changes that occur due to normal aging. We now live in a world that is made up of more and more people displaying more contoured figures, including the butt, especially in form-fitting jeans and dresses. These new and accretive figures would not be possible except for the latest methods of filling out the flat or drooping butt. Fat Grafting Treatment Fat grafting can be done on almost all areas of the face and body. This is possible if the site being treated has good blood circulation and enough capillaries and large blood vessels for the injected fat cells to receive the nourishment needed to survive. Living fat tends to form its own blood supply. This is a key factor in getting the best and longest-lasting results.

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This page and the next depict a 26 year old woman after fat transfer to the

buttock (Brazilian buttock lift). 400cc injected per side.

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Before

After

The same woman before and after fat transfer.

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Before

After

This depicts a 25 year old woman after fat transfer to the buttock (Brazilian

buttock lift). 400cc injected per side. She also had a tummy tuck at the same

time.

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Advantages of Fat Transfer over Traditional Buttock

• Cost-effective: There is no limit on the volume. For instance, 1 ml of traditional filler costs the same as 5 ml of fat transferred to the butt.

• There is excellent correction of buttock imperfections with fat.

• Fat from one’s own body is safe, so there is no risk of allergic reactions or rejection.

Skin Condition As part of the natural aging process, the skin and muscles of the buttocks lose elasticity, resulting in poor contours. The aging process is gradual, creating almost imperceptible changes to the body, and the buttock is no exception. As the buttock slowly ages over time, there is loss of elasticity, dehydration, and atrophy that increases laxity lines such as fine lines and wrinkles.

The wrinkles of the sagging skin are most apparent in buttock cheeks, where the muscles have decreased in size. For many people, there is often a host of changes that take place with aging skin. With younger people, they simply are dissatisfied with a flat or small butt, which they may have been born with. They want it to be fuller and more attractive.

Hopefully, the more pronounced signs of the aging buttock may not occur until much later in life. Yet younger people moving into their middle-years, experience some of the visible aging components of the drooping butt. Today there is a method for dealing with aging without a serious surgical solution and it is found in fat grafting. This new innovation has risen to become the most effective method to achieve a full, rounded buttock that is so often seen on beautiful stars.

Many people in their middle years look in the mirror and detect some imperfection or age-related change that they would like improved, but many still think it is too difficult to achieve the success of obtaining a more youthful, pleasant, rounded buttock without a major medical procedure. Actually until

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recently, most treatments have been too invasive, too costly, and too much of a radical change, plus they have resulted in excessive downtime. Fat Grafting

1. Antiseptic and anesthetic medications are applied to the areas of fat extraction as well as to the treatment area (where the fat is to be injected).

2. The fat cells are then harvested from the donor site, usually through a liposuction technique, which involves making small incisions and using a cannula (fat extraction device).

3. The fat cells are then purified and re-injected into the treatment area. Fat grafting is the process of taking small amounts of fat from one part of the body and re-implanting them elsewhere. It is minimally invasive and can help correct the small areas or the entire buttocks that distress patients.

Fat taken from areas of the body and grafted into the buttock is soft, feels natural, and doesn’t cause immune problems. Best of all, there is the added benefit of having extra fat removed from elsewhere, which allows for a more sculptured body, particularly in the tummy.

The main downside to fat grafting is that your body tends to absorb the fat to some degree. The amount of fat that is implanted and then absorbed by your body varies depending on the methods of extraction and injection into your buttocks A great deal of the success of fat fillers that are not absorbed into the body involves the doctor following the latest methods of fat removal and injection. It does work when properly done.

Fat Grafting and Technology The major reason that fat grafting has become more accepted today is technology. Advances in harvesting methods and the processing of the fat cells are the two main areas of improvement. Any plastic surgeon is aware of the need to be extremely careful in obtaining the fat from the body, which must be done very

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softly and carefully. He/she must extract the fat and then purify it by not allowing any contamination to be introduced into it before slowly injecting the fat in a series of small punches. This is to preserve and not damage the fat as it is plumping up butts and filling out any wrinkles and hollowness. The cells are harvested, prepared, and then injected into the treatment site in many small crisscrossed tunnels. The fat cells survive and keep their volume if and when the new blood vessels grow in to feed them. It is a race between hooking the fat cells back up to a nourishing blood supply and making certain that the cells remain well-nourished.

Fat transfers performed as an outpatient procedure may be cheaper that in-hospital procedures for the buttock enhancement. The cost of the procedure will also depend on the geographical area where you will have the treatment done. Fat transfer costs may range from $1,500 to $9,000. There is little question today that the most sought-after buttock filler is the newly-revised and carefully performed procedure of removing fat from one area of a patient’s body and injecting it smoothly into the buttock for a much more youthful appearance.

Before

After

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Female Buttocks

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This 24 year old woman after fat transfer to the buttock (Brazilian buttock lift). 400cc injected per side.

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Body Fat Cells Your body fat cells are very much a part of the fat grafting process. One aspect that has occurred in the process of fat grafting is a wider acceptance and usage of stem cells. The realization that high concentrations of stem cells reside in fat has raised the potential that they can be used for better volume preservation and even to promote healing in difficult wounds. Autogenous fat grafting continues to have tremendous appeal due to its ease of harvest, ample donor sites (in most patients), and its ability to be injected. But no matter how it is done, the fate of the injected fat grafts can be unpredictable if not properly extracted.

Fat as a biologic tissue is far more complex than just a storage site for needed energy. Fat is clearly much more diverse than once thought. It is interlaced with numerous cell types and it functions in some ways as an endocrine organ.

Fat cells develop from less-specialized cells called fibroblasts: a type of flattened cell that is abundant in the body. As part of tissue maintenance, fibroblasts can develop into fat cells or other connective tissue types to suit the needs of the body. Once created, they remain in the body unless surgically removed, although the size of the cell can change as the fat droplet inside the cell grows or shrinks.

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Even those with great bodies that are in excellent shape have enough fat to harvest, sufficient to supply the needed fat for “buttock contouring”) Most fat cells have the appearance, under a microscope, of round, fat cells. The fat cells lack tissue stain and appear white when observed in a lab. Each adipose (fat) cell has within it a single large droplet of fat that takes up the majority of the cell’s space. At the end of the cell is a flattened section of the cell’s membrane. The fat cells are numerous and found in various tissues of the body, such as the skin, bone, and around some vital organs. However, when it comes to fat extraction, most surgeons secure fat cells from the abdomen because it has an excellent supply of them. Stem Cells in Fat The stem cells play a part in the longevity of cell retention in the butt. Stem cells were once not known to be a major part of the fat cell, but it is now debated whether or not they are the secret to sustained cell life in the body.

Fat has the greatest number of stem cells of any tissue in the adult human body. This makes it a potentially powerful tool in grafting. How the stem cells in fat grafts may contribute to better volume preservation is not clearly understood, yet it exists.

Early on, revascularization may play a role in helping some of the mature and intact fat cells survive the transplantation process. Stem cell conversion undoubtedly plays a significant role in the transplanted fat. Blood supply to feed

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the fat cell is absolutely essential and during the injection process, the surgeon needs to be aware of crisscrossing the injected fat to get the best results. What special methods are used to prepare the fat? The usual preparation is concentrating the fat and removing as much of any extraneous fluids present as possible. The fat cells are uncontaminated by the environment and are prepared with precision. As described in a later chapter, this method offers the potential for growth. Fat Cell Careful Handling With today’s methods of fat transfer and injection, some damage can be done to the fat cells either during the extraction process or in the purifying of them, but by far, the greater part of the extracted fat is suitable for transplanting where there is tissue.

As one surgeon said: ―We are not putting in the best material possible. We are simply putting in the best material available that is easiest and relatively harmless to get. This is true!

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Consultation with Your Plastic Surgeon

Most likely, prior to meeting with your plastic surgeon, you will be asked to fill out some forms. Answer each question on the form in detail. Your surgeon or surgeon’s coordinator will discuss the answers with you. If you smoke, you may be asked to temporarily stop. Smokers tend to have a longer recovery time and may have problems with their wounds healing, especially in larger fat injections. Avoid anti-inflammatory drugs prior to surgery. This helps to prevent increased bleeding. Go over the list below.

Discuss with your doctor any health conditions that you have, including any pre-existing problems or the risk you may have for developing problems.

During the consultation, you will be asked what it is that you wish to achieve by undergoing buttock fat injections. Be frank about your goal. What shape do you hope to achieve and what is possible? Your plastic surgeon will have answers for you in an effort to guide you as to what is possible and what is not. He/she will determine your buttocks size, fat distribution, and the amount of fat present. These are all part of the optimal plan to give you the best result.

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The more open and frank you are with your surgeon, the better the outcome. He/she can’t divine your wishes, so you have to let the doctor know what you want to achieve.

In some cases, a full history and physical examination will be conducted prior to the procedure. Your plastic surgeon may take pre-procedure photographs and you will be required to sign an informed consent acknowledgement.

Make certain you follow all pre-surgical instructions and be prepared to make financial arrangements for the full cost of the procedure. Be open with your surgeon as you discuss costs and what you can reasonably afford. Many surgeons offer assistance in getting financing to cover much of the costs. However, most plastic surgeons request advance payment of the buttock fat transfer procedure.

At some point, your surgeon will explain how the stages of removing the fat, purifying it, and injecting it into your buttock will work. Upon initial evaluation, your plastic surgeon will determine your type of buttock and make recommendations on how to make improvements to the shape. Your plastic surgeon will also suggest which areas to harvest the fat from in order to get optimal results. The amount of areas suggested depends on the amount of change that you are looking to achieve. In many cases, the fat removed from surrounding areas is equally important to the final shape as is the fat transferred to the butt.

Since the shape and size of the buttock is a personal preference, each individual will help to determine what the expected goal will be. Once all parties agree on the expected shape, your plastic surgeon will put drawings on the area to guide him/her throughout the procedure. We will also identify the areas for liposuction to harvest fat and mark those areas. Pictures and measurements will be taken prior to the procedure for documentation. Advanced Preparation for Your Surgery Your surgeon will give you instructions on how to prepare for surgery, including guidelines on eating and drinking, smoking, and taking or avoiding certain vitamins and medications. In addition, while explaining your surgical procedure,

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your plastic surgeon will discuss anesthesia, the recovery process, and your obligations as a patient.

You should also discuss where your procedure will be performed. There may be a waiting period of several days or weeks from the time of your commitment to have the surgery until the day of the surgery. While making preparations, be sure to arrange for someone to drive you home after your surgery and to help you for a few days if needed.

No anticoagulants should be taken for two weeks prior to surgery. If general anesthesia or sedation is to be involved, the surgery will usually be in the morning and fasting from midnight the night before is required. If only local anesthesia is to be administered, fasting is not required. Smoking must be avoided for about two months prior to surgery, as nicotine interferes with circulation and can result in the loss of tissue.

Items to Consider before Scheduled Surgery There are items to be checked off prior to buttock fat transfer surgery that will ease the experience and allow for greater success:

• No aspirin or anti-inflammatory medications before the procedure (your plastic surgeon can provide you with a list of OTC medications to avoid).

• Make arrangements to have someone drive you to and from the operation. Arrange for someone to care for you during the first 24-72 hours after surgery.

• Fill prescriptions (especially pain medications and antibiotics) before the surgery. • Have a pill case with a time chart for taking medications. Prepare and freeze

meals a week or two in advance of the surgery.

The preoperative instructions are important to follow if you wish to maximize the results of fat transfer for buttock contouring, as well as to avoid any complications. At times, buttock fat transfer surgery may be cancelled, though rarely. There may be a need to hold off on performing the surgery; this could

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happen should you fail to follow the precautionary measures that are required in order to avoid complications.

When consulting with your plastic surgeon, bring a list of current medications that you may be taking. In addition, bring any results of recent surgery and the date on which they were performed. Your surgeon needs to know of any health conditions that you may have.

Your plastic surgeon will likely explain that there are three stages to the buttock fat grafting surgery:

Stage one is securing the proper amount of fat cells to make the enhancement possible. In this stage, the surgeon suctions out the fat from an area of the body. The most common area of fat cell extraction is the abdomen. However, fat can be extracted from the hips, the thighs, or other areas of the body.

Stage two is the cleaning of the fat cells to purify them to be injected into the butt.

Stage three is the injecting of the fat by means of a small needle on the end of a syringe.

Proper planning is a must for the best results and in order to achieve improved, balanced, and increased size of your buttocks for a more attractive you.

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Gentle Liposuction and Fat Cell Preparation

This step has two equally important purposes: first, to collect the fat that will be transferred to the butt; second and most important, to contour the area being suctioned. The liposuction procedure that extracts fat will result in an improved appearance in the area of the body where the fat was extracted. A careful surgeon does not simply harvest fat; rather, he/she treats the area with the same precision as a skilled surgeon would in a normal liposuction procedure except that it is much gentler than simply doing a body sculpting procedure.

Liposuction involves the removal of fat cells by suction through a metal tube that is no bigger around than a narrow pencil, called a cannula, or the surgeon may choose to extract the fat with a syringe.

Through this process, fat cells will be slowly and very carefully sucked out to protect them from damage. With current methods of harvesting fat, there is more than one way to do this. Some surgeons use the Water Jet technique and others the Internal Ultrasonic Liposuction method, which involves the liquefaction of the fat with sound waves prior to fat cell removal. There are others that do what is referred to as the Vaser Liposuction surgery. All of these methods have received high approval by plastic surgeons performing liposuction.

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Fat harvesting with liposuction can be performed on most areas of the body, including in fat deposits under the chin, in the neck, the abdomen, the chest and upper arms, the hips, thighs, knees, calves, and ankles. In some cases, liposuction may be combined with customary surgical procedures that stretch and remove excess skin and fatty tissue, such as a tummy tuck (abdominoplasty).

In addition, liposuction surgery can be performed on any person who is in reasonably good physical condition and who may have localized, unwanted fat. Large volumes of fat removal can be dangerous and is often performed as staged procedures in a series of liposuction surgeries. Removal of fat is performed with minimal trauma and manipulation of the fat removed.

Liposuction and Tightening and Lifting Skin Liposuction can be a good tool for tightening the skin. The removal of quantities of fat from under the skin allows the elastic skin to retract to its genetically predetermined position and sometimes become even smaller. Good examples of this effect are seen after liposuction to the arms, stomach area, and breasts.

The level of skin retraction following liposuction is also determined by the age of the patient as well as the quality of the skin, the presence of underlying disease or smoking, and the presence of previous skin damage, such as that caused by childbirth and surgery. Liposuction techniques such as sub-dermal undermining using a small cannula can stimulate further skin retraction. While sub-dermal undermining may help the skin contract, patients with severe elasticity loss and heavy stretch marks prior to liposculpture may require the removal of redundant skin by surgical means after liposculpture. Usually this can be performed after six months.

While performing a fat transfer procedure, surgeons often do the suctioning phase in about 30-60 minutes. It is a slower process than simply removing fat for body sculpting. The fat cells have to be harvested to preserve their integrity.

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In review, the following is what you can expect: The targeted areas are marked on the body while the candidate is in a standing position. Sometimes pictures will be taken of the area to be treated so that the patient will have before and after photos.In the perating room, a sterilizing solution such as Betadine is applied to the relevant areas The initial part of the procedure is injecting fluid into the area to be suctioned in order to numb it. Then comes the surgeon’s focus is on the liposuction equipment used to harvest the fat. The fat is removed using special techniques to increase the amount of viable fat cells. The surgeon may also use the liposuction approach in some of the surrounding areas of the butt. This is done to create the new borders of where the buttock should start and end. When the surgeon estimates the amount of fat cells needed to enhance the butt, he/she will then process and prepare the fat for transfer. The fat will then be carefully arranged in a special instrument designed specifically for transferring fat. Once the harvesting begins, it is essential that the harvested fat is handled as gently as possible in order to ensure that most of it is kept viable. With today’s latest methods, liposuction is the primary means of harvesting fat for grafting purposes. While removing the fat cells, the fat enters small holes at the tip of the cannula and then travels down the length of it. Attached to the end of the cannula is clear tubing. The other end of the tubing is attached to a canister that collects the fat that will be used for fat transfer. This canister is not the same as the typical liposuction canister. It is a specially designed container used to keep the fat sterile. When a smaller volume of fat is required for a revision of the butt, the fat extraction can be performed by hand with a syringe attached to a uniquely manufactured cannula. Suction of fat from the body is performed by a vacuum. The key to maximum fat viability during the harvesting process is to perform the technique with low negative pressure liposuction. This can be accomplished either by machine or by a small syringe vacuum. The gentle method of extracting the fat needed is performed by using half of the pressure that is normally required with the machine method. For extracting smaller volumes of fat, the small syringe liposuction works well. Patients who require a greater volume of implantable fat have the low negative pressure machine vacuum method. It is more efficient. Many surgeons employ the Body-jet® liposuction device set at low negative pressure. Body-jet® uses a

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pulsing water jet to gently dislodge the fat. It is considered to be the most gentle of the machine-harvesting methods with demonstrated end results in 80 to 90% viability of the fat. When the required amount of fat cells is safely in the canister, they will be transferred to the next phase of the buttock fat procedure. The next phase involves a process of isolation and sterile preparation of the fat cells and is oft times referred to as washing. This is done following the fat extraction.

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Fat Cell Isolation and Preparation

Once the harvesting of fat cells is complete, the fat is transferred sterilely through multiple syringes. The liquid part of the graft is gently washed free of oil, lidocaine, and blood as part of the purification process.

The aspiration stage of cleaning the fat is done with the layers of fat in the sterile container. The top layer is ―free oilǁ‖ from ruptured fat cells. The surgeon will decant (gently blot) the oil. The middle layer of extracted fat consists of fat cells for grafting.

The surgeon must be gentle with this layer. The fat must be treated to remove blood and other fluids as well as any damaged fat cells. Whole, healthy fat cells are best used for re-implantation to maximize the chance for success. The surgeon may manually aspirate the fat to be grafted, which is then spun in a centrifuge machine to remove excess fluids and damaged fat cells, which are separated out. The fat, which looks like a yellowish liquid in the syringe, is cleaned.

Vigorous washing or straining may damage the fragile cells and decrease the viability of the graft. The bottom layer of accumulated fat contains variable amounts of tumescent fluid and blood and is drained off.

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There are other methods employed by surgeons, but the ones listed above are the most acceptable.

The fluids used for fat suspension are normally saline or lactated Ringer solution. Serum-free culture medium is also available. Some surgeons use heparin, insulin, vitamin E, and non-steroidal anabolic hormones.

Some surgeons who anticipate the need for additional adipocytes (fat cells) in the future will freeze the tissue to -30°C and reuse it later to be injected into the patient’s butt, should the patient want additional enlargement where some of the fat, after the first injections, has died off. A high number of viable cells exist even after defrosting. Slow freezing and thawing is currently the best method of retaining the maximum number of live cells.

A photo of the processed fat in a canister

If the

surgeon uses a syringe to remove the fat, the same syringe is not used to inject the fat during the buttock fat transfer

procedure. The fat must

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be treated to remove blood and other fluids as well as any damaged fat cells. The fat is prepared to be concentrated and purified and is thereby rich in

ADIPOSE DERIVED STROMAL/STEM CELLS (ADSC). This system, which minimizes the chance of contamination, adds an extra safety feature that is vital for buttock fat transfer.

The fat, which looks like a yellowish liquid in the syringe, is now cleaned. Once the cleansing phase is complete, it is ready for the next phase, which is the injection of the fat into the buttock using a separate, smaller hypodermic needle. Injecting one’s own fat into the buttock is certainly gaining in popularity. The structural fat for grafting to the body for correcting flaws or reconstruction defects has become widely practiced throughout the world with excellentresults. The artistic skill of the surgeon makes all the difference in the results. The injection process is most often done with syringes. Plastic surgeons who are skilled in the procedure of injecting fat into the buttock fat grafting procedure use a specially designed injection cannula to transfer the fat to the buttocks. It’s critical here to use many injections of very small amounts of fat and work the fat into the site in order for it to join with the tiny blood vessels that are present. Once the harvesting begins, the goal is to harvest the fat as gently as possible in order to ensure that most of it is kept viable. With today’s latest methods, liposuction is the primary means of harvesting fat for micrografting purposes. Injecting Small Amounts of Fat Cells Large amounts of fat cells tend not to survive; therefore, the injections will be in small amounts of fat cells that will be placed throughout the butt, slowly sculpting the cheeks to the desired size and shape. This method is time-consuming but it improves fat survival and ultimately gives a much better result. Buttock scars from the needle injections are hardly noticeable. With a buttock fat transfer procedure, it is difficult to detect the amount of fat to inject in order to achieve the desired goal. The fat has to be delicately injected, as one surgeon commented―like strings of ribbon throughout the muscle so that it can receive a proper amount of blood supply.ǁ‖

Before the fat can be re-injected, it must be treated so that blood, lidocaine, or any other material is removed. Plastic surgeons can use several techniques to complete this separation process. Some use a centrifuge, which rapidly spins the liquid down. Others "decant" the material, which simply means that they allow the material to settle in a test tube so that the fluid separates from the fat. A saline solution can also be used to purify the fat cells. There is actually

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no standardized method for purifying fat cells. You may wish to discuss which technique will be used with your plastic surgeon prior to the procedure.

Once treated, the fat cells are then loaded into a small syringe. The buttocks will be anesthetized, or numbed, with lidocaine. Plastic surgeons often describe the injection process as "weaving" or "layering" to achieve the desired cosmetic effect, especially when treating larger areas. Unlike collagen, which is injected into the dermis (the skin's superficial layer), fat is injected subcutaneously (under the skin). This allows plastic surgeons to plump up the area more aggressively while maintaining a natural appearance.

No bandages or other wrappings are required afterwards. The entire procedure usually takes one hour.

Once loaded into syringes, the pure fat is ready for injection into the targeted areas of the buttocks. Surgeons who are skilled in the procedure of injecting fat use a specially-designed injection cannula or syringe to transfer the fat to the butt.

A Syringe filled with fat prepared for injecting into the buttock

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Using excessively large injections of fat into various areas of the buttock is discouraged. Rather during the injection of fat cells small amounts of fat throughout carefully predetermined areas of the buttock achieves a sculpted shape and fill. This artistic shaping takes more time but improves the fat survival rate and ultimately offers a better, more natural result. Don’t worry about scarring of the butt. The fat injections can be done through tiny needle punctures that leave no visible scars. Volume of Fat With the fat transfer procedure, it is difficult to determine the exact volume of enlargement that will be achieved in the desired buttock enhancement. The fat has to be delicately placed throughout the muscle so that it can receive an adequate blood supply and be positioned to give the best results.

Measured Injections It is very important in the process that the fat graft relies on the fact that each grafted fat cell is near a blood vessel or other cells where it can borrow from them for a time. As mentioned, small amounts of fat are placed in different layers of the skin and muscle to increase the chances that each fat cell is close to another cell to borrow from. The more this takes place, the better the overall success rate.

Fat injection of

buttocks

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Need for a Touch up Touch-up fat grafting is sometimes needed. A growing number of patients seek out the more experienced fat grafting plastic surgeons who have learned how to keep the transferred fat alive and nourished with blood. If a touch-up is needed, it means that more fat is required to completely achieve the desired result. After six months to a year, if the desired level of fat grafted into areas of the buttock has become less acceptable, it is possible to do a touch-up with one’s own fat once again. Keep in mind, though, that the patient will still have an enhanced look with the increase of fat that has already been grafted. Once the blood supply is firmly established, within three to six months, the fat begins to take hold and thrive. Usually within a year, the result of the fat grafting process is well-established.

What to expect Fat adds volume to the buttocks. Fat injections to the buttocks may be overfilled for a few days. This compensates for the absorption of some of the fat cells, but when the fat is settled in with an adequate supply of blood that tends to attach itself to the stem cells, the result can be a more refined, full buttock appearance.

Swelling, which is commonly seen after fat injection, usually resolves within two to three weeks. The degree of swelling is mostly dependent on the area of the buttock that has been injected.

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This 26 year old woman had fat transfer to the buttock (Brazilian buttock lift). 400cc injected per side. The results of here fat injections to the buttocks are illustrated in the following photos.

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Before

After

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Before

After

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Final Results The results of buttock fat transfer are permanent. It is a living graft that achieves a blood supply much the same way as a hair transplant is able to flourish and sustain itself. In the transplanting of fat, when the process of neovascularization (new blood supply) has been established, the fat grafts not only survive in their new environment, they thrive. Generally this process takes as much as two to three months to occur. The fat grafts transition over months from survival to a natural state of living fat as with other fat in the body.

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Scars With fat injections, it is now common for lines, depressions, folds, and depressed scars to be corrected with fat grafting. The buttock can be successfully treated with injectable fat up to a point. It is not always possible to remove all depressions, scars, and lines, but it is certainly feasible to remove some of them and lessen the appearance of these bothersome skin defects that some find distressful. In these situations, the fat is normally injected into the patient just below the skin. The rich dermal subdermal vascular plexus has excellent blood supply to receive the graft. Typically smaller amounts of fat are used with slight over correction. This is to make up for the lass of take of the fat graft which may be as much as 30%. Many scars, including from former surgery, are depressed. Some of this is due to the loss of blood supply to the subcutaneous fat. Excising the scar, Lifting flaps over the underlying tissue with a plastic closure has been the standard of care up to now. In recent years the technology of fat grafting has been applied in limited circumstances with good results in patients who do not want scar revision surgery. The fat fills work especially well in the face where there is excellent blood supply. One must remember that scars are permanent. All plastic surgeons can do is make them better for you. Timing the fat fill or scar revision is important. We must accept that wounds heal over a period of time usually 6-9 months. Initially any wound goes through a period of inflammation where the blood supply engorges at the margin of the wound. Special cells migrate to the wound to provide closure. Once that is accomplished scar tissue with fibroprotein is laid down giving the tissue breaking strength. This process takes several weeks to months. Then the tissue undergoes collagen maturation for several more months. At the end of the healing process, the tissue get very soft. At that time, scar revision surgery or a fat fill can be performed to improve you appearance. Fat fills are especially useful for depressed scars.

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Recovery from Surgery Depending on the extent of the liposuction For the next two to three weeks, it is wise to wear a impression garment or bandage. Non-absorbable sutures, if they were placed during surgery, will be removed after five to ten days. There is typically some bruising and swelling. Bruising clears within a few days; swelling may last for several weeks. It is likely that the buttock area will be reddened within the first 48 hours. procedure performed, generally patients return to work within a week.

Pain and discomfort can be managed with oral medications. Scabs may form at the injection site as well. Report any unmanageable pain or any symptoms that are progressive or abnormal. They should be reported to the doctor immediately. Any pain is controlled by a prescription or over-the counter medication. Pain can last as long as two weeks, depending on the area where fat was extracted as well the buttocks. The use of ice or an anesthetic cream can numb the area, rendering the injections nearly painless.

The fat requires adequate blood supply to nourish and sustain it. Therefore, it is recommended to not put pressure on the buttocks for two months following the procedure. Avoid tight clothing that could be restricting. Limited sitting is required, although this can be troublesome and challenging. It is limited in order to ease any direct pressure of sitting for at least two weeks followed by careful sitting for two months. It is possible to sit without much pressure on the buttocks. Discuss this with your plastic surgeon.

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Fat Transfer Expectations Your diet needs an increase in carbohydrates, which will start your body storing fat. However, watch the calories to avoid gaining weight. Avoid fat burning exercises that will tend to deplete the fat stores and decrease the amount of fat that may survive following fat transfer, which may include any exercise that causes excessive sweating. Focus on strength building rather than fat burning exercises, meaning use heavier weights with less repetitions.

Side Effects A side effect, as opposed to a complication, can be uncomfortable, annoying, and even painful.

• Bruising: can be painful in the short term and should fade after a few weeks. • Swelling: should subside gradually over a month or two. • Scars: will vary in size depending on the particular procedure and should fade

over the weeks. Scarring is an individual matter, partly dependent on heredity. For some, scar healing may take as long as a year.

• Pain: should be temporary and controlled by either over-the-counter medications or by a prescription.

• Numbness: sometimes persists for a few weeks. • Limited mobility: will depend on the exact procedure. • There could be various factors limiting movement for a short while, such as: •

Follow Up with your plastic surgeon Regardless of how you see the progress in your recovery, you must make the follow-up appointments with your surgeon. Results As with any surgical procedure, patients need to give it time to show lasting results. The fine needles used during the injection of fat result in a smoother, more

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enhanced area of the body. The injected fat pushes the depressed, flat, or wrinkled buttock forward to project a more rounded appearance, offering satisfaction with the procedure.

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8 Summary of Fat Grafting

Fat grafting enhances the visual appeal of the face and body. Fat augments areas of the body that a patient may find unsatisfactory for perhaps several reasons. The combined liposuction, fat grafting and tummy tuck surgeries have introduced a marvelous method of creating a slimmer, more attractive body that sheds years off a person. Fat grafting is a method of injecting which is increasing in recognition. It is now considered the safest and least invasive method of restoring the face and body to a more acceptable appearance. Fat is a well-tolerated injectable accessible to plastic surgeons, and therefore provides extensive solutions. One of the outstanding aspects of fat grafting is the natural-appearance of patients and if is pretty much risk-free. Regarded as efficient filler, it can be used for altering physique shape. It revises scar problems, filling depressions and offers a tool in today’s cosmetic procedures that a few years ago were not possible with injections. In short, fat grafting adds much needed volume-enhancement that is a generated risk-free opportunity and natural appearing with reduces fat deposits mainly in the tummy. The combined procedures of buttock fat grafting and tummy tuck surgery are an excellent method of regaining a more youthful body.

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9

Possible Complications During the recovery time there will be soreness and some pain, however much of the pain can be controlled. Patients have varying thresholds for pain. Pain is a result of most surgeries. The doctor will prescribed medication. Even so, you should be aware that although pain medications do help reduce pain and make it more tolerable, don’t expect to have no pain. Nausea may occur due to anesthetics, narcotics, and antibiotics. Likely the doctor will prescribe an anti-nausea medication. This will usually happen just before, during, and after surgery. While eating, it helps to take the medications as prescribed. This helps to reduce the incidence and degree of post-operative nausea. There will be swelling and bruising. This is normal with the abdominoplasty surgery. The skin of the abdomen, navel, genitalia, buttocks, and thighs will most likely have some inflammation and swelling, as well as bruises following the surgery. This could endure over several weeks. Some of these conditions can persist for over a month or more. It depends on the patient’s circulation. If circulation is poor it may take longer to for bruising to fade.

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It is not common to have bleeding after surgeon, though it could happen. There may be localized small amounts of blood that can collect under the skin (hematoma). This can be treated through aspiration or placement of a drain. Do not take blood thinners, such as aspirin, anti-inflammatory or vitamin E. Hold off for at least 10 days. Infection may occur. However, it is not common. The doctor will give you antibiotics during and prescribe antibiotics that you will be asked to take after surgery. This helps to reduce any risk of infection. Numbness occurs in the area of the abdomen, pubic area, flanks, and parts of the thighs following surgery. This resolves gradually several months. There may also be tenderness, though this may disappear in time. Sutures — Most surgical techniques performed by plastic surgeons use deep sutures, which might spontaneously poke through the skin, become visible, or produce irritation that might require removal. .

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10

Frequently Asked Questions

How is the procedure performed ? Buttock augmentation by way of fat transfer (Brazilian buttock lift) is usually performed under general anesthesia as an outpatient procedure with patients going home the same day. The success of the surgical outcome has a lot to do with the technique. The fat must be harvested or collected in a manner which preserves the structure of the fat cells-this is accomplished through liposuction. Then the fat cells must be strained and prepared in a very gentle manner for re-injection. The injection of the fat cells must be done at the appropriate depth (into the muscle) and the correct distribution (upper and lower buttock). Who is an ideal candidate for this procedure? The best candidate for a Brazilian buttock lift is someone who is in good overall health but slightly overweight. This excess fat is needed in order to ensure a good outcome. Patients who are very thin are not good candidates for a fat transfer to the buttock. Some thin patients may be advised to gain some weight before having this procedure.

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What about buttock implants vs. fat transfer to the buttock? Buttock implants are limited in that they can only deliver volume to one specific area. There is not a lot of sculpting and contouring to be performed with gluteal implants. Furthermore, these implants tend to feel less natural than your body’s own fat. Buttock implants also have more complications such as infection, implant displacement, sagging, capsular contracture (scar tissue formation), and wound healing problems at the incision site. They are not generally preferred by most board certified plastic surgeons for buttock augmentation for these reasons. Which areas of my body will be used for the fat transfer? Typically the abdomen, flanks (love handles) and lower back are the primary areas treated with liposuction. However, the arms and thighs can also be used to donate fat for the procedure if needed. How much fat can be injected into each side? There is no defined minimum or maximum amount of fat that can be transferred per side during a Brazilian buttock lift. The final amount depends on the volume of good quality fat that can be removed (via liposuction). Patients who have more fat on their bodies can generally have a higher volume injected, this can range anywhere from 200 cc to 1000 cc per side. More important than the amount of fat injected is the amount of fat which survives long term. How much of the fat can I expect to keep permanently? This varies from person to person and technique used, but most patients can expect to keep about 70% of the transferred fat (volume). The longer a patient can avoid sitting, the higher the percentage of fat cell survival after a Brazilian buttock lift. After about six months, the amount of fat that remains is thought to be permanent. If I lose weight after surgery, will my buttock size decrease?

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The buttock size can increase or decrease depending on your overall body weight change. If you gain weight, you may see an increase in the size of your buttock as well as your entire body. If you lose weight after a Brazilian buttock lift, your buttock may get smaller but so may your entire body (arms, legs, abdomen, etc.). How long is the recovery from a Brazilian buttock lift? Most patients will take one to two weeks off from work to recover from a buttock augmentation (Brazilian buttock lift). Since it’s important to avoid direct sitting on the buttock for about two weeks, patients will modify their sitting with the use of pillows and cushions. When can I begin exercising after a Brazilian buttock lift? Patients are to avoid strenuous, fat burning exercise for about eight weeks after surgery. This will allow the newly transferred fat cells an opportunity to survive and establish the necessary blood supply. Some light aerobic activity and weight training is acceptable a few weeks after surgery. Walking after surgery is highly recommended. When is it ok to sit after a fat transfer? Patients wear a compressive garment from their waist to their knees for about four weeks. It is important to avoid direct sitting on the buttocks for approximately two weeks as this can harm the delicate fat cells. Positioning after a Brazilian buttock lift therefore becomes very important-patients. It is best to sleep on sides or on the stomach during this period. Patients can sit but with the assistance of a special pillow or cushion placed under the back of their thighs. Most of the obvious swelling resolves in about two to four weeks. As with any type of fat transfer, some of the fat may shrink or atrophy, however by six months you will have a good idea of how much fat (volume) is retained. The Brazilian buttock lift really allows the surgeon to re-sculpt the entire buttocks, waist, hips, lower back and abdominal area; while at the same time increasing the buttock size.

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Can I have other procedures done at the same time as a Brazilian buttock lift? It is possible to perform other procedures such as a tummy tuck or breast augmentation at the same time as a buttock augmentation, though it depends on overall health. This can be discussed during consultation with the surgeon.

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Storing Fat Cells

There’s desire by some to freeze their fat cells for future use in cosmetic injections. Fat works as a great filler for your nasolabial folds, cheeks, and eye hollows. Using fat tissue from your own body has the added benefit of allowing your own stem cells to improve collagen growth and blood flow, an advantage over using synthetic injectables like Juvederm and Restylane. An issue of Bazaar reports that plastic surgeons are recommending their patients to place their fat on ice, particularly after liposuction. The first fat bank in the United States, Bio Life Cell Bank in Dallas, has had an increase in activity since late last year, with the number of people banking their fat doubling every three months. The Ideal Age to Harvest Your Fat Cells Don’t wait until your 50′s and 60′s to harvest fat – the best age to remove and store fat cells is during your 20s, 30s, or 40s, when your stem cells are still potent. Fat is able to be banked for at least 20 years. Therefore, if you bank it at 30 years of age, you can use it for cosmetic injections when you’re 45 years old, the common age where fat loss and tissue descent happen.

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What If You Don’t Need Liposuction? Your plastic surgeon can remove 10 or 12 ounces of fat from your thighs or buttocks, which is enough fat to use as filler for a lifetime – within an hour and without pain. The Procedure and Costs After your fat is harvested, it is shipped to the bank, where it is stamped with a barcode and put into liquid-nitrogen vapor as a preservative. The fat storage costs $1,700 for the initial first year, and then $200 a year after that. All in all, the procedure can cost $2,500 and up. When it’s time to use some fat filler for a cosmetic procedure, a part of your stored fat and stem cells is divided and recombined, put into a syringe and shipped to your doctor’s office via Fed Ex for about $2500. Although this may seem pricey, an article in the Bazaar magazine reports that if you re-inject the fat in 5 years, this costs approximately the same as paying for Juvederm and Restylane injections twice a year for 5 years. To store 250 to 300 cubic centimeters of fat, the Gold Center charges $900 for the first year and $200 every year after that. After your fat is harvested, it is shipped to the bank, where it is stamped with a barcode and put into liquid-nitrogen vapor as a preservative. The fat storage costs $1,700 for the initial first year, and then $200 a year after that. All in all, the procedure can cost $2,500 and up. When it’s time to use some fat filler for a cosmetic procedure, a part of your stored fat and stem cells is divided and recombined, put into a syringe and shipped to your doctor’s office via Fed Ex for about $2500. Although this may seem pricey, an article in the Bazaar magazine reports that if you re-inject the fat in 5 years, this costs approximately the same as paying for Juvederm and Restylane injections twice a year for 5 years.

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Glossary

Aspiration: The withdrawing of a fluid from the body by means of suction.

Biocompatible: Being biologically compatible by not producing a toxic, injurious or immunological response in living tissue.

Fibrous Tissues: Connective tissues composed mostly of fibers.

Hemorrhage: Abnormal internal or external discharge of blood.

Inpatient Surgery: A surgical procedure in which the patient is required to stay overnight in a hospital. Lumpectomy: Surgical removal

Opaque: Not transparent; impenetrable by visible light rays and x-rays.

Outpatient Surgery: A surgical procedure in which the patient is not required to stay overnight in a hospital.

Prosthesis: Any artificial body part.

Sensory Nerves: The nerves that conduct afferent impulses from sensory receptors to the brain or spinal cord.

Sepsis: The presence of various microorganisms, their poisonous products or their toxins in the blood or tissue. Silicone: A material that is widely used in medical implants, composed primarily of silicon, carbon, hydrogen and oxygen.

Silicone Gel: Silicone produced in a semisolid, semiliquid state, used as a filling in breast implants, similar in consistency to a normal breast.

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Thrombosis: The formation or development of a blood clot.

Tissue Expander: An adjustable implant that can be inflated with salt water to stretch the tissues at the mastectomy site. Courtesy of Mentor

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About the Doctor/Presenter

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