Over the past 5 to 10 years, the popularity of fat grafting of the buttocks, also known as Brazilian buttlift, has soared. This can be attributed, in a large part, to the influence of Kim Kardashian and, to a lesser extent, the growing impact of Latin American culture. Within the realm of plastic surgery, BBL surgery one of the most highly sought-after aesthetic procedures.

Targeted sculpting using liposuction in conjunction with fat grafting is a very powerful way to rejuvenate and feminize the female form, which may have been damaged by time, pregnancy, or bad genetics.

Social media influence in Plastic Surgery

For better or worse, social media has played a significant role in popularizing the BBL procedure. This is a double-edged sword in part because digital images can be EASILY manipulated. I’ve been a hobbyist photographer since the 80s, learning the art from my professor father. I have a very keen eye. I take all my own clinical photographs and I can easily spot images online that have been digitally altered. There’s an ocean of them both on social media, Instagram, plastic surgery websites, etc. 

The most common sins are an artificially small waist with ballooned buttocks. The telltale signs are a slight digital haze or blur around the waistline in conjunction with the circumference of a size of a six-year-old girl’s along with the ass of a hippopotamus. It’s a phenomenon that will only get worse with AI and deep fakes. Digital deception can create very unrealistic expectations in the world of BBL.

The second related issue that feeds the fire of unrealistic BBL expectations is the fact that not all bodies are created equal. A majority of the BBL images online are carefully curated results of patients with optimal anatomy. 

Like many plastic surgery practices, a lot of my BBL clientele do not always have optimal anatomy. They have been through weight loss, pregnancy, or have aged. The BBL is not a creative miracle. You can’t take someone’s body who has been through a lot of abuse, or lacks the ideal anatomy, and then make them look like a 20-something Instagram fitness influencer.

Of all the procedures that I perform, BBL has THE most unrealistic expectations attached to it for the reasons described above. I do my very best to be as transparent and honest as possible, as to what’s feasible. For the most part, my patients are very adult and realistic, and

are not seeking out a cartoonish aesthetic, but something natural. From time to time, I do have people who slip through the cracks with occult, unrealistic expectations, and who later light me up like I’m the devil for not making them look like Jessica rabbit. With that slightly meandering and irritable preamble aside, here are some of my criteria for delineating patients who are a good candidate for a BBL.

Who’s a good candidate for BBL surgery?

1. Realistic expectations
2. A positive mindset
3. A normal BMI
4. An active lifestyle
5. A healthy diet
6. Good skin elasticity
7. No background medical issues such as diabetes or hypertension
8. Adequate fat to allow for graft acquisition using liposuction
9. Good anatomy: optimal anatomy for a whizbang BBL result often includes a small waist, lots of lateral hip flare, with healthy fat deposits of the abdomen, hips, and lower back and a reasonable sized buttock with minimal cellulite. With this patient demographic, liposuction alone can often be produced an excellent result with fat grafting merely being icing on the cake.

Who’s a bad candidate for BBL surgery?

1. Unrealistic expectations
2. A negative mindset which can often be due to abuse, bad relationships and generalized unhealed psychological issues, which often manifest as anxiety, depression, or anger.
3. A high BMI
4. Loose and damaged skin from weight loss or pregnancy
5. Medical comorbidities, such as diabetes, hypertension, etc.
6. Bad anatomy: there’s several body types that do not lend themselves to a good BBL result. This includes massive weight loss, or significant weight shifts with voluminous skin laxity. These patients almost always require skin excision in the form of a tummy tuck or body lift in addition to fat grafting. It’s like trying to put an implant in a deflated and loose and long breasts. It just doesn’t work.

Another subcategory of bad anatomy for the BBL procedure is severe or grade III cellulite. Bad cellulite is fibrotic in nature and has an actual volume deficit. Fat doesn’t have the robustness of an implant to expand and push out that tissue. You typically need a preemptive procedure often using radiofrequency devices along with multi-stage fat grafting. 

Another subcategory of patient involves someone with severe hip dips, and or a mid to upper buttock linear shelf or depression that once again is very hard to pop out with a single stage of grafting, if it can be done at all. 

Another demographic of patients who are poor candidates for a BBL without appropriate expectations are individuals that have large square or barrel-like torsos, often with a high BMI, along with petite buttocks plus or minus cellulite. This category of patient is the most difficult of all honestly to deal with. 

My fat grafting work is very consistent and I rarely have poor results, keeping in mind I’ve been doing this since 2012. I do have the occasional negative review from patients almost always in this category. Even after I tell them this is not a creative miracle and you will need more than one stage, I get zinged with a one-star review.

In summary, the optimal BBL surgery candidate has a combination of positive attributes of both mind and body and awareness and are pursuing an healthy change in their physique with realistic expectations.