Fat grafting of the buttocks, otherwise known as a Brazilian Butt Lift or “BBL,” is a very popular procedure these days. Its prevalence is partly a reflection of the effect social media has had on the population (think Kim Kardashian), in addition to the changing body aesthetics of our multicultural world. When I began my surgical training at the University of Minnesota in 1997, butts were not in vogue, nor were they a part of the collective consciousness. I spent zero time thinking about how to make butts look better. Back then, it was all about breast augmentation. That has since changed, and in my opinion, for the better. Natural, healthy curves are in (including the buttocks), and the sinewy, chiseled, six packish, almost anorexic aesthetic with tight, oversized breast implants is out!

My current approach to plastic surgery and the BBL procedure centers on balance and harmony. Body parts, whether it is the buttocks, breasts, or legs, have to flow with the rest of a person’s anatomy and physique. If any one part is abnormally large or out of balance, it looks odd or “fake” and everyone around you knows it. In my opinion, if people know you have been altered, it completely defeats the purpose of plastic surgery. I want people to look at my patients and wonder why they look better! This is the mindset I bring to all the surgery I do, whether it is a breast augmentation, abdominoplasty, breast lifts, or BBLs. I focus all my energies on accentuating or embellishing God-given anatomy.

So, what do I love about fat grafting of the buttocks?  First, when women age or go through pregnancy, the buttocks, like the breast, can deflate and sag.  By adding additional volume using fat, you can plump and rejuvenate the buttocks and restore or establish a more feminine silhouette. In addition, with aging and hormonal changes, women’s torsos can become square due to fat accumulation and redistribution, particularly around the hips and flanks. By using liposuction to carve down these areas, these age-related changes can be reversed, thus creating a more youthful silhouette. It’s all about rejuvenation.

So, what do I dislike about the BBL (and the culture that surrounds it)? Well, for one, I really hate what I call the “diaper butt.” That’s a butt that is too large for the frame carrying it. Think skinny, chicken legs and two huge watermelons. The two things do not work together, and to my eyes, its aesthetically unattractive and not subtle. It makes me wince seeing a big set of buttock implants that do not move naturally when the patient moves.  Everyone knows what has had done. It defeats the purpose of plastic surgery in my book.

In conjunction with my first dislike is the second: doctored or photoshopped social media images that do not reflect reality. I council many patients who darken my doors with wish images that were obviously altered. Even though many of these images are deceptive and false, women torture themselves chasing that aesthetic, despite it being a complete mirage.  It’s time that we wake up and try to be the best versions of ourselves, instead of a copy of someone else.