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With the popularity of Jennifer Lopez, and Kim Kardashian’s shapely buttock curvature, buttock augmentation has been reported to be one of the top cosmetic procedures predicted to increase in 2011, according to the American Society of Aesthetic Plastic Surgery.  Recently, there has been an increasing demand for having a youthful, prominent and perky buttock to obtain a more sensual body profile. The classic hourglass shape (full buttocks, narrow waist) of the female body has been thought to be aesthetically pleasing, and is what men universally find most attractive according to one study.  Several types of augmentation, such as the breast and that of the buttock, have sprouted demand to help create this hourglass figure.

The buttock has been an important element of sexual attraction in essentially all cultures throughout recorded history.  Buttock augmentation can be performed by using several methods such as the insertion of silicone buttock implants; by rearranging muscle and fat from your buttock; and by injection using fat grafts.  The so-called “Brazilian Butt Lift” has been increasingly popular in the United States, especially since this buttock augmentation procedure does not involve placement of a buttock implant.  This particular procedure involves the harvest of fat from areas with excessive fat (such as the lower abdomen, flank and hips) by performing liposuction.  These fat grafts are then subsequently injected in areas of the buttock desired to be augmented in order to produce a more attractive and sensuous body profile

Figure 1:  Before & After Brazilian Butt Lift in Houston performed by Emmanuel De La Cruz M.D.

Who are Candidates for Buttock Augmentation?


Buttock augmentation can enhance the natural curves for patients who are unhappy with the shape of their rear ends. It can also add volume and roundness to a flat or small butt for patients seeking a more balanced body profile. Body-builders may seek buttock augmentation if they are unable to develop gluteal muscles in proportion with the rest of their bodies. Generally, if you are looking for a fuller, curvier butt, buttock augmentation may be for you.

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Figure 2:  Before and After Brazilian Butt Lift with 4D VASER Hi-Definition Liposuction performed by Dr. De La Cruz

Patient Safety during Surgery


Dr. De La Cruz values patient safety during your surgery.  For the 4D VASER high-definition liposuction, there are certain criterias that should be met prior to your plastic surgery.

  1. For patients who have co-morbidities, such as Diabetes, obstructive sleep apnea, and hypertension, a medical and cardiac clearance are required prior to surgery. For patients whose age >45, a cardiac clearance from a Board-certified cardiologist is required by Dr. De La Cruz prior to your surgery.  Safety is priority in our practice.

  2. Prevention of Infection:  During your surgery, a peri-operative intravenous antibiotics are given during your surgery to prevent a wound infection. If fat transfer is involved, such as the Braziliant Butt lift procedure, the fat that is harvested is washed with antibiotic irrigation to further reduce your risk of infection.

  3. DVT Prophylaxis:  Dr. De La Cruz calculates your Caprini Score to evaluate your risk for Deep Venous Thrombosis. All patients would have an intermittent sequential compression device during your surgery to prevent a DVT.  Moreover, an anti-coagulant, such as Heparin or Lovenox, is given to further reduce your risk for a Deep Venous Thrombosis. 

  4. For large volume high-definition liposuction patients, all patients are admitted in the hospital overnight to monitor your recovery.  A hospitalist and Dr. De La Cruz would typically oversee your care while you are in the hospital.

  5. The use of the VASER liposuction system is associated with less bleeding when it comes to large volume liposuction.  A randomized clinical trial had shown that the VASER liposuction is associated with less bleeding during surgery when compared with traditional tumescent liposuction.  This is key when it comes to large volume liposuction.  It is essential to minimize your risk of bleeding when it comes to undergoing this procedure.

  6. Prevention of Fat Embolism Syndrome:  Methylprednisolone is typically given during your surgery prior to fat transfer.  This prevents the development of fat embolism syndrome.  Fat embolism is further prevented by superficial fat transfer with NO INJECTION into the gluteal muscle.  Studies have shown that fat embolism can be prevented if it is  NOT injected into the gluteal muscles. 

  7. Dr. De La Cruz uses the Wells-Johnson High-Volume Precision Auto-graft syste for fat tranfer.  This utilizes a sterile closed-system fat collection chamber which minimizes contamination of the fat harvested, and thus is associated with less infection.  

Buttock Implants vs. Fat Transfer


The preferred method for performing buttock augmentation is fat transfer, the use of the patient’s own body fat to reshape the butt. Fat injection achieves a more natural result, has a lower risk of infection, and also contours the areas around the buttocks to enhance the overall effect. However, implants may be recommended for patients who have very little body fat to harvest,

such as body-builders and naturally thin patients.

Buttock Augmentation with Fat Transfer (“Brazilian ButtLift”)


Following the High-Definition liposuction, Dr. De La Cruz proceeds to perform the Brazilian Butt lift, a two-step procedure for buttock augmentation with fat transfer. This technique, named in tribute to its origin in Brazil, involves the collection of the patient's own fat through liposuction. Dr. De La Cruz typically targets areas such as the lower back, waist, flanks (love handles), thighs, and stomach to not only provide the necessary fat for buttock enhancement but also to contour the surrounding areas, resulting in a more striking outcome.

To ensure the highest quality fat for reintroduction into the body, the liposuctioned fat undergoes a specialized purification process. Dr. De La Cruz utilizes a closed-system fat harvester, minimizing the risk of contamination and reducing the likelihood of infection. Additionally, antibiotics are used to cleanse the fat, further mitigating any potential sources of contamination.

To further prioritize patient safety, it is important to note that the transferred fat is carefully injected into the subcutaneous plane using a blunt cannula. This technique is employed to minimize the risk of fat embolism, a rare but potentially serious complication. By utilizing a blunt cannula, Dr. De La Cruz ensures a controlled and precise transfer of fat, reducing the likelihood of any adverse events associated with fat embolism. This approach underscores the commitment to both achieving desired cosmetic results and prioritizing patient well-being throughout the Brazilian Butt lift procedure.

In the second step of the procedure, the harvested fat is meticulously injected into the buttocks using numerous tiny injections at varying depths. This meticulous approach ensures an even and aesthetically pleasing augmentation. Notably, particular attention is given to enhancing the upper buttocks, resulting in a youthful and naturally lifted appearance for the entire posterior region.

By combining liposuction and fat transfer techniques, Dr. De La Cruz is able to provide patients with a shapely contour and long-lasting results in their buttock augmentation journey.

Buttock Augmentation with Silicone Implants


Buttock implants come in a variety of shapes and sizes to best fit each patient’s body type and desired goal. They are made of soft silicone, which provides a firm, smooth and natural feel. They are placed away from important nerves as well as the bony area on which you sit. The upper and outer regions of the butt become rounder and firmer once the implants are in place. The procedure takes about two hours and is performed under general anesthesia. Incisions are made inconspicuously in the depression between the buttocks.

Recovery from Buttock Augmentation


After buttock augmentation with fat transfer or silicone implants, patients should avoid sitting directly on the buttocks or lying on their backs for two to three weeks to maximize results. During this time, compression garments may be worn to reduce swelling. Patients may experience some pain or discomfort, bruising and swelling after the procedure. Most patients return to work one to two weeks after their buttock augmentation and are able to resume all normal activities within four weeks. Swelling typically dissipates by the sixth week.


Post-Operative Instructions after Buttock Augmentation or Brazilian Butt Lift

  • Avoid sitting for two months; one may use the Brazilian Butt Lift pillow

  • Avoid exercising for two months

  • Sleeping in prone position (on your tummy) for two months

Potential Complications of the Brazilian Butt Lift


  • Wound infection/Cellulitis (<2%)

  • Seromas/hematomas

  • Asymmetry

  • Fat necrosis

  • Fat embolism (rare)

  • Partial reabsorption of grafted fat

  • Transient sciatic paresthesias (numbness)

Plastic surgery is a rapidly evolving field.  It is imperative to have a plastic surgeon who has solid mastery of clinically relevant anatomy in aesthetic gluteal body contouring surgery to perform these emerging procedures of aesthetic plastic surgery.  Buttock augmentation using fat grafts may seem to be a simple procedure, but like any procedure, potential complications and adverse events may occur.  I recommend seeing a plastic surgeon in your community if you are interested in getting the “Brazilian Butt Lift.”

Emmanuel De La Cruz MD, PLLC

» Contact Dr. De La Cruz today for more information by calling 832.520.1844

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