More is more when it comes to the butt, if the recent spate of butt implants, lifts, and injections is any indication. Butt augmentation, which enhances the shape and size of the buttocks, happens via two main methods: fat transfer, as in the case of the Brazilian butt lift, or BBL, and gluteal implants. Less common (but also less invasive) are butt injections, which add volume without the more dramatic payoff of surgical options.

The sheer breadth of options makes it all the more important to review all the facts when considering butt enhancement, including the provider in question. “Choose a surgeon who understands what you are looking for, follow their post-op instructions carefully, and maintain your healthy lifestyle,” says Chicago board-certified plastic surgeon Dr. Niki Christopoulos. With that, experts and RealSelf members share what to know ahead of time.

1. Choose an experienced, board-certified plastic surgeon
Make sure you’re working with a board-certified plastic surgeon—ideally, one who’s known to be a butt-aug authority. Not going with an accredited provider is one of the biggest red flags when getting butt augmentation. Next, “ask how many BBLs they perform in a day, a week, or a year,” says board-certified plastic surgeon Dr. Stanley Okoro, who practices in Marietta, Georgia. You want a surgeon who performs this procedure routinely and is up on the latest safety protocols.

Dr. Okoro recommends checking their before and after photos too, keeping an eye out for patients who have a similar body shape to yours in the before photos.

Reviews are also helpful, as is vetting every single step of the surgery. “’I checked credentials, visited the office, looked at the surgery room, spoke to the anesthesiologist,” says one RealSelf member. “I checked until I could check no more.”

If your preferred provider winds up being out-of-state, Dr. Okoro recommends factoring in travel for surgery, as airfare, a rental car, and post-op care can quickly add up.

2. Know all your augmentation options
RealSelf members haven’t always loved the butt augmentation method they went with. “I had butt implants done. I like the look, but I don’t like how hard they are. The doctor says that it takes a few months for them to get soft and natural-feeling,” says one member. Another received hydrogel injections, which are not FDA-approved or recommended for the buttocks. “My butt was big for a year. After a year? Back to the flatlands and out $6,000. No complications, but I regret it now because of the horror stories,” they reported.

The right choice largely depends on your body. “Some patients are great candidates for fat transfer, while others do not have enough fat sources and are better suited to gluteal implants. Other patients need both,” says Dr. Christopoulos. “My own personal preference is to use a patient’s own fat whenever possible.”

There’s also a noninvasive option. “For patients who are just looking for a little boost and don’t have time for surgical recovery, then injectables with Sculptra, Radiesse, or Voluma may be a better option,” says Dr. Shafer. (Fillers can be very expensive, however, sometimes rivaling—if not exceeding—the cost of surgery.) As always, have a discussion with an experienced board-certified plastic surgeon, to determine the right option for you.

3. Prepare for surgery properly
Don’t gain weight in an attempt to give your doctor more fat to work with. “In most cases, the weight patients gain will be visceral, which cannot be removed,” Dr. Okoro explains. That came as a surprise to Realself members. “I thought, ‘I want my fat to be big and juicy for the transfer.’ I wanted the best results possible. When I told my doctor that I was trying to gain weight, he said, ‘Why?’ He said that if my cells were smaller, he could collect a greater number of them in that 400 cc,” one shared.

Dr. Okoro recommends incorporating more protein into your diet ahead of the surgery, to help with healing, and practicing sleeping on your stomach. Then, of course, keep up any good habits. “As for any elective cosmetic procedure, patients should prep for their surgery by maintaining and continuing their healthy lifestyle, including diet and exercise and refraining from tobacco products of any kind,” says Dr. Christopoulos.

4. Research your anesthesia options
Whether general anesthesia, IV sedation, or local anesthesia is right for you depends on a number of factors. “The length of surgery, the amount of liposuction performed, any other ancillary procedures performed—as well as your own personal medical history—can all affect the type of anesthesia recommended for you,” says Dr. Christopoulos. “This decision should be made in conjunction with your surgeon and anesthesiologist.”

Pain tolerance is an important factor. Dr. Okoro notes that while fat can be numbed ahead of liposuction, the butt and hip area can be more difficult to numb well—so fat grafting can be painful without general anesthesia. “I don’t want to scare anyone, but if you have the option of general anesthesia, I’d highly recommend it,” says a RealSelf member who received local anesthesia. “I remember most of my procedure, including waking up to a giant needle stabbing me in the buttocks repeatedly, my legs kicking and flailing, but no one doing anything to relieve my discomfort.”

5. Brace yourself for post-op pain
As with any invasive procedure, discomfort can last well after the surgery. The pain level, however, tends to vary among RealSelf members. “The first 24 hours were hell! Pain like I’ve never felt before, and I have two kids. If you can withstand pain for 24 hours, you will be fine,” says one patient. Another reported: “Yes, I was sore but not in enough pain to take any of the pain pills. I took Tylenol Extra Strength, and I was OK.”

To help his patients handle it, Dr. Okoro gives them a long-acting local anesthetic during surgery that keeps the area of liposuction numb for about three days. “Patients also take medicine by mouth, the day before and after surgery, to assist with postoperative pain,” he says.

6. Be ready for recovery
While having a postoperative nurse can be expensive, it can be a worthwhile investment, even if only for the first 24 hours. “Friends and family simply do not know what to expect or how to take care of someone after a BBL,” says Dr. Okoro. “Even if it’s for the first 24 hours, a good post-op nurse can help teach your caretaker so they will be able to assist you after the initial day.”

Also, expect to not be able to sit for a while. “’The very worst part, believe it or not, is just doing everything on my stomach,” says a RealSelf member. “Having to eat, drink, sleep, watch TV, always on my stomach. It killed my neck. That was by far the worst part for me.”

7. Have a compression garment on hand
A compression garment will be important, if not essential, especially if you’ve harvested fat via liposuction, according to New York City board-certified plastic surgeon Dr. David Shafer. “They help keep the swelling down and shape the skin,” he explains. “However, it’s important that garments are not too tight, as they can cut off the blood supply. I recommend taking them off several times a day, to let your skin breathe.” The good news? Some patients actually like the compression. “’I wouldn’t have been able to sleep without it!” says one RealSelf member.

8. Expect to not be able to sit normally
Not being able to sit on your bottom may sound tough to handle, but RealSelf members have found that it’s not so prohibitive. As a RealSelf member reports: “I was afraid of the recovery, especially because not being able to sit sounds like a huge deal, but it was worth it. I was able to sit after one week, but you cannot sit with the upper part of your butt touching the chair. That is, you have to sit with your back very straight. After four weeks, I could sit normally.”

To offset this, Dr. Shafer recommends using a memory-foam pillow for the first month following surgery. Also a good idea, he says, is to “get comfortable pillows and sleeping aids—and perhaps set up a standing desk, so you don’t have to sit too long during the first few weeks.” (Of course, you should always follow your plastic surgeon’s specific post-op instructions.)

9. Account for liposuction aftercare
While fat grafting can offer great results, the liposuction portion can make recovery more challenging. “The fat was harvested from my upper/lower abs, flanks, lower hips, lateral back, and upper arms to part of the armpit area,” says one patient. “Needless to say, having just the lipo alone would’ve been a lot, but adding the fat transfer to the butt has made this one tough recovery.” Another member had their liposuction drains in for 24 days, so, as they put it, “maybe that is why it took a good month for me to feel 100%.” On the bright side, Dr. Shafer notes that the aftercare involved from both lipo and fat grafting tend to be the same, with a compression garment, hydration, and good nutrition being key.

10. Remember, results can vary
RealSelf members have conflicting reports about their BBL results. “I think I was lucky. I would say I retained 80–90% of the fat that was injected. I was measuring my butt the whole time, almost daily. From day one to week three, I went down an inch and a half only. It hasn’t changed since then,” says a member. Meanwhile, another says, “At almost six weeks post-op, my bottom has shrunk considerably. Most of the fat placement has shifted downward—there is some fullness to the cheek areas but not the upper buttocks, as was the goal. I can now say I don’t feel the end result was worth the effort. Too much fat was absorbed.”

According to Dr. Christopoulos, the results of a butt augmentation with fat transfer depends on how much fat survives the transfer along with proper aftercare, genetics, metabolism, and even weight fluctuations.

In general, butt augmentation outcomes can also vary according to the type of procedure that was done. “Butt implants can last forever but do have a risk of displacement and infection,” says Dr. Shafer. “Filler treatments with Sculptra, Radiesse, Voluma, or Radiesse just last as long as the filler duration—about one to two years.”

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