The Bartsich Butt Lift

The BBL is one of the most requested plastic surgery procedures in the United States today. Social beauty ideals have drawn attention to the gluteal region, and it seems like the bigger the better. But the original butt lift is not what it has become today, and the procedure itself is a risky proposition, one that I am not willing to accept.

The original Brazilian Butt Lift was a highly invasive surgical procedure that involved creating large skin flaps on the lower back, and using them to bulk the upper portion of the buttocks. This approach created long incisions, which produced very long permanent scars. The second version of this was to use implants to augment and shape the buttocks; but these had many possible complications such as infection, malposition, and shape irregularities. The final iteration of the Butt Lift is the version we have come to know today: fat grafting.

While there has been great progress in fat grafting in recent years, fat remains difficult to control. More specifically, once fat is loosened from tissues and then replaced into them, its blood supply often fails. As a result, a lot of grafted fat will ultimately die, making part of the procedure unsuccessful in the end. Fat also is notorious for producing hard lumps or other shape irregularities, and you have to remove a huge amount in order to have a moderate amount to graft. But the biggest issue with fat grafting to the buttock in particular is safety. Fat grafting to the buttock has the highest incidence of death of any cosmetic surgery procedure. Most often, patients are young and healthy, and this one procedure can be the point of no return. Many patients are so intent on the results from a BBL that they choose to ignore the risks and roll the dice on having the surgery anyway.

So what of the patients who don’t want to risk it all for a more shapely bottom? Do they have any other options? The Bartsich Butt Lift is your best alternative.

One of my core values in plastic surgery is to achieve balance and proportion. Both balance and proportion occur in the context of what they are near. In other words, when you make your breasts bigger, your belly will look smaller by comparison. Nothing exists in a vacuum, and this is very true for the human body.

In considering what is achieved from a BBL, the goal is to have a rounder, larger buttock area, that also appears to be riding higher. In order to reach this goal, fat is suctioned from the waistline and placed into the buttock. It is during the fat placement, which has to happen over many different injections, that small globules of fat may accidentally enter blood vessels, and in the worst case, travel to the lungs. When this happens, there is no good treatment for the problem, since this is fat and not a blood clot, so there is no medication to burst it and dissolve it away.

A large part of the effect of the BBL is the way that the buttock looks in comparison to the newly shaped waistline. Part of the effect is the new fat in the buttock itself, but a large part of it is the illusion of size next to the small waist. When you couple this with thigh contouring, and you leave the buttock untouched, the end result can be strikingly effective. Furthermore, much of the grafted fat will eventually go away, requiring repeat procedures. If you simply contour around, there is no need to come back for more. The effect persists.

In terms of “lifting” the butt, this can also be accomplished without fat grafting in many instances. The proper change in shape at the transition point between the back and the buttock will cause the skin to tighten, and this will in turn roll the upper portion of the buttock up, creating a lift that is actually supported by the skin on the lower back. This too, is more enduring than fat grafting, and can, in some patients, be incredibly effective in producing that desired look. What’s more, because no fat grafting is involved, there is no additional risk to the patient, and – wait for it – you can sit down any time you want! What’s better than that?

I have spent much of my career championing women and the celebration of their bodies. I hear and respect the desires of all of my patients to realize their best selves. In the last few years, as I read more and more about the poor young women who have died in the name of beauty, I have made it my mission to offer others a safer and equivalent procedure that can bring them to a result without wondering if this will become the ultimate regret. On the surface, it sounds like it can’t be done; but the results don’t lie. It all goes back to surgical basics and the oath to do no harm. And the Bartsich Butt Lift satisfies both of those requirements. Let this be the fourth stage of BBL, one that can be celebrated without fear.


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