Brazilian butt lift buttock augmentation implants and injection

Aaron Stone MD - Plastic Surgery: Brazilian Butt Lift - Buttock Augmentation Implants and Injections
Aaron Stone MD - Plastic
Surgery
A board certified cosmetic and reconstructive plastic surgeon
performing plastic surgery of the eyes, face, ears, nose, breast,
abdomen, thighs in Los Angeles, California.
Tuesday, February 5, 2013
Brazilian Butt Lift - Buttock Augmentation Implants
and Injections
Fertility dolls with large hips and buttocks have been found dating back to the pre-dynastic Egyptians of
4000 B.C.
Doll statues and carvings were often placed near a couples bed or on the family altar with suitable
offerings that would ask the fertility goddess to work in their favour.
With colonization of Africa in the 1800s women's clothing styles in Europe aimed to accentuate a thin waist
first this was accomplished by layering clothes on top of each other (petticoats). These could become
quite heavy so caged or hooped underskirt frames (crinolines) followed by bustles and then corsets were
introduced.
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120 South Spalding Dr #330, Beverly Hills CA 90212
310-246-0537 www.aaronstonemd.com
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The American W. S. Thomson patented the metal cage crinoline in the USA, France and Britain in 1856
to free women from the heavy petticoats. It became hugely popular among all classes of women. At the
height of its popularity enough steel was produced in Sheffield England to make half a million hoops a week.
In the early 1880s the bustle was introduced. It consisted of a straw filled cushion sewn into the skirt with a
series of steel half hoops inserted in the skirt lining down to the ground and another loop that went around
the waist. This had the effect of throwing the skirt out almost horizontally from waist level behind. The effect
was to exaggerate the buttocks even more. This bustle is still frequently seen today in wedding dresses.

This infatuation for accentuated buttocks continues today but now we have surgery to do the job that was
previously done by clothing. Silicone implants were used in the buttocks for the first time in 1969 by the early
1980s surgeons began placing them in the muscle. Some of the buttock craze is fueled by the constant
exposure to celebrities with such assets like Beyonce, Kim Kardashian and Jennifer Lopez but this look has
been a goal for many women for centuries. Pippa Middleton, the younger sister of Kate Middleton,
experienced huge fanfare after donning a white clingy, sheath dress in the royal wedding that indicated a
large backside. The Pippa Middleton Ass Appreciation Society Facebook fan page then appeared with more
than 243,000 "likes." The American Society for Aesthetic Plastic Surgery counted 2,100 buttock augmentation
procedures in 2004. RealSelf searches for butt augmentation procedures, including the Brazlilan butt lift,
were No. 1 in 2011, and surged by 28% in 2012. According to American Society for Aesthetic Plastic Surgery
statistics Americans spent more than $31 million on buttock augmentation surgeries in 2010, a 40 percent
jump from the year before. According to the American Society of Plastic Surgery (ASPS), the number of
legitimate buttock implantations, which cost up to $15,000, rose by 43 percent between 2010 (806 reported
cases) and 2011(1,149 reported cases) and more than 140 percent from 2000 to 2010. That compares to
4,546 people who got buttock lifts in 2011, and 301,000 who got breast augmentation. In Brazil aesthetic
buttock surgery increased 20% between 2008 and 2011.
Around World War II, silicone shots were used to boost bustlines, predating today's breast implants. In 1992
the FDA banned liquid injectable silicone, and today board-certified plastic surgeons won't inject silicone
into any body part. Instead, for those looking to enhance their rear view, buttock implants and fat transfers
are the only doctor-approved procedures. There is no data on the number of illegal silicone butt injections,
but anecdotal evidence suggests the recent recession may have led many people to try these injections
which can cost $300 to $1000 vs. $15,000 for legitimate buttock augmentation On November 29, 2009, 38
year old Solange Magnano, who won the title of Miss Argentina in 1994 died after undergoing a buttock
augmentation procedure at a plastic surgery clinic in Buenos Aires. She was rushed to the hospital from the
clinic after sustaining a blood clot or the movement of injected liquid to the lungs and died 3 days later in
intensive care. After winning the title she participated in the 1994 Miss Universe contest and then modeled in
Paris and other cities. She left behind a husband and 8 year old twins.
In 2004 a 38 year old Los Angeles cosmetologist paid a "pumper" to inject industrial grade silicone to
enhance her buttocks. Her friends also used silicone injections. During a hair appointment, her hair sytlist
showed off her new derriere and recommended the pumper. The cosmetologist knew that the pumper wasn't
a doctor; she was a salon client. But the lure of larger buttocks clouded her judgement.
For her first injection she went to the pumper's two-story home outside Los Angeles. The pumper sent her into
her teenage daughter's bedroom, where an assistant filled syringes with what she assumed was silicone. The
pumper injected her several times in the crease between the butt and the thigh. The pumper then instructed
her to massage the area regularly to settle the silicone and to wear cheek-exposing shapewear to help reduce
returned for round two, because she did not see enough improvement, it was more painful.
Over time the injected area became intensely irritated and painful, and the skin blackened. At first she was too
embarrassed to tell her doctor what she had done, waiting almost a year before seeking help. By that time
she was desperate to have the silicone removed but none of the doctors referred by her HMO would agree to
do the surgery because the procedure is risky and often leads to disfigurement.

Aaron Stone MD - Plastic Surgery: : Brazilian Butt Lift - Buttock Augmentation Implants and Injections
The medications used to sustain her life with a viable blood pressure cut off the circulation to her lower
arms and legs and she ended up with amputations from the shins downward and forearms downward. She
lost her hands, feet and most of her buttocks. Now she spends her days at home on disability. Determined
to warn others about the risks of silicone injections, she established the Apryl Michelle Brown Trust, an
organization that hosts self-esteem workshops and motivational speaking engagements.
She appeared on a recent episode of the Katie talk show.
The San Francisco victim of such an injection described an incident that took place at the non-physician
injector's home, where a buttock augmentation procedure was performed by injecting her buttocks with
liquid to make them “bigger” as she stood near the dining room table in view of the injector, "Dr. Carlos's",
mother. This resulted in infections in her buttocks that lasted one year. She went back and was injected
two more times. He used toilet paper and glue to seal her wounds. During one procedure he allegedly
broke off a piece of a cannula, into her right buttock and left it in place. Nine months later, it protruded
from her skin and she was able to grab it to remove it. Another victim paid $10,000 for a breast and
buttock augmentation and liposuction, which were allegedly performed in Tijuana, Mexico, in January
2011. According to testimony, the victim could not recall who actually performed the procedures in
Mexico. However, Dr. Carlos allegedly took a flight with her from San Francisco to San Diego, and then a
train to Tijuana where the procedure was performed.
That "Dr. Carlos" was charged with 17 felonies, including practicing medicine without a license out of a
San Francisco clinic (Derma Clinic), identity theft, assault, rape, sexual penetration by an unknown object
against the victim’s will and unlawful oral copulation. Nine alleged victims were connected with the case.
In the summer of 2011 she woke up feeling lethargic and was suffering from a shortness of breath. Her family
rushed her to the emergency room where she was diagnosed with septic shock from necrotizing soft tissue
infection secondary to infected foreign material. Tissue from her lower back down to her midthigh was dying
from a barrage of bacteria from the silicone. Over the next few weeks she underwent over 20 operations to
save her life.
In February 2011, British tourist Claudia Aderotimi died after receiving a cosmetic buttocks injection at a
Hampton Inn in Southwest Philadelphia.

In early 2011 a 49 year old successful Dallas real estate broker who owned two homes, a luxury car, an
SUV and a small office building underwent liposuction and fat grafting by an internal medicine doctor,
Hector Molina. After a more-than-nine-hour liposuction and fat-transfer surgery, Molina and a doctor
assisting him abandoned her in his office "without any medical supervision or monitoring. Her friend found
her "short of breath, unable to stand" and in severe pain in her legs and feet. She was rushed to the
emergency room and transferred to a trauma center. So much fat was injected into the muscles in her
buttocks, it caused the compartment syndrome, which Molina failed to diagnose. She needed 27 more
surgeries to treat the compartment syndrome and related complications and spent a month and a half in
the hospital. A year and a half later she was out of work, had to use a walker and wheelchair to get
around and had nothing left to her name. The money she earned selling real estate, which she did
starting at age 25, went to pay medical bills, because complications from cosmetic surgery aren't covered
by insurance. She now lives off $698 a month in disability benefits. In April 2012 a Texas Medical Board
disciplinary panel found his "entire knowledge" of the procedure consisted of reading a book provided by
the manufacturer of the liposuction equipment, completing an online program over two weeks, passing an
online exam and completing one procedure under the direct supervision of another surgeon and prohibited
him from performing any more cosmetic surgery.
In June 2011, 36-year-old Whalesca Castillo was sentenced to a year in prison after pleading guilty to
operating without a license and injecting women’s breasts and buttocks with liquid silicone from her home
in the Bronx.
A Baltimore exotic dancer was hospitalized in October 2011 when she experienced shortness of breath
after receiving buttock injections. Doctors found fluid in her lungs and treated her for pneumonia. The
liquid was reportedly made of silicone often found in paint or furniture polish. The injector was not a
doctor and was injecting non-FDA approved material in hotel rooms in various cities including Baltimore,
New York and Washington D.C. for $500 to $1,600 per treatment. After being arrested in a Washington D.C.
hotel the injector pleaded guilty, in March 2012, to charges of conspiring to introduce and deliver into
interstate commerce an adulterated and misbranded device, for which she faces a maximum of five years
in jail and a $250,000 fine.
Between June and October 2012 a Palm Beach Florida man obtained weekly buttock injections in a motel
room by an untrained ex-convict transvestite for $100 per session. In October 2012 he began to develop
open sores at the injections sites. Medications given to him by the injector did not help so he went to the
hospital in November 2012. Multiple bacterial infections were found in his buttocks, some of which were
antibiotic resistant MRSA so parts of his buttocks were surgically removed. When police came to interview
this victim in December 2012 they had to do so with him lying in a fetal position in his hospital bed. This
injector was finally arrested and formally charged in January 2013.
On November 1, 2012 a woman was seen at a Flushing, New York home decorated like a doctor's office
and had what was later determined to be either silicone or paraffin injected into her buttocks for $2,300.
After experiencing pain and seepage for several days she returned and again was injected with penicillin
and another substance. The injector then tried to seal the leaking injection sites with Krazy Glue. The
woman then went to a hospital and was diagnosed with a massive infection and gangrene. The injector
was charged with assault, reckless endangerment and unauthorized practice of medicine in Queens
Criminal Court and faces seven years in jail if convicted. A surgeon at the hospital stated that he had seen
patients who had been injected with brake fluid or caulking silicone used to seal plumbing fixtures.

In November 2012, Florida police arrested 30-year-old Oneal Ron Morris of Miami and charge her with
manslaughter in the death of one injection patient as well as charges of practicing health care without a
license and causing serious bodily injury for allegedly injecting at least two women with a toxic mixture of
Fix-a-Flat tire sealant, mineral oil and cement in a backroom attempt at buttock enhancement.
You can see her resemblance to the 1880s bustle in these police mugshots.
In December 2012 a Hialeha FL couple were arrested for practicing medicine without a license and injecting
buttocks.
The public has gone buttock crazy with disastrous results and ever increasing numbers of prosecutions for
injecting non-approved substances into the buttocks in the unlicensed practice of medicine. At times this
takes on the picture of drug seeking behavior with injections performed in seedy motel rooms. The ethnic
groups that most commonly go to these injectors are African Americans and Latinos. Sometimes the alien
material, infected with bacteria, has to be removed from the body by cutting out the tissue it is embedded in,
causing massive disfiguration
BUTTOCK AESTHETICS
FRAME
The buttock area is best analyzed like a picture in a frame with the skin and fat layers being the frame on one
side, the deep bones making up the frame on the other side and the buttock muscle taking the space of the
painting itself. Prior to any surgery every component needs to be examined in order to individualize a surgical
treatment plan.

This photo shows the frame of fat outside the buttock muscle and the bone deep to the muscle.
The frame comes in various shapes: square, A-shape, V-shape and round and can be asymmetric as
shown in the round example.

The alignment of points A, B and C govern the frame shape and tell the surgeon where fat
needs to be removed or added. In the A shaped example above fat needs to be removed from
points C and B. In the V shaped example fat needs to be added to point C (the mid-lateral
buttock depression)
The bone portion of the frame is assessed by the vertical height between points A and D. If the
height is large fat is removed from A and put in D.
It is also assessed by the tilt of the pelvic bone, The more tilted the bone is the less fat needs to be
removed from the lower back area.
MUSCLE
The muscle shape can also be A, V, square or round and can be deficient in any of 4 quadrants. If it is
deficient in the lower outer quadrant that is the B point which can be grafted with fat. Lastly the point of
maximal outward projection should be at the level of the pubic bone in front. You can see that in the 2 left
pelvic tilt photos above.

Aaron Stone MD - Plastic Surgery:Brazilian Butt Lift - Buttock Augmentation Implants and Injections
This is an example of someone with an asymmetric A frame but a V shaped muscle and a high point A to
point D height. The ideal option would be remove fat from points A and B and in the lower back and put
fat into point C and just behind point B.
SURGERY
Aesthetic buttock surgery at the time of a body lift after massive weight loss is not covered in this blog
but will be covered in a future blog.
Contrary to popular belief, exercise cannot increase the size of the buttocks or significantly improve their
shape. In fact, fat reduction associated with aggressive exercise may lead to a decrease in the size of the
buttocks.
The available surgical options are:
*liposuction of the frame only
*liposuction plus fat grafting
*implants with or without liposuction
By narrowing the waist and the area just above the buttocks in the midline (presacral, prelumbar) a
significant change in the buttock contour will result. Depending on the patient this can account for 70% of
the end result no matter what is done to the buttocks themselves.
Fat fillers are the typical procedure for buttocks augmentations, not silicone injections. For reasons
unbeknownst to me fat grafting is currently referred to as Brazilian butt lift. Industrial silicone and other
materials are being injected by illegal pumpers. It is highly unlikely that any of these pumpers would
know or do the critical analysis I have described above prior to injecting someone and without which a
good aesthetic result is seldom achieved. Furthermore they are injecting unsterile material in a way that
allows it to enter the bloodstream and travel to other organs as in the case of the Baltimore exotic dancer
who was hospitalized in October 2011.

For an optimal fat grafting result the fat should be harvested under low pressure, minimally manipulated
or exposed to air after harvesting and injected in small aliquots close to or into the muscle in multiple
layers using a blunt instrument preferably as it is being withdrawn. Injecting fat in a large clump increases
risk of infection with or without abscesses that need draining, decreases fat survival, increases risk of
forming cysts of oil after the fat cells die and leak out their contents and therefore increases the risk of
indents or lumps. If large clumps are injected into a muscle with sharp needles the muscle compartment
pressure can increase from blood and fat leading to the problems experienced by the Dallas patient
described above. That is why I use a ratchet injector with a blunt tube to inject fat. Each advancement of
the ratchet injects only a small piece of fat and the chances of fat clogging the tube so the injector keeps
pushing till a large piece of fat is injected does not happen. Fat injecting really allows the surgeon to fine
tune the procedure as all components can be adjusted.
The main drawback to fat grafting is a large amount of fat is usually required, anywhere from 500cc to
1500cc for each side of the body. This can be challenging to impossible to achieve in thin patients without
causing problems at the harvest sites or bizarre body contours. Also no matter how good the surgeon the
more fat you inject the more likely some is going to get into the blood stream. If this amount is sufficient
it can cause a fat emboli syndrome. I saw this once in another surgeon's patient and that patient had to be
admitted to an intensive care unit on a respirator for a few days. Fortunately they did well and it did not
affect the end result. However even that complication is something your surgeon needs to be prepared for
and you will not get that with discount surgery by non-qualified or non-licensed individuals.
Buttock implants have always been controversial amongst plastic surgeons. They think they are fine or
think they are dangerous. Few surgeons are in the grey zone between these two opinions. Because of the
infrequency of this surgical procedure being performed in training programs and most surgeons' offices,
there is little bibliography about it. A literature search in the Plastic Reconstructive Surgery journal only
yielded a couple of articles. For the same reason, the training of many professionals in this specific area,
and especially in the correct placement of gluteal implants, and in the proper evaluation of the patient
preoperatively is, in many cases, deficient. For this reason, in the great majority of cases, the results are
not what the patients really expected.
The implants come in round and anatomical or oval shapes much like breast implants and in sizes
ranging from 10.6 to 14.5cm diameters with projections of 3.8 to 5cm which corresponds to 280 to 460cc.

Buttock implants are placed via a 7cm incision between the buttocks with preservation of the midline
ligament in order to maintain the trough. By dissecting off to the sides and then into the muscle 4cm off the
midline 2 separate intramuscular pockets are created. The pockets are placed so the patient will not usually
sit directly on the implant. A well defined pocket lowers the risk of implant migration, visible/palpable implant
edges and later drooping. Skin sutures stay in 10 to 14 days and activity restrictions such as no lying on
your back are enforced for 60 days . There is no sitting for long periods for 10 days. As you can imagine no
matter who does the surgery it is associated with high rates of suture dehiscence (up to 30% of
intramuscular implants and 15–30% of subfascial implants), seroma, infection and implant displacement. So
separate skin cuts are required for liposuction and for any drains related to liposuction. Because of the
seroma rate most patients are better served with drains after surgery. Because of the location of the incision
and placement of foreign material meticulous hygiene is required even after recovery is completed.
The main disadvantage of augmentation gluteoplasty with silicone implants is the substantially high rate of
complications. The most common complication being wound dehiscence. I recently reviewed a case of a
plastic surgeon who placed buttock implants and the patient had a very bad infection with breakdown of the
suture line. A brazilian study published in 2012 showed a high rate of implant rupture begining 7 years after
placement of silicone gel buttock implants. The other problem with buttock implants is they only affect the
muscle portion and can only increase muscle projection. To address the frame or transition areas between
the frame and muscle you still need liposuction and possibly fat grafting.

This is a patient of mine in whom I performed fat grafting to the buttocks at the same time as a body lift.
The question arises whether aesthetic buttock surgery can be performed at the same time as a tummy tuck.
That depends on the type of abdominoplasty and what type of buttock surgery. If large amounts of fat need
to be grafted to the buttock area and a significant amount of that fat will have to come from the abdomen it is
safer to do the buttock surgery first and come back some months later to do the abdomen unless all or most
of that fat can be harvested from the tissue that is removed at the time of the tummy tuck.
Another area I have not addressed is the use of hyaluronates or Sculptra injectable fillers in the buttocks.
So far this has not been performed very much because the cost is prohibitive and the results are temporary.

Brazilian butt lift buttock augmentation implants and injection

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