Hello! This is Dr. Perry. Today we’re going to be doing the Brazilian Butt Lift consultation.
The Brazilian Butt Lift is a liposuction and fat transfer. What we’re doing with the Brazilian Butt Lift is changing storage locations for calories.
Fat is a storage compartment. If you take in any calories, and you do not burn the very second you take them they are stored as fat. Everyone is born with a certain number of fat cells, in certain concentrations and certain locations.
The areas that have the highest number of fat cells store the most calories. These areas are called the problem areas. These are areas where we gain weight first and lose weight last.
What we’re doing with liposuction is trying to get an even concentration of fat cells. The absolute, perfect liposuction we leave an equal amount of fat cells head to toe. So if you gain a pound, you gain it evenly.
Liposuction works because fat cells don’t replicate. We’re all born with a certain number of fat cells at certain locations. If we gain weight, each cell gets bigger. And if we lose weight, each cell gets smaller but the number stays the same.
If fat cells replicate, liposuction would never work. If you took one cell away and another one grew right back in its place, your back to square one.
Perfection in liposuction is in equal concentration head to toe. It is not perfect to take all the fat cells from one place because if you take all fat cells from one place, you’re condemning someplace else to gain weight. Theoretically, if you take all the fat cells from the shoulders down, from the body, legs, arms, if someone gained weight, they gain all the weight in their neck or their head. That would be a disaster.
So perfect is not taking all the fat cells from a place. Perfect is getting an even distribution. If I can get that same concentration of fat cells in the back, waist and hips, then we will have a smooth curve. If you gain weight, you will get wider but the curve will be intact because the concentration is the same. If you lose weight, you will get smaller but the curve will stay.
Now, when we do a fat transfer, what we’re doing is we’re increasing concentration of fat cells in the buttocks. So we’re making it the problem area. We’re going to make it the place that gains weight first and loses weight last.
What we’re doing physically when we do this transfer of the buttocks is a non vascularized tissue graft. Like a skin graft. We’re taking the fat cells away from the body where they have a blood supply. We’re putting them in the buttocks where they have no blood supply.
The fat cells that get blood supply will live and give a permanent result. The fat cells that don’t, die. Best case scenario 70% of what we put in will live and give permanent result. We’re going to lose 30% no matter what you do. If you float in the sky, if you stand on your head, you’re still going to lose 30%.
Now, in my patients, I see that loss of 30% in the first three weeks. I think whatever is there in three weeks, is there. I think after three weeks sitting, moving will not affect the cells. I think they’re either alive or dead.
Now, what we ask after surgery is not to sit for 10 days. Ten days is really an arbitrary number, just greater than four or five days. Blood vessels start to grown at day 4 so the first four or five days is when the fats are weakest. After that, it’s getting stronger and stronger.
There is no difference between Day 9 and Day 11. There is no magic day where the cells live. It’s just Day 11, the cells are slightly stronger than Day 9. I think the time that it doesn’t make any difference is three weeks. From 10 days to three weeks, we just start to sit but we don’t sit for hours. We sit for 30 minutes, stand up for 10 seconds, move left, move right. Don’t keep pressure on that same area or one area for the entire time.
That’s the idea of what’s happening, what we’re doing with the surgery so far as the liposuction and the transfer. Physically what are we doing? Physically we’re coring out fat cells. We make it solid and make it into a Swiss cheese or sponge. If you did a cross section, it will look like sea sponge.
All the holes where we took the fat cells away will fill up with water, these holes fill with water and that’s what the swelling is. The swelling physically is fluid in the holes where the fat cells were.
The swelling goes away by all those holes healing and scarring closed. Each of those holes will scar close. When its scar close, there’s no place for the water to go and that’s when the swelling goes away.
I always think of our post-operate regime as collapsing the sponge. I’m going to put on a tape garment or a tape cast. I’m going to make a cast out of a tape to squeeze you and collapse the sponge. We’re going to put a garment on and squeeze it and collapse the sponge.
We’re going to have you do massage. I’m going to teach you how to do your own massage because my results are better when people do their own massage as opposed to when they go out and get a lymphatic massage. All I’m trying to think about is collapsing the sponge.
If I have a tissue separated by water, it cannot scar together so we have to push that water out and get it to scar together. The swelling will be like an accordion. It’s going to go up and down throughout the recovery. What’s going to happen is maybe the first day 1% will scar closed and the swelling come back 99%. The next day 98%, the next day 97%, then 96%. Three months later, it will be 100% scarred.
If we start off with something 4 inches thick, after the liposuction is something this thick will scar and collapse into a pancake. So we might start off with something like 4 inches thick, it will collapse into something 1/2 inch thick. That’s what’s making the skin contract. It’s that collapse that helps the skin to contract.
You can see, if you look at the muscle, the skin is very far away. Now, the skin is very closed. When you do superficial liposuction correctly the skin will always contract. It’s not a question of if the skin will contract it’s a question of how much the skin will contract. The scarring of the liposuction is what’s doing this. That’s part of the reason why the skins contracting.
Physically, that’s what we’re doing decreasing the concentration of fat cells were we don’t want them. Again, when we do the fat transfer, we’re adding those fat cells where we do want to. There getting a blood supply, they’re living. And we are storing more calories in the buttocks where we want them.
Now so far as recovery recovery. First day hurts like sink. On the first night you’ll be wondering why you did it. It really hurts. It’s throbbing, achy, bruising kind of pain.
The second day it starts to get better, maybe 20% better. Day 4, Day 5 you start to turn the corner. Maybe the pain is down by 30%, maybe it’s down by 40%. But then you get better and better.
The key to getting better faster is eating, drinking and moving. This surgery is an injury. In order to heal from an injury, in order to make scar tissue you will need protein. Your metabolism will increase in order to heal. So you have to eat more than normal. Instead of 40 grams of protein, now you got to eat 50 because you need that scar tissue to heal. If you don’t eat, if you don’t have protein, you cannot make scar tissue. You cannot heal the swelling will stay.
The only place in your body that stores water is your vascular system. That’s IN your blood vessels. So whenever you have swelling, the water is coming out of your vascular system. Swelling makes you dehydrated. So, if you don’t drink and you’re swollen, you’re going to be dehydrated.
If you swell one gallon of water into your tissue, you got to drink one gallon of water. The people who get better faster, eat, drink, move and don’t take a lot of pain medicine. If you take a lot of pain medicine and you feel worse Day 4 than Day 2, it’s the pain medicine. Nothing wrong with after surgery taking Motrin or Aleve for pain. The people who use these get better faster then the ones who take a lot of narcotics.
If you stretch from Day 1, you’ll never get stiff and you will avoid pain of stiffness. If you pull into a ball, then you just have pain and you keep pain.
So far as the recovery these are the things we should do to try to get better. no sitting for 10 days. Two weeks without exercise. Mild exercise for two weeks, heavier exercise at four weeks. Garment day and night for 24 hours for one month, then you can start to back off.
After a month your activity and the garment are based on trial and error. You can do anything that doesn’t make you have additional swelling. You can take garment off. When you take it off, you don’t have additional swelling, it’s fine to be off.
Everything is a trial and error. If you take off the garment and you get swollen afterwards, put it back on. If you do some treadmill and you get swollen afterwards, stop doing the treadmill. Come back and try it week later, two weeks later. It’s kind of trial and error.
The only thing we’re judging by is that you don’t have additional swelling with that activities or when taking the garment off.
It will take three months for you to have your best look. Nobody looks their best at one month. Everybody looks better at two months than one month. So you just have to let those areas heal.
Again, we’re going to have you doing self-massage that we’ll teach you. We’ll use body weight. We’ll use yoga rollers and we’re just going to collapse your swelling like a sponge using these things. The people that do the self massage have best results. That is essentially the recovery.
The complications, we have to be concerned about is the next topic. This is general anesthesia procedure. Whenever you have general anesthesia, the chance for blood clot, and for pulmonary embolism.
Wile you’re in surgery, you’ll have a machine on your leg called a Sequential Compression Device that squeezes your leg. That keeps the blood moving and prevents clots. After surgery, it’s moving and drinking prevents clots.
The setup for a clot is a person who’s dehydrated and doesn’t move. If you’re dehydrated the blood’s thick, it clots. If you don’t move, the blood sits still and clots. The night after surgery, you got to get up and move. Moving prevents clots, even just flexing your feet, tapping your toes, or moving your legs makes the muscles contract and prevent clot formation. Clots usually start in your legs. What you will see one leg swollen and painful, the other one normal.
The dangerous thing is called the pulmonary embolism. The clot breaks from the leg and goes to lung. That will cause chest pain and shortness of breath.
Chest pain and shortness of breath is the 911 of this whole thing. If you have chest pain and shortness of breath, you don’t call me, you don’t call mom. You call 911. That is the emergancy of the whole situation.
Fat embolism. Fat embolism is fat getting into the blood stream when you do the fat injection. There’s nothing you can do about this. It’s how I inject the fat that decreases the chance of that happening.
I inject with my hand so it’s low pressure. I inject small amount at a time. When I inject small amounts the chance of getting fat into the blood stream is less. I might inject 1 cc, 2 cc per injection. If I have 1,000 cc that means I make 500 injections to put it in.
That is how I get better result and that is how I get safer results. When I put small amounts in many places, I have a greater surface area. Greater surface area mean a better blood supply and better fat survival.
If i just put one big glob of fat the chance of me getting 70% fat take is non-existence. All the fat inside of that glob will die, because it has not blood supply. Also by putting small amounts the chance of me forcing fat into a vessel is very unlikely.
The last thing that prevents fat embolism is I inject the fat while withdrawing the cannula. If I’m near a blood vessel, I do not stand still and inject. I’m always going to be backing away when I inject so I’ll never be in the same place for any period of time and this makes it less likely to force fat into a blood vessel and retrograde back to the lungs.
Infection can happen within the operation. Fever, pain, chills is a sign of infection.
The last thing so far as complications have to do with anesthesia. This is general anesthesia. You might have an allergy to anesthesia. You might have atelectasis , lung collapse after anesthesia. You might have pneumonia after anesthesia. You’ll could get laryngeal spasm after anesthesia. These are the complications of anesthesia.
Hello. This is a continuation of the virtual Brazilian butt lift consultation. These are the photographs I would show you if you were in the office for a consultation. The point of this video is to show you what can be done and what can’t be done with a Brazilian butt lift.
First photograph is the patient has had some liposuction done by someone else for this first picture. What we see is the diameter of the waist, the diameter of the hips are too similar. So there’s no shape and she’s straight. The other thing we see is the skin is loose.
Now what I want you to see after – between the before and after pictures is creating a narrow waist is the key to the procedure. When you make a narrow waist, everything looks good. The other important thing to see is that skin contracts. If you look at the skin before and compare it to the skin after, the skin before is looser and it’s tighter after the surgery.
If you do superficial liposuction correctly, the skin will contract. Not a question of if the skin will contract. It’s a question of how much. The better the skin tone, the more the skin contracts. The lesser stretch marks, the more the skin contracts. But the skin will always contract if superficial liposuction is done correctly. Skin will not get looser after liposuction. It will get tighter.
Now we look at the back. Again, the big deal is the waist. When you make a small waist, everything looks good. So far as the fat transfer, we add the fat to the hips. If you look at the thigh, you see a curve, the flat line, then another curve.
The goal is to fill this area to get one smooth curve really from the thigh to the hips. The narrow waist and the small back is a key to the operation. Everybody is a little flat on the bottom. Adding fat to the bottom gives more projection.
Another patient. Again, the primary example I want you to see, the skin after is tighter than the skin before. Again, some people would say this person had to have a tummy tuck, liposuction. It didn’t work. But it does work. Skin will contract if superficial liposuction is done correctly. Again, if you look at the curve on the hips, we see a curve, a flat line, a curve. Goal is to get one smooth curve from the waist to the hips. The waist is the key to the operation. Look at the skin on the back. After the skin is tighter than it was before and more projection in the buttocks.
A small back. That looks great. That’s the problem. If you have a small back and small waist, everything looks good. You can see this indentation. You fill this out to get a smooth curve. Then more projection.
The next example, this is a thin person. She wanted more definition. She wanted a six-pack to show. So what we did was liposuction, abdomen, plank, back, inner thigh and knee. Do extra liposuction here and here and then less the six-pack show. If you like the muscle look, that’s what we will do. If you look, indentation, now no indentation. It just looks cleaner. When you take away the inside of the knee, the inside of the thigh, the thigh looks more muscular and the knee looks more muscular.
Even though she’s thin, extra on the waist. Everyone has got extra on the waist. You take down the waist, everything looks good. Again, flat on the bottom. Add to the bottom. Everybody is flat on the bottom.
Now here’s one of my pictures that’s trying to prove that skin contracts with liposuction. I made a C-section length cut here and took out a football-shaped skin to tighten the skin below the belly button because this skin was very stretched and very loose and would not contract on its own. Everything above the belly button, all the skin above the belly button is contracting with liposuction alone. The cut only helped from the belly button down.
The point is the skin can contract. It did not have to be a tummy tuck. Abdominal wall, her abdominal wall muscles were strong. If the abdominal wall muscles were strong and the stomach is round because of skin and fat, liposuction becomes an option.
If the abdominal wall is weak, then you mandatorily have to have a tummy tuck in order to tighten the muscles. But you can just see a completely different look. Here she’s just straight up and down. Here shaped and curved.
Again, the big deal of everything is the small back. You get a small back, everything looks good. When you look at the thigh, a curve, a flat line, curve. Now we got one smooth curve. You look at the buttocks. A curve, a flat, flat, flat. Now we fill this out to get one smooth curve. The smooth curve is the key to looking good. If things are smooth and it’s a smooth curve, that’s what looks good. Not necessarily it has to be so, so big but the curve is good.
What I want you to see is she has hidden all of her curve. Very curvy person but it’s hidden and we just allow it to show. Her big problem is the deficit here. Adding to that, you can see where the curve should be and find that curve. Look at the skin before. Look at the skin after. The skin after is tighter than before.
Again, skin will always contract in a superficial liposuction done correctly. Small back is the key. We take down the back, everything looks good. That’s too much of a straight line. Create a curve. It looks good. The indentation, you see where the curve should be. You fill it to where it’s supposed to be. That’s a straight line. That’s a curve.
Great skin. You know it will contract. All we did was find the small body inside of here. No curves to very curvy. Look at the length of this line. Look at the length of that line. This line is at least 30 percent shorter than that. That means the skin contracted 30 percent. Taking down this big back. Given a tiny back, looks great. Now what do I do when I see scars? You can never – I can never get them perfect. Better but not perfect.
Now this is just liposuction alone. There’s no fat transfer. What I’m trying to show with this picture is when you liposuction one area and take away a storage area for fat, another area will compensate. Liposuction is not a weight-changing procedure. If you take away one storage area, some cells will get bigger. This lady had liposuction, abdomen, flank, back, arms, inner thigh. She’s too straight. Now curves.
So we’ve taken away all the fat here, all the storage here, all the storage here. Look at the buttocks after. Look at the buttocks before. Without touching it, the buttocks just looks bigger afterwards.
Some optical illusion, you make the waist smaller, the buttocks look bigger. But I think part of what’s really going on is calories can no longer store in here. They can no longer store here. They’ve got to store some place else. That tends to be the buttocks. So liposuction on its own may make the buttocks bigger.
Thin person but no shape. Thigh is more prominent than the hips. The waist is wider than the ribs. Liposuction, abdomen, flank, back, inner thigh, outer thigh, arms, fat injection in the buttocks. Your eyes beforehand go to the thighs. Now your eyes go to the hips. Nice, smooth curve.
And even though this lady is thin, there’s still extra in the waist. Everybody. I don’t care if you weigh 100 pounds. There’s still extra here. You get that down. Everything looks better. Her big problem was hollow in these hips on the side. We use what fat we have to fill the hips. This is just a better shape than that. There’s just more projection in here.
Again, just finding a great curve that’s inside. The curve is hidden by this. Liposuction, abdomen, flank, back, arms, inner thigh. This skin is tighter than that skin. Let these curves show. Flat line, fill those to more curves.
Taking down this big back. Letting it show. Curve, flat line, curve. Now it’s smoother curve. More projection. Hollow area. Fill that hollow. Not a heavy person but this nice curve is hidden again. Good skin. It contracts. Liposuction, abdomen, flank, back, inner thigh. You bring a small waist, everything looks good. Look at the skin on the abdomen before, skin after, tighter afterwards.
Everybody has got too much here. It doesn’t matter how much you weigh. You bring that down, everything looks good. Too straight. That’s a straight line. Straight lines never look good. You got to fill them and get a smooth curve. Then just more projection in the buttocks. Fill the hollow here.
Took two surgeries to move from here to here. But the point is she has good skin, doesn’t always have to be a tummy tuck. Liposuction, the skin contracts. We go from here to here. Before, the waist is wider than the hips. Now the waist is nowhere near as wide as the hips. Look at the skin contract from this to that.
So it does not always have to be a tummy tuck. If the muscles are strong, liposuction option, filling these buttocks.
Look at the skin on the back. Still not completely contracted but 90 percent tighter than it was before. The back is bigger than the hips. Now the hips are bigger than the back. Filling the buttocks, getting that shape, filling the hollows, giving more projection. So liposuction is a powerful tool and can make a terrible difference – a wonderful difference in how people look.
Thin person, great-looking person but hollows. Liposuction arms, abdomen, back, flanks, inner thigh. Good-looking to great-looking. Stomach is flatter. Not a whole lot of fat but filling this hollow, filling these flat spots and just a tremendous change in the look from great to gorgeous. Filling this hollow is a big deal. Taking the waist down. Everyone has got too much in their waist. Small waist, fill the hollow. Everything looks good. That’s the indentation. Now it’s a smooth curve from the waist to the hips. The hollow in the buttocks. Fill the hollow in the buttocks.
I mean just fantastic look. Again, waist, almost as wide as the hips. Great skin. You know it’s going to shrink. Good-looking to great-looking. This skin is tighter than the skin before, always tighter. Very flat on the bottom, fill the bottom.
Taking down this back is the key to the whole operation. When you have a small back like this, it looks fantastic. Curve, smooth curve from the waist to the thigh. One smooth curve. It looks fantastic. That’s great-looking. More projection. Fill this hollow.
Straight up and down. There’s a straight line from the ribs to the knee. That’s a straight line. Now, curves. This skin is tighter than that skin.
Taking down this back is the key. Hollow in the buttocks, filling that hollow. Good look, very good look, very curvy.
So that is the conclusion of the before-and-afters, trying to give you an explanation of what can be done and what can’t be done, trying to show you how liposuction plays a role in the Brazilian butt lift.
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Skin contraction is just as important as removing fat when you do a liposuction. If you do superficial liposuction correctly, the skin will contract. Not a question of if, it’s a question of how much.
I think there are three things that probably have to do with the skin contracting. One thing is that when you do liposuction, you create a network in the areas where you remove the fat. So if you liposuction something too much as thick, as it heals, it will scar down into a quarter inch think.
So an example of that is here. Her muscles are here. The abdominal wall is here. So this is maybe three, four inches away. As it scars, the skin will pull it back toward the muscle. And you see here, now the muscle is here and the skin is here. So this is a tremendous amount of skin contraction and I think that’s probably the main thing that’s driving that skin contraction.
The second thing I think is probably doing that is actually injuring the skin. When you do the liposuction, you rub the cannula underneath the skin. You are injuring the skin, and when you injure something, you lay down collagen .If you ever had a scar, you feel that skin. It’s always thicker and harder than the normal skin next to it. That’s because of the extra collagen is laid down. So I think that’s also happening.
The last thing is probably magic stem cells. When you shake up fat, you release stem cells. Fat has a lot of stem cells and you’re probably bathing the skin with stem cells and that’s probably has something to do with getting the skin to contract although nobody really knows.
Now, the point is this result from here to here is about removing the fat cells but it’s really about the skin contracting. If the skin was a loose bag after you remove these cells, this result would be horrible. But because the skin contracts from this to this, form that to that, that is a key to really a good liposuction.
The skin contraction is just as important as removing the fat. Let’s look at some examples. And every example we see, the skin afterwards will be tighter than the skin before. A before and after of this lady who have liposuction done before as least by somebody else. Without doing the liposuction correctly, the skin did not contract. When doing the liposuction correctly, the skin contracts. We go from this to this. This skin is tighter than before.
The back, this is the big deal. But this skin again is tighter than that skin.
Stretch marks. But the skin can still contract. She is a very curvy person but it’s all hidden by this, by skin and fat. Remove the fat and get that skin to contract, we see this little tiny waist. Look at the skin at the back. Look at the skin after. Look at the skin in the stomach. Look at the skin after. This skin is much tighter than this. Without the skin contracting, this skin still looks like this, that would be a useless liposuction. The skin contracting is probably as important or maybe even more important than removing fat.
Look at the skin here. Look how it’s tighter there. It’s the skin contracting.
Thin person, still even this person looks muscular. This one not as much muscular.
This back, the skin is tighter than that.
Another example. Look at the skin contracting. It doesn’t always have to be a tummy tuck. The skin can contract.
The back is tighter than it was before.
This skin is tighter than that. The back is tighter afterwards than before. When that skin contracts, it gives you that tiny. Look at the volume of skin here compared to the volume of skin there.
Look how tight the skin is, how loose the skin is here hanging over the bra. Tighter afterwards. It’s the skin contracting. That’s the big deal.
Really the skin tone always shrinks. Look at this little body that’s hidden inside here. Look at the length of that line. Look at the length of this line. This line is 20% shorter. It’s about the skin contracting.
Look at the back. The skin is tight.
This is a thin person. The skin is still tighter.
Again, the skin is tighter.
Making the small back but that skin shrinks to the back.
This skin is tighter than before. The back tighter than before. Wrinkles, no wrinkles.
Look at the skin on the back. Much improved.
Key. Look at the skin of the abdomen. Much tighter afterwards. You find this little body. The skin contracts like a glove. Now, you see the results.
The back, taking down the back. They key, taking down the back and get that skin to contract. It’s the skin.
Again, the same picture. This is really skin contracting.
This back contracted? Maybe not a 100% but it did contract 95%. This surgery is about eh skin contracting.
Good skin, not a big issue.
Adding fat here was a big deal for her.
Look at the skin after. Look at it before. It’s tighter after than before.
Look at the wrinkles on the back. Look how much less. This is only a week. It’s about the skin contracting.
Liposuction is about removing fat but the most important thing is the skin contracting.
Thank you very much for your support.
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