The Brazilian butt-lift is a liposuction and a fat transfer. What we’re doing with the Brazilian butt lift is changing the storage locations for calories. Fat is a storage compartment. When you take in calories and don’t burn them the very second you bring them in the body, they’re stored as fat. We’re all born with a certain…a certain number of fat cells in certain locations. Genetically determined that one person will have more fat cells in one location, one person another, more fat cells in another location. The areas with the high concentration of fat cells are the problem areas. The area that has the higher concentration of fat cells will store more fat, so that’s the place with — little place where we gain weight first and lose weight last. We all, genetically, are born with these certain number of fat cells in certain locations. Fat cells don’t replicate, so we keep the same number of fat cells throughout life. If you gain weight, each cell gets bigger, and if you lose weight each cell gets smaller, but the number stays the same. The number of cells stay the same. That’s why liposuction works. If fat cells replicated, liposuction would never work: if you took one out and another one grew right back in this place, the shape would be exactly the same as it was before. So, because they don’t replicate when we take them out, it’s forever hanged. The absolute perfect liposuction: you leave an equal concentration of fat cells head-to-toe, so if you gain a pound you gain it evenly instead of gaining a pound all in the problem area. It is not best, it is not a perfect liposuction to take all the fat cells fall in place. If you take all the fat cells from one place, you condemn someplace else to gain weight. If you theoretically took all the fat cells from the shoulders down, if you gain weight, it would all gain weight in your neck and your face and that would be a disaster. So, liposuction is a “rob Peter to pay Paul” surgery. When you take away one storage location, another storage location will compensate and store those calories.
What we’re trying to do with the Brazilian butt lift, which is the liposuction fat transfer, is control where the storage takes place. Basically, what are we doing when we do the transfer? We’re doing a non-vascularized tissue graft. We’re taking the extra fat cells from the stomach and from the waist from the back, and then adding them to the buttocks. So now we’re making the buttocks a high concentration for fat cells. So now the calories, instead of storing in the… in the stomach and the problem areas, will tend to store more in the buttocks. When we do that transfer, what we’re doing is a non-vascularized tissue graft, like a skin graft. When we first take them… when we take the fat cell out of the stomach, it has its own blood supply. When we put it in the buttocks, it has no blood supply. We’re waiting for the recipient site blood vessels to grow into the fat cells. The fat cells to get a blood supply live, the fat cells that don’t get a blood supply die.
Best-case scenario, 30 — 60 to 70% of what we put in will live and give a permanent result. So, 30% will die no matter what. You know, in my case — in my surgeries – in my case, I think that takes three weeks. What I see in my patients is a buttocks shrinks for three weeks, and pretty much whatever is there at three weeks, that’s what’s going to be the permanent result. They’re still swelling and the shape is not perfect, and it’s going to look better, the projections going to get better because the skin gets softer as the swelling goes down, but the size stays pretty much what it is. So, I think three weeks is a time where either the cells live or the cells die.
Now, physically what are we doing? Physically, we’re taking a cannula and just coring out fat cells in those problem– in the — in the areas we liposuction. So, we’re, you know… physically what we do, what you’re doing is you’re taking a solid, you’re making to a Swiss cheese – it would look like a sea sponge. You see little holes where the fat cells were taken out, nerves and blood vessels in between, connective tissue in between. It would look kind of like a sea sponge. The swelling, physically, is fluid filling the holes where the fat cells were. So, this swelling is like a wet sponge, and our goal is to collapse the wet sponge. The way the swelling goes away is by each one of those holes scarring closed. And once the scars close, there’s no place for the water to be, and that’s when the swelling goes away. So, when I put on a tape cast, I make a tape cast after surgery to prevent the swelling and to hold things in place, and it collapses the sponge. We wear a garment to hold that down, collapse the sponge to let it heal. We do rolling, and I teach you how to do your own massage using your body weight, using yoga rollers, medicine balls, in order to collapse the sponge. Not trying to move fluid up, down, to lymph nodes, anything like that, just collapsing a sponge. What happens when we have tissue separated by water and it doesn’t touch? It can’t scar together. When we put pressure and make it touch, now it has a chance to scar. So today, in the first day after surgery maybe 1% will scar. Then this one, that will come back 99%. Next day, one more percent, so 98, 97, 96, 95… so three months later, it’s 100% scar. So, that’s what we’re trying to do to get the swelling to go away. ,
The recovery: the first night, it hurts like sting, you know. It’s burning throbbing, achy, bruising, and it’s just rough. You’re throwing the, you know, anesthesia’s got you nauseous, got you dizzy, and it’s just not a good day. Next day is better, pain down by 20%. Third or fourth day is when you make a turn, maybe 40, 50 percent less pain. Most people by the third or fourth day are not necessarily taking pain medicine around-the-clock. They’re quiet, probably don’t have much pain, don’t need pain medicine. They’re moving around, they take the pain medicine. They go to sleep, they take the pain medicine. But it’s not like you got to have it everything, every four hours, it’s not like that.
Right, day four or five. The things that make us recover faster are eating, drinking, moving, and taking the least amount of pain medicine. When you are healing from the surgery, your metabolism goes up you need that extra metabolism and energy to heal. So, you also need extra protein. All those scars that you’re making to close the holes require protein. If you don’t eat you can’t heal. You have no protein, you can’t make scar tissue. Scar tissue is made of protein, so you have to eat. Most people lose their appetite, so you have to graze. You got to keep something… gotta eat small meals every two hours instead of trying to eat one big steak, that’s not it. Small meals every two hours.
Now, the only place in your body where fluid is stored is in your vascular system, inside your blood vessels. So, all that swelling is pulling water out of your blood vessels, so you will be dehydrated after surgery, and you have to keep up. If you have a pound of swelling, you’re gonna drink a pound of water. If you go to the bathroom, you know, and empty a gallon of water, you got to drink a gallon of water. So, you got to be drinking a lot of water to keep up with all the water that you’re losing from the swelling, from the urination, it’s a just a fluid shift world. The people that are in the mall at 4 or 5 days eat every two hours and drink 10 bottles of water a day. The people that don’t eat and don’t drink, day 5 they look like day two. They don’t heal, they don’t get better, they just wallow in pain. So that is the key to get better, getting better fast. If you’re taking the pain medicine, 30 minutes later you’re nauseous, it’s the pain medicine. You’re taking the pain medicine, 30 minutes later you’re dizzy, it’s the pain medicine. After surgery, it’s nothing wrong with using Tylenol, Motrin, Aleve. You can’t do it before the surgery because it makes more bleeding, but after the surgery if that works for you, it’s probably better than taking narcotics.
Ok, now, ten days, no sitting. The first five days is when it’s most critical, when you do the most damage to the cells. The blood vessels start to grow at day four, so for the first four or five days the cells are weakest. If you sit, you do more damage. From day five to day ten, they’re getting stronger. And day ten, they’re getting some strength, but they’re not very strong. So day ten, you can start to sit, but you sit for thirty minutes, you stand up for ten seconds. You don’t want to just sit and be in one place for hour after hour, you lean to left, lean to the right, move forward, move back, just so it’s not putting pressure on the same place. That’s what you’re gonna do from day ten to three weeks.
After three weeks, you do whatever you know whatever you like. I don’t think it makes any difference to the fat cells living. It will take three months for the swelling to go away. You know, one month, 50% of swelling’s gone. Two months, 70% of swelling’s gone, three months and ninety, ninety-five percent of the swelling’s gone. So, so, that is always the case. Everybody has a smaller waist and looks better at two months than one month. Everybody looks better at two months than one month. You will look…you will see a change right after surgery, but you will be better and better as the swelling goes away. You’re really not going to know the final thing till about three months. You’re going to see how you really look and then… so you’re gonna look great right after surgery, you look fantastic at two to three months.
Now, no exercise for two weeks. Two weeks you can do light exercise, four weeks heavier exercise. All the activity is just trial and error. You can do anything that doesn’t make you have swelling. At two weeks you can start to experiment, do a little treadmill. No Swelling? Fine to do it. Four weeks you just you know do the rope class. No swelling when you do it? You can do it. After the class you have swelling? Wait a Week, try it again later. The garment we’re gonna use for one month, 24 hours a Day. At a month, you start to experiment with the garment. Take it off overnight and no swelling the morning? Fine to be off at night. A week later take it off when you’re sitting down eating. No swelling? Fine to be off. Swelling? And put it back on. Last thing: if you take it off when you’re exercising is asking to get the most swelling. So, activity and garment is trial and error, you know. And you know if you can do anything that doesn’t make you have swelling, that’s all it is.
Now i’ll teach you how to do self-massage. My patients are getting better results with the people that do the self-massage than if they go and do the lymphatic massage. The goal of the self-massage is just to collapse the sponge. All we’re doing is using your body weight, we’re putting you on rollers medicine balls, moving around, and we’ll teach you how to do this, just to put your body weight and collapse the sponge, and that’s what’s working best. So, that’s the idea of the– that’s the idea of the recovery.
The complications… complications we have to worry about. The primary complication anytime you have general anesthesia you have to worry about is a blood clot. Whenever you have general anesthesia and muscles are paralyzed, the blood vessels dilate, blood could sit still in your leg and clot. If it clots in your leg, it’s called a deep vein thrombosis. The side of that is swelling in the leg, one leg painful and swollen, the other one normal, one leg twice as big as the other leg — that’s the sign of the deep vein thrombosis. Now, the thing we do to prevent that in surgery is a machine called a sequential pressure device, that’s the pneumatic pump that squeezes the legs. Squeeze the legs, and it keeps the blood moving so it doesn’t sit in one place and clot. After surgery, it’s drinking and moving. The person that’s set up for clot is dehydrated and not moving. So we got to keep the hydration. You’re dehydrated, the blood’s thick, it clots. You don’t move the blood sits still, it clots. The night of surgery you get up go to the bathroom just pumping your feet, calf muscle contracts and blood flows. That’s what prevents a blood clot. Another complication: fat embolism. Fat embolism is fat getting into the bloodstream when you do the fat injection. If that happens, it causes swelling in the lungs and shortness of breath. Now… now, there’s nothing you do to prevent that. How do how is it prevented? How i prevent it is how i inject. I inject small amounts at a time. I’ll use my hand to inject. Injecting small amounts [at a] time, i get small amounts in many places, a big surface area, the fat lives. That gives it better… that gives a better result and also safer, because it’s hard if you put one cc at a time to force it into a blood vessel. Now, the other thing is i inject with my hand so it’s low pressure. So again, low pressure, hard to force it in blood vessel. The last thing is, i inject while withdrawing the cannula. If the blood vessel’s here and i’m moving the cannula, the chance for me forcing fat is very low.