Hello, this is Dr. Perry. Today we’re going to be doing the virtual 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 calories, you don’t burn them the very second you take them in, they store as fat. Everyone is born with a certain number of fat cells in certain concentrations in certain locations. The concentrations that have the highest number of fat cells store the most calories. These are called our problem areas, are here, in our areas where we gain weight first and lose weight last are the areas that have this higher concentration of fat cells. 

What we’re doing with liposuction is trying to get a even concentration of fat, low fat cells. The absolute perfect liposuction we leave an equal concentration 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 in 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 replicated, liposuction would never work. If you took one cell away and another would go right back in this place, you’re back to square one. So perfection in liposuction is an equal concentration head to toe. It is not perfect to take all the fat cells from one place because if you take all the fat cells from one place you’re condemning someplace else to gain weight.

Theoretically, if you took all the fat cells, you know, from the shoulders down from the body, legs, arms if someone gained weight they gained all the weight in their neck or their head, and 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 the same concentration of fat cells in the back, waist, and hips, then you will have a smooth curve. If you gain weight you’ll go here, but this curve will be intact because the concentration is the same, you got to gain weight the same. If you lose weight you get smaller but the curve will stay. 

Now, when we do a fat transfer, what we’re doing is we’re increasing the concentration of fat cells in the buttocks. So now we’re making it the problem area. We’re gonna make it the place that gains weight first and loses weight last. What we’re doing physically when we do this transfer, the buttocks is a non vascularized tissue graft. It’s like a skin graft. We’re taking the blood vessels 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 a blood supply will live and give a print of a result, the fat cells that don’t die. Best-case scenario 70, 70 percent of what we put in will live and give a permanent result. We’re going to lose 30% no matter what you do. If you float it in the sky, if you sit 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, so I think whatever is there at three weeks is there, you know? 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 that we don’t sit for 10 days. 10 days is really an arbitrary number, just greater than 4 or 5 days. Blood vessels start to grow when wounds are healing at day 4, so the first four or five days is when the fat’s the weakest. After that, it’s getting stronger and stronger. There is no difference between day nine and day 11. There’s no magic day where the cells live. It’s just that date, day 11 the cells are slightly stronger than day nine. I think the time that it doesn’t make any difference is three weeks. So, you know, from ten days to three weeks we can 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, on one area for the entire time. So that’s kind of 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 taking canas* and we’re pulling out fat cells. So we’re making a solid and make it into a Swiss cheese or a sponge. If you did a cross-section it would look like a sea sponge. So all the holes where we took the fat cells away, took the fat cells out or remove them, those are the holes where water fills up and that’s where 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 closed, when  the scars close there is no place for the water to go and that’s when the swelling goes away. So I always think of our post-op regime as collapsing a sponge. I’m gonna put a tape garment on a tape cast, I wanna make a cast out of tape to squeeze you and collapse the sponge. We want to put a garment on you and squeeze you in that collapsed sponge. 

We’re gonna have you do massage. I like to teach you how to do your own massage because my results are better when people do their own massage as opposed when they go out and get a lymphatic massage. But everything is about, all I’m trying to think about is collapsing the sponge. If I have 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 surgery. You know, what’s going to happen is maybe the first day 1% of the whole scar close, so now this won’t even come back 99%. The next day 98 percent, 97 percent, 96 percent. Three months later it’ll be a hundred percent scar.

If we start off with something this thick and liposuction something this thick, as it scars it will collapse into a pancake. So we might start off and liposuction something two inches thick, it’ll collapse into a quarter inch. That’s what’s making the skin contract. That’s what’s making the skin change from this to that. It’s that collapse, and if you see if you look at the muscle the skin is very far away now the skin is very close, that’s when it contracts. And you can see the skin is always tighter when you do superficial liposuction. This contracting of the scar, of the scarring, of that liposuction area is what it’s doing, that’s part of the reason why that’s happening. Um, so physically that’s what we’re doing, you know what we’re doing when we’re working on that massage and the swelling going away. And again, when we do the fat transfer we’re adding those fat cells, they’re getting a blood supply, they’re living. They’re putting more, they’re putting, storing more calories in the buttocks where we want them.

Now we’re recovering. First day hurts like sting. The first night is like, you’ll be wondering why you did it, it really hurts. It’s throbbing, achy, bruisy, burning kind of pain. The second day is starting to get better, maybe 20% d-, better. Day four day five you started 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, you think of it, it’s an injury. In order to heal from an injury, in order to make scar tissue, your metabolism, your metabolism will increase. 

So you need protein to heal also, so you’ve got to eat more than normal. You’ve gotta, if instead of 40, 40 grams of protein and now you gotta eat 50 cause you need that scar tissue to heal. If you don’t eat, if you don’t have protein, you cannot make scar, you cannot heal the swelling, the swelling will stay. All the water, the only place in your body that stores water, is your vascular system. That’s 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 you’ll be, and if you don’t drink, and you’re swollen, you’re going to be dehydrated. If you swelled one gallon of water into your tissue, you got to drink one gallon. So the people who get better faster eat, drink, move and don’t take a lot of pain medicine. If you’re taking a lot of pain medicine and you feel worse day four than day two, it’s the pain medicine, you know? So nothing wrong after the surgery with taking Motrin or Aleve, these are the people that get better faster.

If you stretch from day one, you never get stiff, and you avoid pain. If you pull into a ball then you just have pain and you keep pain. So that’s the things that we’re trying to do to get better. Um, it’ll be ten days without sitting, two weeks without exercise. Mild exercise of two weeks, heavier exercise of four weeks. A garment day and night for 24 hours then you can start to back off. The activity and the garment, it’s trial and error. You can do anything that doesn’t make you have additional swelling. You can take the garment off, when you take it off, you don’t have additional swelling, it’s fine to be off. So 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 then you get swollen after, stop doing the treadmill. Come back and do it a week later, two weeks later. So it’s kind of trial and error. The only thing that we’re judging by is that you don’t have additional swelling with those activities or with 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 that areas, let those areas heal. Again, we’re gonna have you doing self massage that we’ll teach you. We’ll use bodyweight, we’ll use yoga rollers, and we’re just going to collapse the sponge using those things. These are the people that have their best results. 

Now, that is essentially the recovery. The complications we have to be concerned about. This is general anesthesia, whenever you have general anesthesia the chance for blood clot, for pulmonary embolism, is there. When you’re in surgery you’ll have a machine on your leg called a sequential compression device that squeezes your legs. 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, it clots. The night of surgery you got to get up and move, you walk. Even just flexing your feet, tapping your feet, calf muscle contracts. Moving your legs, the muscles contract, you are preventing a clot. That’s what we’re doing to do that. The signs of a clot, if a clot will usually start in your leg, is a swollen one leg swollen and painful the other one normal. 

The dangerous thing is called a pulmonary embolism. Clot breaks from the leg goes to the lung, that would cause chest pain and shortness of breath. Chest pain or shortness of breath is the 911 thing. If you have chest pain and shortness of breath you don’t wait to call me, you don’t call mom, you called 9-1-1. That is the urgency of the whole situation. Fat embolism, fat embolism is fat getting into the bloodstream when you do the fat injection. There’s nothing you do about that, it’s how I inject to decrease the chance of that happening. I inject with my hand so it’s low pressure. I inject small amounts at a time, so when I inject small amounts I’m putting mid-, I might inject one cc two cc’s per injection. If I have a thousand cc’s it means I make 500 injections to put it in. That is how I get a better result and that is how I get a safer result. When I put small amounts in many places I have a great surface area. Greater surface area, better blood supply, better fat take. If I just put a glob in, the chance of me getting 70 percent fat take is non-existent. The fact that all the fat in the inside of that glob will die because it has no blood supply. But by putting small amounts, forcing the vessel is very unlikely. The last thing that prevents that is I inject 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 this, for any period of time to force back into the bloodstream and back into the body.

Infection can happen with any operation. Fever, pain, chills, is a sign of infection. The last thing that so far as the 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 get laryngeal spasm after anesthesia.